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DPT 616 : MSK > Evidence Based Management of the Knee > Flashcards

Evidence Based Management of the Knee Flashcards

1
Q

the lateral femoral condyle extends more …

A

posteriorly

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2
Q

the medial femoral condyle extends more…

A

distally

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3
Q

which meniscus is more O shaped?

A

the lateral meniscus

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4
Q

which meniscus is more C shaped?

A

the medial meniscus

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5
Q

does the lateral meniscus cover more of the lateral femoral condyle or does the medial meniscus cover more of the medial femoral condyle?

A

the lateral meniscus covers more of the lateral femoral condyle more than the medial meniscus covers of the medial femoral condyle

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6
Q

which meniscus has an attachment to the popliteus?

A

the lateral meniscus

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7
Q

why is the lateral meniscus less injured?

A

bc it moves posteriorly when you flex the knee to get out of the way

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8
Q

the menisci are ____ M/L and _____ A/P

A

concave, convex

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9
Q

what is the plica?

A

a fold in the knee capsule

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10
Q

the cruciate ligaments are _____ and _____

A

intraarticular, extracapsular???

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11
Q

t/f: the medial condyle curve into the transverse plane allowing some abd/add at the the knee some

A

true

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12
Q

what may popping/locking at the knee indicate?

A

meniscus injury

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13
Q

what may instability at the knee indicate?

A

ligament injury

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14
Q

what may tingling at the knee indicate?

A

nerve injury

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15
Q

what may bruising at the knee indicate?

A

ligament injury

contusion/blow to the knee

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16
Q

where would the meniscus bleed?

A

in the outer red red or red white zones

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17
Q

if there is immediate swelling would this indicate a ligament or meniscus injury?

A

ligament injury

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18
Q

if there is delayed swelling would this indicate a ligament or meniscus injury?

A

meniscus injury

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19
Q

what is the Hx of present illness for the meniscus?

A

pain with flexion, locking, crepitus, and pain with torsion

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20
Q

what is the hx of present illness with OA?

A

pain in the am, better after, then worse again by night after weight bearing all day

stiffness in am and after immobility

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21
Q

what is the hx of present illness with PFPS?

A

anterior knee pain

pain w/sitting (movie-goers sign), stairs, kneeling, and often crepitus

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22
Q

what is the hx of present illness for an ACL injury?

A

pain/injury w/torsion, feeling of instability, edema upon injury, often pop at the time of injury

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23
Q

what is a common proximal influence for knee pain?

A

glut med weakness

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24
Q

what is a common distal influence for knee pain?

A

pes planus

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25
Q

if there is a valgus force at the knee, what injury may result?

A

ACL, MCL

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26
Q

if there is a varus force at the knee, what injury may result?

A

PCL, LCL

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27
Q

what is genu varum?

A

lateral angulation of the knees (bow legged)

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28
Q

what is genu valgus?

A

medial angulation of the knees (knock knees)

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29
Q

what is genu recurvatum?

A

hyperextension of the knees

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30
Q

what conditions may result in genu recurvatum?

A

coxa valga (long leg) ispilaterally, coxa vara (short leg) contralaterally, tight gastroc, LACK OF DF (equina varus)

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31
Q

what is patella alta?

A

high located patella

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32
Q

what is patella baja?

A

low located patella

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33
Q

what may result in patella baja?

A

tight patellar tendon

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34
Q

what can we do for a tight patellar tendon?

A

superior patellar mobs

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35
Q

what is tibial torsion?

A

twist in the tibial bone

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36
Q

what is a Q angle?

A

the angle bw femur and the tibia

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37
Q

is the Q angle usually larger in males or females?

A

females

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38
Q

how do we measure the Q angle?

A

usually with observation

if measured, measure the angle from the ASIS to the mid patella

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39
Q

t/f: an increase in Q angle can influence patellar problems

A

true

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40
Q

what is normal patellar tracking?

A

6mm lateral
3mm medial

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41
Q

what patellar tracking results from increased Q angle, genu valgus, weak VMO, weak hip abductors?

A

lateral tracking

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42
Q

what patellar abnormality can cause wear on the undersurface of the patella and doesn’t allow good fluid exchange in the articular cartilage?

A

lateral tilt

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43
Q

t/f: the length of the patella should be the length of the base to the tib tub

A

true

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44
Q

what is the role of the patella?

A

to increase the efficiency of the quad by increasing the length for optimal contraction

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45
Q

what can we strengthen and stretch for patellar tracking?

A

strengthen the quads and hip

stretch the HS

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46
Q

how do we measure leg length with a tape measure?

A

from the ASIS to the medial malleolus

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47
Q

what is involved in the lower quarter screen?

A

screening the adjacent joints and neurologic screen of myotomes, dermatomes, and DTRs

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48
Q

what is normal open chain knee flexion?

A

132-141 degrees

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49
Q

what is normal open chain knee extension?

A

0-10 degrees

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50
Q

what is normal open chain tibial IR?

A

20-30 degrees

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51
Q

what is normal open chain tibial ER?

A

30-40 degrees

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52
Q

what is normal open chain knee abduction?

A

10-20 degrees

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53
Q

what is normal open chain knee adduction?

A

10-20 degrees

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54
Q

in the OKC is the femur moving on the tibia or is the tibia moving on the femur?

A

the tibia is moving on the femur

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55
Q

is the femur or the tibia the concave surface?

A

the tibia is the concave surface

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56
Q

is the femur or the tibia the convex surface?

A

the femur is the convex surface

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57
Q

in OKC knee extension, what is the roll and glide?

A

the tibia rolls anterior and glides anterior

med tib con glides ant

lat tib con glides post

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58
Q

in CKC knee extension, what is the roll and glide?

A

the femur rolls anterior and glides posterior

med fem con glides post

lat fem con glides ant

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59
Q

in OKC knee flexion, what is the roll and glide?

A

the tibia rolls posterior and glides posterior

med tib con glides post

lat tib con glides ant

60
Q

in CKC knee flexion, what is the roll and glide?

A

the femur rolls posterior and glides anterior

med fem con glides ant

lat fem con glides post

61
Q

during knee extension, what is the glide of the patella?

A

superior glide

62
Q

during knee flexion, what is the glide of the patella?

A

inferior glide

63
Q

during IR at the knee, what is the glide of the patella?

A

medial glide

64
Q

during ER at the knee, what is the glide of the patella?

A

lateral glide

65
Q

what is the capsular pattern at the knee?

A

flexion loss>extension loss

66
Q

what is the end feel of knee extension?

A

elastic, capsular, tissue stretch

67
Q

what is the end feel of knee flexion?

A

soft tissue approximation

68
Q

when we MMT the HS, how can we target the semimembranosus and semitendinosus better?

A

IR (turn the foot in in prone)

69
Q

when we MMT the HS, how can we target the biceps femoris better?

A

ER (turn the foot out in prone)

70
Q

what should we be palpating at the knee?

A

the joint line, MCL/LCL, patella, muscles/tendons, edema, and leg length

71
Q

how can we palpate the MCL better?

A

prop the leg into valgus

72
Q

how can we palpate the LCL better?

A

cross the leg

73
Q

what are the functional tests?

A

squatting

stair negotiation

leg crossing

gait assessment

jogging/running assessment

jumping/hopping assessment

one leg hop (time, distance, crossover)

step down

box drop

74
Q

if a pt complains of knee pain after 2 miles of running, how can we assess their pain at the clinic?

A

have them get on the treadmill until it provokes their pain and then assess

75
Q

what are the ACL special tests?

A

anterior drawer test

Lachman and reverse Lachman test

pivot shift test

76
Q

what are the special tests for PCL?

A

posterior drawer test

posterior sag sign

77
Q

what is the special test for LCL?

A

varus stress test

78
Q

what is the special test for MCL?

A

valgus stress test

79
Q

what are the tests for ligament dysfunction?

A

anterior drawer test

Lachman and reverse Lachman test

pivot shift test

posterior drawer sign

posterior sag sign

varus stress test

valgus stress test

80
Q

what are the stats for the anterior drawer test?

A

sn: 22-95%

sp: 78-97%

(+) LR: 5.4-8.2

(-) LR: .09-.62

.34-.54 kappa

81
Q

how do we perform the anterior drawer test?

A

in supine hooklying, sit on their foot to stabilize the foot

grab behind the calf near the jt line and pull forward on the tibia

should feel excursion and hard end feel of the ACL

feel unaffected side to feel their normal

82
Q

if an anterior drawer test produces pain and laxity, what may this indicate?

A

could be a partial tear of the ACL

83
Q

if an anterior drawer test produces laxity and no pain, what may this indicate?

A

could be a full tear

84
Q

what are the stats of the Lachman and reverse Lachman test?

A

sn: 63-99%

sp: 42-100%

(+)LR: 1.12-27.3

(-)LR: .04-.83

85
Q

how do we perform the Lachman test?

A

in supine flex the knee to 30-35 deg

stabilize the femur and grab the tibia behind the calf and yank forward

feel the anterior jt line with your thumb

should feel excursion and hard end feel of the ACL

86
Q

how do we perform a reverse Lachman test?

A

in prone, flex the knee to 30-35 deg

pull back on the tibia in line with the jt

87
Q

what is a positive anterior drawer test?

A

pain and or laxity

88
Q

what is a positive Lachman and reverse Lachman test?

A

pain and or spongey end feel of the ACL

89
Q

if there is a pop at the time of injury, the MOI is non-contact, and there is immediate swelling, what is the likely injury?

A

ACL injury

90
Q

what are the stats of the pivot shift test?

A

sn: 18-98%

sp: 97-99%

(+)LR: 4.2-41

(-)LR: .18-.35

91
Q

how do we perform the pivot shift test?

A

IR with valgus forces into flexion

ER w/valgus into extension

92
Q

what is a positive pivot shift test?

A

with IR and valgus force into flexion, there is a clunk out of place at about 30 deg flexion

with ER and valgus force into extension, there is a clunk back into place at about 30 deg flexion

93
Q

what are the stats of the posterior drawer test?

A

sn: 25-90%

sp: 99%

(+)LR: 90

(-)LR: .10

94
Q

how do we perform the posterior drawer test?

A

in supine hookyling

push back on the tibia just below the jt line

should feel excursion then hard end feel of the PCL

95
Q

what is a positive posterior drawer test?

A

pain and or laxity

96
Q

what are the stats of the posterior sag sign

A

sn: 46-100%

sp: 100%

97
Q

how do we perform the posterior sag sign?

A

at 90/90 hip/knee flexion observe the level of the tib tub (should be roughly at the same height of the patella)

98
Q

what is a positive posterior sag sign?

A

the tib tub drops below the level of the patella

99
Q

when could we get a false positive anterior drawer test?

A

if someone has a positive posterior sag sign

100
Q

what are the stats of the varus stress test?

A

sn: 25%

.88 kappa

101
Q

how do we perform the varus stress test?

A

at 15-25 deg knee flexion, push the knee at the tibia into varus

102
Q

what are the stats of the valgus stress test?

A

sn: 86-96%

.02-.66 kappa

103
Q

how do we perform the valgus stress test?

A

at 15-25 deg knee flexion, push the knee at the tibia into valgus

104
Q

what are the tests for meniscal dysfunction?

A

McMurray test (+ heel to buttock test)

Thessaly test (+ Appley test)

105
Q

what are the stats of the McMurray test?

A

sn: 16-95%

sp: 25-98%

(+)LR: .39-8.0

(-)LR: .83-2.84

.35-.95 kappa

106
Q

what is the heel to buttock test?

A

overpressure into hip/knee flexion

107
Q

what test can be combined with the McMurray test?

A

the heel to buttock test

108
Q

how do we perform the McMurray test for the medial meniscus?

A

IR tibia and valgus force at the knee

hand at the ankle, palm at the lateral knee while feeling the jt line

109
Q

how do we perform the McMurray test for the lateral meniscus?

A

ER tibia and varus force at the knee

hand at the ankle, palm at the medial knee while feeling the medial jt line

110
Q

what is a positive McMurray test?

A

pop and/or pain (document if it’s one or both)

111
Q

what test should we do before the McMurray?

A

the varus/valgus stress test to rule in/out MCL/LCL

112
Q

if you perform the varus/valgus stress test and McMurray and they are both positive, what may this indicate?

A

it could be MCL/LCL or meniscus

113
Q

if you perform the varus/valgus stress test and McMurray test and the varus/valgus stress test is negative, but McMurray is positive, what may this indicate?

A

more likely a meniscus injury

114
Q

what are the stats of the Thessaly test?

A

sn: 66-81% (at 5 deg) ; 89-92% (20 deg)

sp: 91-96% (at 5 deg) ; 96-97% (20 deg)

(+)LR: 6.8-16.5 (5 deg) ; 23.29.7 (20 deg)

(-)LR: .21-.76 (5 deg) ; .08-.11 (20 deg)

reliability= .95

115
Q

how do we perform the Thessaly test?

A

excessive force at the knee with rotation

single leg stance w/5-20 deg knee flexion, arms crossed, and twisting the whole trunk/pelvis to grind the knee

116
Q

what is a positive Thessaly test?

A

crepitus, pop, and/or pain

117
Q

what is the OKC Thessaly test?

A

the Appley test

118
Q

how do we peform the Appley test?

A

in prone, flex the knee to 90 deg and apply compression and grinding

119
Q

what is a positive Appley test?

A

crepitus, pop, and/or pain

120
Q

what are the tests for patellofemoral dysfunction?

A

apprehension test

moving patella apprehension test

121
Q

what are the stats of the apprehension test?

A

sn: 7-39%

sp: 70-92%

(+)LR: .87-2.3

(-)LR: .79-1.0

122
Q

how do we perform the apprehension test?

A

push the patella laterally to see if the pt is apprehensive

123
Q

what is a positive apprehension test?

A

the pt is apprehensive that the patella will pop laterally

124
Q

what are the stats of the moving patella apprehension test?

A

sn: 100%

sp: 88.4%

125
Q

how do we perform the moving patella apprehension test?

A

push the patella laterally and extend the knee to see if the pt is apprehensive

can push the patella medially and see if it feels better

126
Q

what is a positive moving patella apprehension test?

A

the pt is apprehensive that the patella will pop off laterally

127
Q

if the HS are tight, the quads have to work harder which may lead to what?

A

patella compression and pain

128
Q

what is the lunge test?

A

have the pt lunge in dif positions and listen for a pop or crepitus

129
Q

what are the tests for ITB dysfunction?

A

Ober test

Noble test

Renne test

130
Q

how do we perform the Renne test?

A

have the pt in single leg stance and do mini squats while you palpate the ITB insertion at the knee

131
Q

what is the test for fractures?

A

Ottowa knee rules

132
Q

what are the Ottowa knee rules that may rule in/out a fx?

A

> 55 y/o

tender patella or fibular head

unable to flex the knee >90 deg

inability to take 4 steps

133
Q

what are the stats of the Ottowa knee rules for adults?

A

sn: 98-100%

sp: 19-54%

134
Q

what are the stats of the Ottowa knee rules for children?

A

sn: 92%

sp: 49%

135
Q

what are the (+)LR of the Ottowa knee rules?

A

> 10=conclusive inc in likelihood

5-10=mod Inc in likelihood

2-5=small inc in likelihood

1-2=min inc in likelihood

1=no change in likelihood

136
Q

if the (+)LR of the Ottowa knee rules is >10, what does this mean?

A

conclusive inc in likelihood

137
Q

if the (+)LR of the Ottowa knee rules is 5-10, what does this mean?

A

mod inc in likelihood

138
Q

if the (+)LR of the Ottowa knee rules is 2-5, what does this mean?

A

small inc in likelihood

139
Q

if the (+)LR of the Ottowa knee rules is 1-2, what does this mean?

A

min inc in likelihood

140
Q

if the (+)LR of the Ottowa knee rules is 1, what does this mean?

A

no change in likelihood

141
Q

if the (-)LR of the Ottowa knee rules is .5-1, what does this mean?

A

min Dec in likelihood

142
Q

if the (-)LR of the Ottowa knee rules is .2-.5, what does this mean?

A

small Dec in likelihood

143
Q

if the (-)LR of the Ottowa knee rules is .1-.2, what does this mean?

A

mod Dec in likelihood

144
Q

if the (-)LR of the Ottowa knee rules is <.1, what does this mean?

A

conclusive Dec in likelihood

145
Q

what are the (-)LR of the Ottowa knee rules?

A

.5-1=min Dec in likelihood

.2-.5=small Dec in likelihood

.1-.2=mod Dec in likelihood

<.1=conclusive Dec in likelihood

DPT 616 : MSK (18 decks)

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