Exam 1: Soft Tissue Pathologies of the Knee Flashcards
What are the three types of patellar bursitis
prepatellar, suprapatellar, and infrapatellar
Patellar bursitis is typically inflamed secondary to (acute/chronic) trauma, but may be (acute/chronic) or associated with infection
acute; chronic
(prepatellar/suprapatellar/infrapatellar) bursitis presents with significant anterior swelling
prepatellar
True or False:
Although there are risks with draining, patellar bursitis usually responds to conservative management
true
Pre-patellar bursitis may be a result of _____ or repetitive _____. Commonly seen in carpet and tile workers
trauma or compression
With pre-patellar bursitis, AROM and PROM (flexion/extension) may be limited because in this motion the bursa is compressed
flexion
With pre-patellar bursitis, resistive testing is usually (positive/negative) and mobility testing/joint play is (normal/abnormal)
negative; abnormal
True or False:
If a patient presents with pre-patellar bursitis, it is normal for the knee to be very swollen, red, and warm to the touch
true
If a patient has pre-patellar bursitis, they should avoid the _____ position.
kneeling
What does PT management include for a patient presenting with pre-patellar bursitis
modalities for pain and swelling, anti-inflammatory meds, and start ROM/strengthening when swelling subsides
Which occupation population is likely to present with pre-patellar bursitis
Tile workers and carpenters
What type of bursitis can be described as inflammation of bursa between pes anserine insertion and MCL
pes anserine bursitis
How is pes anserine bursitis usually caused
repetitive motions or overuse
If a patient has Pes Anserine Bursitis, which motions will be painful
AROM and PROM with knee extension
Resisted hamstring, sartorius, or gracilis may also be painful
Pes Anserine Bursitis is typically common in patients after what type of surgery
TKA
Patient’s with Pes anserine bursitis may have tightness of the (quadriceps/hamstrings) or the (adductors/abductors)
hamstrings and adductors
What does PT management of pes anserine bursitis look like
modalities for pain and swelling, gentle stretching, avoid repetitive knee flexion and extension, and isometric strengthening
Excessive foot (supination/pronation) might also influence pes anserine bursitis
pronation
(tendinitis/tendinosis) is reserved for tendon injuries that involve acute injuries accompanied by inflammation
tendinitis
(tendinitis/tendinosis) implies a pathology of chronic degeneration without inflammation
tendinosis
True or False:
Anti-inflammatory medicine can help relieve tendinitis
true
True or False:
Anti-inflammatory medicine can help relieve tendinosis
false
What is another name for patellar tendinitis
jumpers knee
What are the three phases of tendinitis or tendonosis
- Pain after activity
- Pain during and after activity
- Pain leading to functional disability
What activities/motions can cause patellar tendinitis or tendinosis
running, jumping, overuse, eccentric activities
If a patient has patellar tendinitis or tendinosis, what landmarks might be irritated
inferior patella
tibial insertion
superior patella
the tendon in mid-stance
If a patient has patellar tendinitis or tendinosis, what motions would be painful
AROM and resisted knee extension
What would PT management for patellar tendinitis or tendinosis look like
modalities for pain/inflammation, activity modification, cho-pat straps, cross friction massage, gentle stretching, eccentrics when there is no pain and progress into plyometrics
If a PT were to perform cross friction massage, how long should the massage be performed in order to stimulate the inflammatory phase
20 minutes
Tendons need (concentric/isometric/eccentric) contractions to heal properly
eccentric
Treating patellar tendinitis or tendinosis with injections can be (helpful/harmful). _______ medications are (better/worse).
harmful, anti-inflammatory meds are better
How would a patient acquire hamstring tendinitis
eccentric deceleration with running
Hamstring tendinitis has a similar history as _____ tendinitis and so it is treated the same way
patellar
What is the difference between a contusion and a strain
A contusion is a result of a direct blow and a strain occurs via indirect trauma like a pulled muscle
What secondary medical condition can contusion lead to if its not taken care of properly
Compartment syndrome or myositis ossificans
what is a quad contusion
a direct trauma to the quadriceps
If your patient presents with swelling, a palpable hematoma, and a warm quadricep what would be your initial hypothesis
quad contusion
If a patient presents with a quad contusion, which motions are going to be painful
AROM and PROM knee flexion as well as resistive knee extension
A patient with a quad contusion will have painful knee flexion. List the degrees that will cause mild, moderate, and severe pain
greater than 90 results in mild pain
45-90 results in moderate pain
less than 45 results in severe pain
What does the PT management for a quad contusion look like
Lots of ice, e-stim, sometimes crutches, gentle stretching after 24 hours, vigorous stretching after 7-10 days, strengthening when 120 degrees of flexion is pain free
What term means inflammation of muscle leading to bone formation
myositis ossificans
What percentage of quad contusions end up with myositis ossificans
9-20%
What causes myositis ossificans
cellular responses while a muscle, like the quad, is bleeding
What is a common site for myositis ossifications in football players
the gastroc or the deltoid
What are the risk factors for myositis ossificans
previous quad contusion
delayed treatment for quad contusion more than 72 hours
knee effusion
injury sustained in a contact sport
What are the three main treatment goals of myositis ossificans
- Limit swelling and bleeding which will
- Minimize scar formation
- Preserve elasticity, contractility, and strength of the injured and uninjured tissue
Which knee soft tissue pathology results from friction between the IT band and lateral femoral condyle during repetitive knee flexion/extension activities
Iliotibial band syndrome
You are seeing a patient with knee pain. Upon examination you find that the patient has experiences popping, pain over the lateral knee and condyle, and has just increased her workouts to involve hill running. What is your initial hypothesis
IT band syndrome
What are some contributing factors that may play a role in acquiring iliotibial band syndrome
tibial varum, genu varum, overtraining, running downhill or on uneven surfaces, and high or low arches,
If a patient has IT band syndrome, what would you find during an examination
Painful AROM knee flexion
Tender lateral condyle with palpation
Positive Noble compression test
Positive Ober test and weak gluteus medius
What does PT management for IT band syndrome look like
Correct imbalances and mechanics, strengthen weak hips, patellar mobs, iontophoresis, NSAID
How do hamstring strains happen
With an eccentric load to the muscle
Untreated hamstring strains can create adverse ____ ____ that will lead to further injury
neural tension
Are static or ballistic warm ups better for the body and why
Ballistic is better because static decreases blood flow in a tissue which is bad
Which types of athletes usually acquire hamstring strains
runners or baseball players reaching for first base
What is the MOI of a hamstring strain
quick, explosive contraction usually eccentrically
What are some contributing factors that might lead to a hamstring strain
muscle imbalances, fatigue, gait, leg length, ROM, muscle innervations
If a patient has a hamstring strain, what would a PT find upon inspection
possible defect, swelling, ecchymosis
If a patient has a hamstring strain, what motions would be painful
AROM and resistive knee flexion
PROM for knee extension
Palpation of the muscle belly/tendon
If a patient has a hamstring strain, which nerve might have neurodynamic abnormalities
tibial nerve unless its way up high then sciatic nerve
What is the rehab progression of a hamstring strain
re-establish normal gait
RICE
Gentle AROM to light stretching
Isometrics to PRE’s to eccentrics
A hamstring strain of grade (1/2/3) may result in no lost time
1
A hamstring strain of grade (1/2/3) may result in 5-12 days of no participation
2
A hamstring strain of grade (1/2/3) may result of 3-12 weeks of no participation
3
