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Lower test 2 > Anterior Knee Pain - Lecture 2 > Flashcards

Anterior Knee Pain - Lecture 2 Flashcards

1
Q

Patellofemoral Pain syndrome affects 9-25% of active sports participants

A
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2
Q

Things that can cause patellofemoral pain syndrome
* Overuse
* Biomechancial issues (think boney deformitites / brith defects)
* Joint mobility (hyper/hypo)
* Trauma
* Degeneration

A
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3
Q

Patellofemoral issues can br driven by extrinisc factors
* Acute Trauma
* Chronic Overuse
* Poor Mechanics
* Training Errors

A
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4
Q

Structures involved in patellofemoral issues
* Intrapatellar fat pad
* Ligaments
* Patellar tendon
* Retinaculum (tight)
* Subchondral bone, joint
* IT band
* Bursa

A
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5
Q

Dysfunctions that can cause patellofemoral issues
* Patella femora instability
* Patella femoral pain w/ malalignment or biomechanical dysfunction
* patella femoral pain w/o malalignment
* Tightness
* Weakness
* Muscular imbalance
* Neuromuscular factors (think proprioception / poor balance in the area causing overuse of muscles to provide external and internal stability)

A
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6
Q

These are examples of lateral problems w/ patallela

A
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7
Q

Patellofemoral knee instability are the pts that say they feel their kneecap roll off to the side or they have to kick their knee out a few times and can pop their patella back into place
* So the pts are often dislocators

A
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8
Q

Which way patella most likely to sublux?

A

Latearl subluxations

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9
Q

What 4 things can cause the patella to sublux latearlly?

A

Q angle, patella alta, tight latearl retinalcumum

Inadeqate medial stabilizers (not much stuff to pull patella back to the middle)

Trauma to stabilizers or shallow groove where their patella should be sitting

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10
Q

5 biomechanical issues that could be causing PF pain

A

1) Tight latearl retinaculum
2) Weak vastus medialis
3) Neuromuscular deficits in hip musculature
4) Joint hyper/hypomobility
5) Inappropriate firing of quads (arent having as much of an active stabilization component)

Feel all this when walking especially

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11
Q

Things that cause knee pain w/o malalignment:
* Soft tissue lesions to the area (i.e., trauma)
* Tight medial or lateral retinaculum (normally latearl)
* Osteochondritits dessecans of patella or femoral trochlea (where the patella is going to sit - where he was mentioning about ti being shallow)
* Traumatic patellar chondromalcica (trip or fall)
* PF OA
* Apophysitits
* Symptomatic bipartite patella

A
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12
Q

PF pain w/o malalignment soft tissue lesions
* Plica syndrome
* Fat pad syndrome
* Tendonitis
* IT band Friction syndrome
* Prepatellar Bursitits

A
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13
Q

What is Plica syndrome
* medial or lateral
* hyper or hypomobility

A

Synovial membrane that has invaginated in on itself - folded in and gotten pinched

Normally medial plica

because of abnormal loading there is tissue hypertrophy around the area and fibriotic scaring - CAUSING HYPOmibility

KNOW: Its tissue inflamamtion often initaed w/ trauma that results in synovitits
* so i think the synovial fluid swells and causes the irritation

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14
Q

This is showing where that medial plica syndrome is

A
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15
Q

We use the Plica Stutter test to test for plica syndrome

A
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16
Q

Plica syndrome hurts the most w/ activity. What movement hurts the most and why

A

Knee flexion - because thats where its goign to stretch it the most

KNOW: Plica is considered an inflammatory condition

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17
Q

What treatment do we do for plica?

A
  • Massage
  • Manage swelling
  • Address muscle imbalances (usually strenghtneing quads and hamstrings and adressing tight structures in the area)
  • Reduce compression on the anterior knee
  • Arthroscopic excision if needed
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18
Q

Fat padsyndrome = Infrapaterllar syndrome = Hoffas syndrome

A
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19
Q

KNOW: The fat pads function is
* Synovial fluid secretion benefits (enclosis it?)
* Joint stability (keeps patella from tilting anterior / posterior)
* Neurovascular supply
* Occupiers of deadspace

A
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20
Q

Patella making contact and pinching down can create inflammation of that fat pad

A
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21
Q

Fat pad syndrome is normally caused by direct trauma
* It can also be caused by overuse

A
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22
Q

Often fat pad syndrome is caused by posterior tilt of inferior pole of patella - causing the fat pad to become irretated

A
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23
Q

Where will swelling and tinderness be present w/ fat pad syndrome

A

Pain inferior to pole of patella along w/ edema

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24
Q

What positions hurt w/ fat pad syndrome?

A

Knee extension pain (when its in the close packed position)

0-15 degrees or flexion where patella doesnt contact the trochlear groove

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25
Q

What to do for fat pad syndrome
* Rest
* Ice
* NSAIDS
* steriod injections
* Address cause through orthotic interventions such as heel lifts
* Tape (superior pole posterior, and superior)
* Surgical rescetion if necessary

A
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26
Q

what is jumpers knee

A

patellar tendinopathy

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27
Q

KNOW: pattellar tendinopathies are common in sports with sprinting and jumping and people whi are just taking up running
* caused by repetitive eccentric activities (hints jumping)
* Normally caused by some kinf of muscular imbalance
* Often in those weekend warriors that just took up running

A
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28
Q

Where is a patellar tendinopathiy

what makes it worse

A

anterior knee localized pain

Made worse by activity or prolonged flexion

also called movie theatre knee

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29
Q

If they dont have OA patellar tendinopathy would be one of my first thoughts

A
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30
Q

outcome measure for patellar tendinopathy:
* Victorian insttitute of sports assessment patellar tendinopathy or LEFS

A
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31
Q

Rule out hip / low back for patellar tendinopathy and other non-musculoskeletal causes

A
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32
Q

Which AROM is limited w/ patellar tendinpathy?

What about PROM

A

AROM = knee extension decreased w/ pain

PROM = knee flexion decreased (essentially stretching the joint)

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33
Q

w/ reissted provocaion w/ patellar tendinopathy what movement brings about pain?

A

Extension brings on pain (AROM)
* Note if it was passive flexion would bring on pain (stretching the joint)

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34
Q

What muscle might hurt w/ patellar tendinoapthy resisted?

A

Extension hurts to quads might be painful

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35
Q

Will be pain over tendin w/ patella tendinopathy (normally just over insertion points - superior/inferior pole)

A
36
Q

What 3 interventions would we do for patellar tendinopathy

A

Pain contorl
EX
mobility and flexibility

37
Q

Patellar tendinopathy treatment in acute phase
* Rest / activity modification
* Pain / inflammation management
* Stretch
* Eccentric strengthening
* Bracing, Taping

A
38
Q

What position is worst for IT band?

A

Repetitive flexion / extension of knee w/ knee in adduction and IR

Essenitally the OBER position

39
Q

What is the most comon cause of latearl knee pain in runners?

A

IT band

39
Q

KNOW: IT band syndrome may be due to poor hip abduction and extension strength

May also be a fat layer compression and not a friction syndrome (its compressing the fat underneath causing the pain)

MOI: Overuse, tight ITB, forefoot varus, tight hip add, LLD, increase in running distance or speed (have you changed your distance or speed), genu varium, hip muscle imbalance, improper shoes, excessive rearfoot pronation leading to increased internal tibial rotation, adhesions of the ITB, tightness of TFL and / or Glute max, Hams, or Quads

May be releated to poor hip abduction and extension strength in atheletes

A
40
Q

W/ IT band sundrome
* pain altearl leg that may radiate to lateral tibia; pain increases w/ continued activity
* ROM: Pain ~30 knee flexion (stretching it)
* MLT: Pain w/ ober
* Special test: Nobles compression
* Palpation: Tender lateral epicondyle, gerdy’s tubercle, latearl retinaculum

A
41
Q

ITB Syndrome interventins
* Soft tissue mobilization
* Stretching associated impairments
* Address dysfunctions at hip and ankle
* Closed chain strengthening

A
42
Q

Prepatellar bursitis = housemaids knee

A
43
Q

What causes prepatellar bursitits

A

Prolonged kneeling

44
Q

More prolonged causes of knee pain are actual chondromalacia of the patella. What is this?

A

Softning or wearing away of that cartilage
* OA of the patella

No clinical tests to confirm this outside of imaging

45
Q

KNOW: Chondromalacia patella causes:
* Abornomal tracking of patella
* Muscle imbalances
* Structural issues
* Weak quads
* Direct trauma
* Repeated trauma (landing on knees over and over)

A
46
Q

Chondromalacia pain is normlly hard for pt to explain. They might say “it feels like its coming from underneath the kneecap”
* if they say its not deep but feels like its underneath knee this is what im thinking
* primary complaint is pain
* note: might also be thinking pre-patellar bursitis (but remember - thats superficial to the kneecap - but is near the same area)

A
47
Q

What 3 things clue us in to chondromalacia?

A

1) popping
2) pain
3) Under the kneecap but not deep

48
Q

Under knee pain clues us in to

A

chondromalcia

49
Q

Chondromalcia pain comes on slowly (its essentially kneecap OA) - unless direct trauma brings it on
* worse w/ climbing stairs, running, squatting, kneeling (really doing anything w/ knee
* also get a stiffness feeling

A
50
Q

Why does chondromalacia get worse w/ long term sitting?

A

Essentially kneecap OA - decreases synovial fluid - stiffness feeling

51
Q

Low impact activitises indicated for chondromalacia of patella - isometric or closed chain quadriceps strengthening EX at first

A
52
Q

Who benefits the most form surgery for chondromalacia of patella? Suergeries?

A

Younger pts who have continued pain –> this is not normal for them and should be addressed

Surgery for this =
* Smoothing over undersurface of patella
* release lateral thigh muscles that are causing tracking issue
* worse case is replacement of patella

53
Q

What is osgood schlatters disease?
* who does it happen the most to

A

AVN of the avolsed portion of the tibial tubercle

Avulsions normally happen when bone growth does not match the rate at which muscles are lengthening
* think someone growing to fast
* Most often in younger boys
* will resolve on its own at 18 or 19

54
Q

Wht is this
* what position makes it painful

A

Osgood shlaters disease (AVN) - theres a bump over that tibial tuberosity because it has avolused there

theres going to be a lesion over the tibial tubercle and swelling

extension is painful because its pulling on that patellar tendin (right where the avulsion is)

55
Q

KNOW: quad contraction hurts w/ osgood schlatters disease

A
56
Q

What test would osgood shlatters disease pts have pain w/ - test question

A

Thomas test rec fem portion (because of the pulling on the avulsed tibial tuberosity)
* this is a good differentiatl diganosis
* note: this tibial tuberosity avulses but the quadrecepts tendin stays intact - so everytime they extend the avulsed area is pulled

57
Q

Osgood schlatters normally resolves on its own
* PTs just strengthen those waek structures

A
58
Q

Hip adduction / internal rotation cause knee pain. What most likely is it?

A

IT band at gerdys tubercle

59
Q

For chonic patello femoral issues we want to strength hip extension / abductors

A
60
Q

In open chain

at what degrees is patellar stress the greatest at ?

What about potellar compression

A

60
75

61
Q

35

A
62
Q

KNOW: Some proximal things that create knee pain:
* Increased hip adduction and internal rotation during certain activities = makes us think tight IT band = more stress at gerdys

A
63
Q

KNOW: In PF treatment of subacute / chronic we want to do EX to the point of symptoms

A
64
Q

For subacute / chronic PF treatment we would want to do some kind of total knee extension w/ light resistance
* We would eventually want to progress them to some kind of plyometric activity

A
65
Q

what is the clinic presentattion for hamstring sprain?

A

Sharp pain in the back of the leg and “couldnt run”

66
Q

What normally causes hamstring strain? (3)
* if its a proximal hamstring injury where is it painful
* what ranges of movement is in painful in

A

Quick stretch in a contracted position

Eccentric contraction

Muscular imbalance (quads to hamstring)

If it is a proximal hamstring tendinopathy it is usally going to be more painful in the sitting position (sit bone)

Hip flexion and knee extension (endrage - most stretched) are painful

67
Q

KNOW: Hamstring strains take forever to heal

A
68
Q

Does sterength retrun and pain relief mean hamstring pts are ready to go back to sport?

A

No! Hamstrings are very frequently reinjuried - as much as 30% - especially in the first 2 weeks - this is because they go back to sport way to quickly (they take forever to heal)

69
Q

KNOW: Focus on aligity w/ trunk stabilization w/ hamstring strains (getting hamstrings back in that quickly lengthened contracted state)

A
70
Q

where does the saphenous n innervate

A

Sensory innervation to the medial aspect of the knee and leg
* articular brnaches of the medial aspect of the kne ejoint as wayy

71
Q
A
71
Q
A
72
Q
A
73
Q

Saphenous n route

A

Passes posteriomedially from the femoral triangle to enter the subsatorial Hunters canal

Pases beneath sartourus, pierces fascia between sartorious and gracillis

Branches to side of knee, second branch along tibial side of leg, descends medial border down the leg

74
Q

What 3 non traumatic things cause injury to the saphenous n

A

moderate thigh obesity

Genu Varum (stretch)

Internal Tibial rotatio

75
Q

Pt reports pain at medial aspect of knee that may radiate doward to medial side of foot. Significant pain when doing stairs

A

Saphenous n issue
* Would have to make sure its not some kind of lumbar radiculopathy
* we would do a lumbar screen to rule this out
* may also get some numbness on the thigh?

76
Q

what two muscle actions does the common fibular (peronlea) n do?

A

Supplies dorsiflexors of the ankle and evertors of the foot

77
Q

Where does the common fibular n provide sensory innervation?

A

lateral Knee, ankle, small joints of the foot, distal lateral surface of the leg and dorsum of the foot

78
Q

Where does common fib n get injuried? (3)

A

Becomes entrapped at the fibular neck
* any fracture the fibula can cause an issue here as well
* Also some kind of tight boot can cause issues

79
Q

w/ common fib n issues we have:
* Pain in lateral aspect of leg and foot
* sensory alteration or muscle weakness
* Foot turning over into inversion w/ walking

A
80
Q

Patient complains that their foot turns over into inversion w/ walking. What most likely is the issue?

A

Common fibular n pathology

81
Q

What position causes the common fib n to have symptoms?

A

Foot plantar flexion and inversion - stretching this nerve

82
Q

What kind of wedge do we use to bring down pain in people w/ fibular n pathologyies?

A

Lateral heel wedge
* Puts them into eversion and takes the nerve out of that stretched position
* also will give them NSAIDS

83
Q

KNOW: ACL and PCL have lots of swelling even though their both intracapsular

A
84
Q

Effusion = swelling

A

Lower test 2 (4 decks)

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