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DPT773: MM1 > 4 - Chronic Knee Disorders > Flashcards

4 - Chronic Knee Disorders Flashcards

1
Q

How can arthritis of the knee be classified? (2)

A
  1. Degenerative

2. Destructive

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2
Q

What type of arthritis is classified as Degenerative? (1)

A
  1. Osteoarthritis
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3
Q

What types of arthritis are classified as Destructive? (3)

A
  1. Autoimmune
  2. Inflammatory (SLE)
  3. Rheumatoid Arhritis
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4
Q

Which form of arthritis is the most common form of knee arthritis?

A

Osteoarthritis (OA)

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5
Q

What compartments can knee OA occur in?

A

Any of the 3

  1. Medial Compartment
  2. Lateral Compartment
  3. Patellofemoral
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6
Q

How is the Medial Compartment of the knee defined?

A
  1. Medial Tibial Plateau

2. Medial Femoral Condyle

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7
Q

How is the Lateral Compartment of the knee defined?

A
  1. Lateral Tibial Plateau

2. Lateral Femoral Condyle

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8
Q

How is the Patellofemoral Compartment defined?

A
  1. Patella

2. Femoral Trochlear Notch

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9
Q

How is knee is knee OA characterized? (3)

A
  1. Progressive loss of articular cartilage,
  2. sclerosis of the subchrondral bone,
  3. and formation of osteophyted.
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10
Q

Knee OA pathological changes lead to: (2)

A
  1. loss of functional ability

2. and decreased quality of life

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11
Q

Common causes of OA: (6)

A
  1. Injury
  2. History of Fractures
  3. Meniscus tears
  4. Post-menisectomy
  5. Chronic knee instability
  6. Congenital Predisposition
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12
Q

What are common causes of OA influenced by? (2)

A
  1. age

2. and body weight

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13
Q

What are symptoms of knee OA? (2)

A
  1. pain

2. and stiffness

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14
Q

What age does knee OA often affect?

A

most often affects patients over 55 years

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15
Q

What is knee OA often associated with? (2)

A
  1. obsesity

2. and family history

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16
Q

In the onset of knee OA pain usually immediate or insidious?

A

insidious

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17
Q

How does knee OA pain progress? (initally to later

A

Initially: pain only with activity
Later: pain can occur even at rest

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18
Q

Patients with end-stage disease complain of:

A
  1. Pain (mild, moderate, or severe)
  2. Stiffness
  3. Limited joint range of motion
  4. Joint effusion
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19
Q

How many critieria need to be met for knee OA to establish a Dx?

A

three

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20
Q

What are the clinical diagnoses criteria for knee OA? (Altman et al)

A
  1. Age > 50 years

2. Morning Stiffness

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21
Q

Are the clinical diagnoses for more sensitive or specific?

A

Sensitivity = .95; Specificity = .69; LR+ 3.1

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22
Q

You can correctly diagnose __% of Knee OA patients when ___ criteria are present? (Zhang et al)

A

99% when ALL 6 criteria are present

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23
Q

What are the clinical for diagnoses for knee OA? (Zhang et al)

A
  1. Persistent knee pain
  2. Limited morning stiffness
  3. Reduced function
  4. Crepitus
  5. Restricted Motion
  6. Bony enlargement of the knee
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24
Q

What things can be analyzed during a Physical Examination of Knee OA? (5)

A
  1. Gait Analysis
  2. Joint Effusion
  3. Knee joint ROM
  4. Muscle Strength and Endurance
  5. Assess of Functional Level (ADL’s)
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25
What is assessed during a Gait Analysis for knee OA? (2)
1. Assess for restricted sagittal plane motion | 2. Assess for frontal plane deformity
26
When assessing for frontal plane deformity during a Gait Analysis for knee OA, what do you look for? (2)
1. Genu varum | 2. and valgum
27
What tests can be done to analyze Joint Effusion for knee OA? (2)
1. Fluctuation | 2. Ballotable Patella Sign
28
What ways is Knee Joint ROM analyzed for knee OA?
1. Passive | 2. and Active
29
What tests are performed when Muscle Strength and Endurance is analyzed for knee OA? (2)
1. Manual Muscle Testing | 2. Functional Tests
30
How do you Assess of Functional Level (ADL's) for knee OA? (2)
1. KOOS | 2. LEFS
31
What are Goal of Physical Therapy Intervention for knee OA? (3)
1. Decrease Pain and Symptoms 2. Improve Functional Levels 3. Prolong the need for Surgical Intervention (Total Knee Arthroplasty)
32
Extensor Mechanism Disorders are defined as dysfunction in any of the following structures: (3)
1. Patellar tendon and attachment to either patella or tibial tuberosity 2. Patellar stabilizing structures (dynamic or static) 3. Proximal Hip &/or Quadriceps musculature
33
Dysfunction leads to disruption of: (3)
1. Patellar articulating surface 2. Femoral trochlear surface 3. Chronic joint inflammation
34
T/F: It is difficult to explain pain and dysfunction with extensor mechanism disorders using pathoanitomical rationale.
True
35
Dye reported that during arthroscopy with NO intrarticular anesthesia: (3)
1. No pain with direct probing of Grade III chondromalacia 2. Intense severe pain with light touch of synovial membrane, infrapatellar fat pad 3. Patellar pain with increase pressure 2deg to saline injection
36
Since Extensor Mechanism Disorders cause pain in front of knee - clinically referred to as ___.
Anterior Knee Pain (AKP)
37
What structures comprise the Extensor Mechanism? (3)
1. Passive Lateral Structures 2. Passive Medial Structures 3. Dynamic Stabilizers
38
Passive Lateral Structures of the Extensor Mechanism include: (3)
1. Iliotibial band Soft Tissue Structures: 2. Transverse Retinacula 3. Periarticular Synovium
39
Passive Medial Structures include: (2)
1. Medial retinacula | 2. Medial patellofemoral ligament
40
Dynamic Stabilizers are broken into what categories? (2)
1. Lateral | 2. Medial
41
Dynamic Stabilizers, Lateral and Medial are broken into what categories? (2)
1. Proximal | 2. Distal
42
Dynamic Stabilizers: Lateral, Proximal include: (3)
1. Gluteus Maximus 2. Gluteus Medius 3. Tensor Fascia Latae
43
Dynamic Stabilizers: Lateral, Distal include: (1)
1. Vastus Lateralis
44
Dynamic Stabilizers: Medial, Proximal include: (1)
1. Hip Adductors
45
Dynamic Stabilizers: Medial, Distal include: (1)
1. Vastus Medialis - Oblique Fibers (VMO)
46
What is the relationship of VMO to Adductor Magnus?
VMO fibers can attach to the tendinous portion of the Adductor Magnus muscle?
47
T/F: Use of ball between knees increases VMO increase activity.
False
48
Proposed Etiologies of AKP include: (5)
1. An increase valgus angulation at the knee 2. Reduction in proximal hip muscle strength (Gluteal group, TFL, Hip rotators) 3. Increased foot pronation 4. Decreased prominence of the lateral femoral condyle 5. Changes in length of the patellar tendon
49
Increased "static" Q angle caused by: (3)
1. Genu valgum 2. Femorial or tibial torsion abnomalities 3. Increased foot pronation
50
T/F: There is minimal evidence to support that an increase in static Q angle is a factor in the development of AKP
True: much more interested in "dynamic" Q angle
51
When is "dynamic" Q angle assessed? (3)
1. Walking 2. Running 3. Jumping
52
What effects the degree of "dynamic" Q angle?
Stabilization by "proximal" hip musculature: 1. Glutues Maximus 2. Glutues Medius 3. TFL 4. Hip Rotators
53
What are the changes in length of the patellar tendon?
1. High riding patella (patella alta) | 2. Low riding patella (patella baja)
54
Both Patella Alta and Baja change ___.
the normal pattern of articular cartilage compression during flexion and extension
55
What are the specific subclassification of Extensor Mechanism Disorders leading to Anterior Knee Pain? (4)
1. Patellofemoral Pain Syndrome (PFPS) 2. Plica Syndrome 3. Patellar Tendinopathy (tendinitis) 4. Physes (Growth Plate) Disorders
56
What is PFPS also known as?
Chondromalacia patellae
57
What is the etiology of PFPS: (4)
1. Trauma 2. Prolonged or repeated stress on tissues as a result of abnormal lower extremity alignment 3. Lack of normal articular cartilage stress (period of immobilization) 4. Post Surgery Complication
58
What are Symptoms of PFPS: (3)
1. General complaints of anterior knee pain 2. Crepitation with movement of patellofemoral joint 3. Symptoms increased with ascending and descending stairs, squatting, &/or prolonged sitting ("theater sign")
59
What is done during a physical examination for PFPS: (12)
1. Observation of standing posture 2. Observation of gait OR functional movements for "dynamic" Q angle 3. Observe patellar movement during active knee ROM 4. Assess Active Knee ROM 5. Observe and palpate Quadriceps bulk (especially VMO as patient performs Quad Set) 6. Assess Joint Effusion 7. Palpation of medial and lateral patellar posterior borders 8. Assess medial patellar mobility 9. Assess for patella Baja or Alta 10. Muscle Strength Testing 11. Appropriate muscle length/flexibility tests 12. Eccentric Step test (from 15cm height)
60
During a physical examination for PFPS, when Observation of Gait OR function movements for "dynamic Q angle look for: (3)
1. Genu valgum / genu varum 2. Patellar position at midstance 3. Foot posture during stance phase
61
During a physical examination for PFPS, what can be done after assessing active knee ROM?
if necessary Passive ROM
62
During a physical examination for PFPS, what can be done for Muscle strength testing? (3)
1. Partial or full squat 2. Vastus medialis coordination test 3. Hip extensors, abductors, external and internal rotators
63
During a physical examination for PFPS, what can be done for Appropriate muscle length/flexibility tests? (3)
1. Ober's test 2. Hamstrings (90/90) 3. Calf muscle
64
During a physical examination for PFPS, what are you assessing and observing in a Eccentric Step test (from 15cm height)? (2)
1. Assess pain and symptoms | 2. Observation of "dynamic" Q angle
65
Cook C, et al reported the strongest PFPS Dx test was pain encountered with
resisted quadriceps contraction of knee
66
PFPS test findings were more diagnostic with 2 of 3 following:
1. pain with quad contraction 2. pain with squatting 3. pain with palpation
67
What is the Etology of PLICA syndrome?
Irritation of embrologic synovial tissue circling the patella (the PLICA)
68
Where on the patella is PLICA experiences?
Usually the superior and medial aspect of patella
69
What can cause increased tissue stress with the plica becoming thicker and fibrotic?
abnormal tracking of the patella
70
What are symptoms of plica syndrome?
Pain and discomfort over the superior and medial aspect of the patella
71
How is it best to assess plica syndrome?
palpation performed with the patient sitting (superior and medial aspect of patella)
72
In what way is PLICA syndrome managed?
Conservatively, hopefully not surgery as usually not successful.
73
What is Patellar Tendinopathy (tendinitis)?
inflammation of the distal pole of the patella and the patellar tendon
74
What can Patellar Tendinopathy also cause?
inflammation of infrapatellar fat pad
75
What is Patellar Tendinopathy caused by?
Chronic repetitive tendon overloading which results in weakening of tendon.
76
What are contributing factors/etiology of Patellar Tendinopathy?
Associated quadriceps weakness, lack of hamstring and gastrocnemius flexibility, as well as patella alta
77
What sports ususally case Patellar Tendinopathy?
Usually caused by repetitive jumping sports: 1. Volleyball 2. Basketball
78
T/F: Chronic patellar tendinopathy shows absent or minimal inflammation as underlying pathology at this point is degenerative.
True
79
Chronic patellar tendinopathy degenerative changes include: (2)
1. loss of longitudinal collagen fibers | 2. as well as fiber disorganization in tendon
80
What are symptoms of patellar tendinopathy?
1. Pain with palapation of tendon, especially inferior pole of patella 2. Infrapatellar fat pad effusion/swelling 3. Extremely painful at start of and after resting at end of activity
81
What are the two types of Physes (Growth Plate) Disorders?
1. Osgood-Schlatter Disease | 2. Sinding-Larsen-Johansson Disease
82
What is the etiology of Osgood-Schlatter Disease?
Repetitive stress leads to an avulsion injury where the patellar tendon inserts into tibial tubercle secondary ossification center.
83
When is onset of Osgood-Schlatter disease?
during early adolescence at secondary ossification site which is weak link to repetitive quadriceps contraction.
84
Occurance of Osgood-Schlatter disease is 5 X's greater in
adolescents active in sports
85
Osgood-Schlatter disease occurs 2 to 3 X's more frequently in
males than females
86
What are symptoms of Osgood-Schlatter disease
1. Pain at attachment site of tendon to tibial tubercle exacerbated by running, jumping and kneeling activities 2. Pain can also occur after prolonged sitting with knees flexed.
87
What is the difference between Osgood-Schlatter disease and Sinding-Larsen-Johansson disease?
SLJ occurs at the junction of the patellar tendon and DISTAL POLE of patella

DPT773: MM1 (6 decks)

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