EEO 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

ON PRACTICAL - if you get knee, also one MMT/GONI on hip and one on ankle (same goes for shoulder/elbow)

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4 important nerves at knee?

Femoral –> Saphenous
Fibular x 3
Sural Nerve
Tibial Nerve

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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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if you want to test the sural nerve you could ____ the foot

to test the tibial nerve you would ___ the foot

invert for sural

evert for tibial

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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 Q)

<165 degrees

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Genu Varum Angle (exam Q)

> 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

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which angle, the tibofemoral or Q angle ties in the position of the pelvis?

Q angle

the tibofemoral just looks at knee

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Increased Q angle increases risk for _________

Lateral Patellar subluxation

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Possible causes of > Q angle?

Genu valgum
Excessive femoral anteversion
Tibial ER

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What does Genu Valgum lead to?

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

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

Children

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What does Genu Varum lead to?

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

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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 Q)

* 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

What is a common test to asses hip flexor tightness?

thomas test - looking at the bottom leg

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

documentation of a pt lacking 5 degrees of extension

0 - 5 - 140

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!** exam Q

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 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

What test can you do to asses IT band tightness?

OBER sidelying, flex knee to 90, then abduct and extend the hip. from there, put the hip back into adduction (drop it) and if it stays horizontal level, positive if it drops back below horizontal its negative (not tight)

IT Band Syndrome pt presentation

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

during the thomas test, if the test leg ER, what muscle is tight?

Sartorius remember hip ER will look like pointing in hip flexion, abduction and ER

if during the thomas test the test leg IR at hip, what muscle is tight?

TFL (TFL does hip flexion, abduction and IR)

IT Band Syndrome Outcome measures

LEFS LEAS LEAP

Out of the LEFS, LEAP and LEAS, which outcome measure asks about sleep and emotional health? EXAM Q

LEAP LEAP RYMES WITH SLEEP

Out of the LEFS, LEAP and LEAS, which one is involved with more athletic and sporting

LEFS

Out of the LEFS, LEAP and LEAS, which are disability scales and which are ability?

ABILITY - LEFS, LEAS DISABILTIY - LEAP

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

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"

meniscal tears swell ____ while ACL tear swell ____

after/delayed immediately

ACL Outcome measures

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

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