Chapter 20 Flashcards
A Angle
- measures patellar orientation to tibial tubercle
- A angle of 35 degrees or greater has been correlated with patellofemoral pathomechanics resulting in patellofemoral pain
Joint Injuries: Knee Plica - Management
- plica that becomes inflamed as a result of trauma treated with rest, anti-inflames and local heat
- recurring condition, may require surgery
Joint Injuries: Knee Plica - Signs and Symptoms
- Hx of knee injury
- recurrent episodes of painful pseudolocking of knee
- snap felt or heard during flexion
- locking and snapping pain while ascending or descending stairs or squatting
- little or no swelling or ligamentous laxity
Joint Injuries: Larsen-Johansson Disease
- at inferior pole of patella
- cause believed to be excessive repeated strain on patellar tendon
- swelling, pain and point tenderness characterize it
- XR
Joint Injuries: Larsen-Johansson Disease - Management
- decrease stressful activities
- ice knee before and after activities
- ISOs for quads and hammys
Joint Injuries: Larsen-Johansson Disease - Signs and Symptoms
- swelling
- hemorrhaging
- gradual detonation of apophysis
- c/o severe pain when kneeling, jumping and running
- point tenderness over anterior proximal tib tub
Joint Injuries: OsGood-Schlatter Disease
- pain at the attachment of the patellar tendon to the tibial tubercle
- most often avulsion # of tib tub
- usually resolves around age 18
Joint Injuries: Osteochondral Knee Fractures - Management
- refer to physician
- CT or MRI
- if still attached to bone, casted
if not attached to bone, reattached or removed
Joint Injuries: Osteochondral Knee Fractures - Signs and Symptoms
- c/o diffuse pain along joint line
- immediate joint effusion
- crepitus and pain with weight bearing when standing or walking
Joint Injuries: Osteochondritis Dessicans - Management
- children —> rest and immobilization
- may take 1yr to resolve
- teenager/adult —> may warrant surgery
Joint Injuries: Osteochondritis Dessicans - Signs and Symptoms
- c/o knee aching
- swells recurrently
- may catch or lock
- may be atrophy of quadriceps muscle and point tenderness
Joint Injuries: Patellar Fracture - Management
- XR
- cold wrap
- elastic compression and splinting
- refer to physician
- immobilized for 2-3 months
Joint Injuries: Patellar Fracture - Signs and Symptoms
- hemorrhage
- joint effusion
- generalized swelling
- indirect # causes capsular tearing, separation of bone fragments and possible tearing of quad tendon
- direct # involves bone separation
Joint Injuries: Patellar Subluxation or Dislocation - Management
- after reduction, knee immobilized in extension for 4 weeks or longer
- crutches
- horse-shoe shaped felt pad during activity
Joint Injuries: Patellar Tendinopathy (Jumpers Knee)
- chronic inflammation developing in patellar tendon
- develops in athletes from mechanical overloading of tendon (jumping)
- acute tendinitis with active inflammation (3-6 weeks)
Joint Injuries: Patellar Tendinopathy (Jumpers Knee) - Management
- Ice
- ultrasound
- deep transverse friction massage
- eccentric exercising using squats on 25 deg incline board
Joint Injuries: Patellar Tendinopathy (Jumpers Knee) - Signs and Symptoms
- point tenderness with palpation on posterior aspect of inferior pole of patella
- c/o dull achey pain after jumping or running
- may be thickening of the tendon
- pain disappears with rest but will return with activity
- occasional feeling of “giving away”
Joint Injuries: Patellofemoral Pain Syndrome - Management
- proximal strengthening and neuromuscular reeducation
- strengthening of the hip and core
- orthotics to correct pronation
- mcconnel taping
Joint Injuries: Patellofemoral Pain Syndrome - Signs and Symptoms
- tenderness of lateral facet of patella
- swelling
- dull ache in the centre of the knee
- apprehensive with lateral patellar movement
Meniscal Blood Supply
- supplied by medial genicular artery
- each meniscus can be divided into three circumferential zones
Meniscal Blood Supply - Red Zone
outer or peripheral, one-third, good vascular supply
Meniscal Blood Supply - Red-White Zone
moddle one third, minimal blood supply
Meniscal Blood Supply - White-White zone
Inner one-third, avascular
Q Angle
- greater than 20 degrees could predispose athlete to patellofemoral pathology
Special Tests: Anterior Cruciate Ligament Tests - Pivot Shift Test
- determines anterolateral rotary instability
- often used for chronic
- sensitive with torn ACL
Special Tests: Apley Distraction Test
- distinguishes collateral ligament tears from capsular and meniscus tears
- traction applied to the leg while rotating it back and forth
Special Tests: Meniscal Tests
- McMurray’s Test
- Apley’s Compression Test
- Thessaly Test
Special Tests: Posterior Cruciate Ligament Tests - Posterior Sag Test (Godfrey’s Test)
- observe both knees in flexion
- injured side will sag posteriorly at tibia if PCL is damaged
Special Tests: Valgus
- MCL
Special Tests: Varus
- LCL
what % of the population has a bipartite patella?
0.03
