11. Knee Flashcards by Chavez Girls

What are the self-report measures for the knee?

AIMS
WOMAC
LEAP
LEFS
LEAS
Lysholm Knee Scale
Tegner Activity Scale
Knee OA Outcome Scale (KOOS)

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Which 2 Self-Report Measures are for ACL?

Lysholm Knee Scale
Tegner Activity Scale

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What are the performance measures for Knee patients?

Wall Sit Test
8” step down test
LE agility test
Hop Tests (4)
Vertical Jump
LQ Y-balance test

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What type of joint is the knee? How many DoF in the knee?

Hinge Joint
2 DoF
- flexion/extension
- IR/ER

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The knee is strongly affected by mechanics of ___ and ______

Hip
Foot/Ankle

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When treating a knee pt, it is important to look at what else?

the hip and ankle joint

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4 important nerves at knee?

Femoral –> Saphenous
Fibular x 3
Sural Nerve
Tibial Nerve

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what does the femoral nerve innervate?

quadriceps
iliacus
pectineus
sartorius

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what does the superficial fibular nerve innervate?

lateral compartment of lower leg
-fibularis longus and brevis

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what does the deep fibular nerve innervate?

Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis (peroneus) tertius
Extensor digitorum brevis
Extensor hallucis brevis

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what does the tibial nerve innervate?

Posterior compartment of the leg:
- Gastrocnemius
- Soleus
- Plantaris
- Tibialis posterior
- Flexor hallucis longus
- Flexor digitorum longus
- Popliteus

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how to stretch tibial nerve?

TED: dorsiflex and evert

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what does the sural nerve innervate?

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how to stretch sural nerve?

PIP: plantar flex and invert

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T/F: Tibial Nerve runs posterolateral and Sural Nerve runs posteromedial.

False

Tibial N. runs along tibia which is posteromedial and Sural runs posterolateral

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What plane is the Tibiofemoral angle measured in?

Frontal plane

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How do you measure the Tibiofemoral Angle?

Angle between longitudinal axes of femoral shaft and tibial shaft

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Normal Tibiofemoral Angle?

165-175 degrees

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Genu Valgum Angle

EXAM QUESTION

<165 degrees

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Genu Varum Angle

EXAM QUESTION

> 175 degrees

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Do you measure Tibiofemoral angle medially or laterally?

Laterally

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How do you measure Q-Angle?

Line from ASIS to midpatella, line from central patella to tibial tuberosity

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Flexed knee: what is tight?

Hamstrings
Hip flexors

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What is normal Q Angle?

10-15 degrees
(females > males)

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What is the malignant Q angle?

> 20 degrees

Increased Q angle increases risk for _________

Lateral Patellar subluxation

Possible causes of > Q angle?

Genu valgum Excessive femoral anteversion Tibial ER

What does Genu Valgum lead to?

Overpronation of foot Longer Leg ER of tibia OA of Lateral knee compartment

Who might you see Genu Valgum for a period of time?

Children

What does Genu Varum lead to?

Supination of foot Shorter Leg IR of tibia OA of Medial Knee

Who is your classic TKA Patient?

Genu Varum

What defines Genu Recurvatum?

Knee Hyperextension past 5 degrees

What are possible causes of Genu Recurvatum? EXAM QUESTION

* Anterior Pelvic Tilt * Quad weakness * Gastroc/soleus weakness * Ankle PF contracture OR DF restriction * Global ligamentous laxity

What does Genu Recurvatum result in?

* Anterior tibiofemoral compression * Posterior knee laxity

What are **knee** flexion contracture causes?

* Immobilization * Prolonged wheelchair use * sleeping with pillows under knees * Capsular adhesions * Abnormal hamstring tone

What do **knee** flexion contracture result in?

* excessive patellofemoral compression * over-worked quads and triceps surae * Loss of hip extension * Abnormal gait pattern

What are **hip** flexion contracture causes?

* Immobilization * prolonged wheelchair use * sleeping with LEs elevated * Capsular adhesions * Transtibial or transfemoral amputation * Abnormal hip flexor tone

What do **hip** flexion contractures result in?

* Excessive lumbar compression * Overactive erector spinae * Loss of hip extension * Abnormal gait pattern

You are evaluating a 63-year-old female patient and she only has 93 degrees of knee flexion. Which of the following activities will she be limited from doing? A. Safely climb stairs B. Safely descend stairs C. Riding a bike D. Walking

C. Riding a bike Note: Requires 115 degrees knee flexion

Full knee flexion = ____ degrees (KF= knee flexion)

140 degrees

Ride a bike = ____ degrees KF

115

Get up from a chair = _____ degrees KF

105

Safely descend stairs = ____ degrees KF

Safely climb stairs = ____ degrees KF

Walking = ___ degrees KF

60-70

Normal documentation of knee flexion --> hypertextension

5-0-140 5 hyper extension 0 normal 140 flexion

knee end feels

flex=soft extend=firm

capsular end feel of knee

ext > flex

causes of Patellofemoral Pain syndrome (PFPS/PFS)

* Trauma: excessive compression to anterior knee * Microtrauma: patellar maltracking -genu valgum - hip abductor weakness

Patellofemoral Pain syndrome pt presentation

* Anterior knee pain * Grinding clicking * Peripatellar swelling * Pain with patellar compression & quad activation * Anterior knee pain with squatting * **Pain with descending stairs!**

PFPS Outcome measures

Kujala Anterior Knee pain scale (AKPS) SLB SLS **8" step down test**

PFPS Tests and Measures

Posture - standing Gait ROM: knee flex/ext - pain! MMT knee flex before knee ext (painful), hip MMT Ober/Thomas Foot - posture/arch

Patellar Tendonitis "Jumper's Knee" Causes

* Overuse/overload of patellar tendon * Repetitive landing on hard surfaces with poor mechanics

Patellar Tendonitis "Jumper's Knee" pt presentation

* Anterior knee pain * **Infrapatellar pain** * Possible delayed swelling in knee * Tenderness at patellar tendon, "gritty" * **Pain with ascending stairs!**

IT Band Syndrome Causes

* Overuse/overtraining of **lateral** knee * postural deviations * biomechanical issues from prox/distal jts

IT Band Syndrome pt presentation

* Tight TFL, IT Band, piriformis * Weak Glute max/med * Positive Obers Test

IT Band Syndrome Outcome measures

LEFS LEAS LEAP

ITB syndrome Thomas test presentation

hip internal rotation → tight TFL

how will a pt with a tight sartorius present during the Thomas test?

hip ER

Meniscal Tears Causes

* Trauma: torsional, particularly in WB * Microtrauma: anything --> degenerative changes

Meniscal Tears pt presentation

* Popping, clicking, locking * **Delayed** swelling in the knee * Tenderness at the joint line

what is the difference between a meniscal tear and ACL tear presentation?

meniscal tear: DELAYED swelling ACL: IMMEDIATE swelling

ACL Tear Causes

* **Rapid direction change on planted foot or sudden stop** * Incorrect biomechanics with landing from jump * Medially directed blow to knee * Non-contact/contact

ACL Tear pt presentation

* rapid swelling in knee joint * decreased quad activation * feeling of knee "giving way"

What should a clinician administer to assess a patient's readiness to retry back to activities for ACL?

single legged hop tests

what should a clinician administer for ACL tear prevention?

plyometric exercises

ACL Outcome measures

* Tegner Activity scale * Lysholm Scale * **8" step down** * **YBT** * **Hop Test**

PCL Tear Causes

* MVA/dashboard injuries * athletic hyperextension injuries

PCL Tear pt presentation

* **immediate** knee swelling * feeling of **instability** * usually not injured in isolation cuz of forceful trauma

MCL tear causes

* VALGUS hit to knee * forceful tibial ER

MCL tear pt presentation

* swelling * pain * knee giving way medially

MCL fun fact!

MCL can heal on its own in 6 weeks

LCL tear causes *rare injury in isolation*

* forceful VARUS force to knee * forceful tibial ER

LCL tear pt presentation

* swelling * pain * feeling unstable * may have numbness/tingling due to stretch of fibular nerve

Knee OA causes

* genu varum/valgum * obesity * female >male * repetitive microtrauma at work * prior knee injuries * age * weak hip musculature * hereditary

Knee OA findings

* loss of knee ROM * knee flexion during stance * loss of hip ROM/strength

TKA reasons

* advanced OA * severe trauma

TKA post op considerations

* avoid knee twisting or crossing legs * priority: FULL EXT * WB restrictions * don't allow gait deviations

TKA Outcome measures

LEFS KOOS TUG w/ AD 10 MWT Gait

what should you MMT last with TKAs

knee ext and hip ER/IR because it will be painful for them