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MSK II > Exam 1 (wks 1-3) > Flashcards

Exam 1 (wks 1-3) Flashcards

1
Q

What type of joint is the tibiofemoral joint, what motion does it prevent and how many degrees of freedom does it have?

A

Double condyloid
prevents motion in the frontal plane
2 degrees of freedom
- flex/ext in sagittal plane
- med/lat rotation in transverse plane

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2
Q

What are 4 characteristics of the femoral articular surface?

A

1) Large AP convexity
2) Small curvature posterior
3) Medial condyle longer than lateral
4) Medial condyle extends further distally (for angled femur)

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3
Q

What are 4 characteristics of the tibial articular surface?

A

1) Tibial plateaus are concave/ slope posterioinferiorly
2) Medial tibial plateau is 50% larger/ 3X thicker
3) Lateral plateau is more circular
4) menisci compensate for incongruence

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4
Q

What are the functions of the menisci?

A

To increase stability by deepening tibial plateau
To increase contact area
To decrease friction
Enhance proprioception
Attenuate forces (50-60% of load at knee)

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5
Q

3 characteristics of the medial meniscus

A

C-shaped
Firm attachment to deep layers of the MCL
Thick posteriorly

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6
Q

3 characteristics of the lateral meniscus

A

O-shaped
Loose attachment to lateral capsule
Uniform thickness

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7
Q

What is the role of the tibialfemoral ligaments?

A

Control/ resist:
- hyperextention
- varus/valgus stress
- AP displacement of tibia on femur
- combination of AP and rotation motions

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8
Q

What does the MCL prevent

A

Abduction (valgus stress) and assists with preventing anterior tibial translation

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9
Q

T/F the MCL and LCL are lax in flexion and taught in extension

A

True. Ligs offer most stability in knee extension

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10
Q

T/F both the MCL and LCL have poor healing potential

A

False. They are well vascularized so they heal well.

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11
Q

What are the origin and insertion of the ACL?

A

Origin = ant. aspect of tibia
Insertion = pos. aspect of lateral femoral condyle

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12
Q

T/F the anteromedial bundle of the ACL is taught in ext and lax in flexion

A

False. (think pant leg)

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13
Q

T/F the posterolateral bundle of the ACL is taught in ext and lax in flexion

A

True. (think pant leg)

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14
Q

Define genu valgum

A

TF angle < 165 deg
Increased lateral compressive forces

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15
Q

Define genu varum

A

TF angle > 180 deg
Increased medial compressive forces

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16
Q

What is Q angle and do males of females typically have a greater Q angle?

A

Q angle = angle formed by line drawn from ASIS to mid-patella to tibial tuberosity
- Males 10-14 deg
- Femailes 15-17 deg

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17
Q

What is genu recurvatum?

A

Excessive hyperextension (anything more than 10 deg)

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18
Q

Decreased closed chain dorsiflexion causes what at the knee?

A

decreased knee flexion

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19
Q

Decreased closed chain plantar flexion causes what at the knee?

A

decreased knee extension

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20
Q

Describe the screw home mechanism

A

During the last 5 deg of extension
- lateral rot of tibia on femur (IR of femur)
- augmented by tension on ACL and lateral pull of quads

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21
Q

Name 4 qualities of the PCL

A

Prevents post. translation of the tibia on femur
Gives minor restraint to varus/valgus stress
Shorter than ACL
Rarely injured (one of the strongest lig in the body)

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22
Q

What is considered normal flexion and extension for the knee?

A

Flexion = 130-140 deg
Extension = 5- 10 deg of hyperextension

23
Q

How much internal/external rotation is in the knee at 0 deg vs. 90 deg of flexion?

A

0 deg = restricted due to interlocking of femoral and tibial condyles

90 deg =
-ER: 0-45 deg
-IR: 0-30 deg

24
Q

What role does the popliteas play in knee joint arthrokinematics?

A

It helps ‘unlock’ the knee.
OKC: moves tibia medially as knee flexes
CKC: moves femur laterally as knee flexes

25
Q

When is the first consistent patellar femoral contact and at what various degrees of flexion do the different facets contact?

A

10-20 deg = first contact
90 deg = medial and lateral facets
135 = lateral and odd

26
Q

What angle of knee flexion has the greatest compression forces on the patella?

A

90 deg

27
Q

How much knee flexion do you need for the following activities?
- Gait
- on/off toilet
- stair climbing
- sit/raise chair
- in/out bath
- advanced function

A

Gait: 60-70 deg
Toilet: 75 deg
Stair climbing: 70-80 deg
Sit/rise chair: 90 deg
In/out bath: 90 deg
Advanced function 115 deg

28
Q

Neoplastic Disease

A

Most common in adolescents
Persistent knee pain with no known cause
Not easily reproduced during physical exam

29
Q

Cellulitis

A

Fever, chills, malaise
History of open wound
More common in pt with venous insufficiency, congestive heart failure, or liver cirrhosis
Tenderness, swelling, warmth, weakness

30
Q

Reactive Arthritis

A

Constant aching or throbbing
Reactive = infection somewhere else that has spread
Septic = infection in the knee

30
Q

Rheumatoid Arthritis

A

Pain an stiffness in more than 1 joint
fever
wt. loss
bilateral symptoms

31
Q

Gout

A

painful knee worse with activity
tends to be chronic with intervals between attacks

32
Q

Osteochondritis (OCD)

A

can occur in adults and children
result of acute trauma or repetitive stress
diagnosed via imaging
Mild effusion
Special tests negative

33
Q

Acute compartment syndrome

A

6 Ps (pain, palor, pressure, paresthesia, pulselessness and paralysis
Urgent refferal

34
Q

Peripheral arterial occlusive disease (PAD)

A

lower extremity pain, cramping, numbness
intermittent claudication
age >60, hx of heart disease, type II diabetes
sedentary, hx of smoking
symptoms = shiny lower extremity, cold skin, decreased capillary refill

35
Q

Superficial vein thrombosis

A

inflammation of superficial vein due to blood clot
swelling, warmth, tenderness, may be hard red cord near surface of skin

36
Q

Deep Vein Thrombosis

A

deep pain and cramping
heart is racing
dizziness
coughing up blood
*wells criteria

37
Q

What structures are responsible for producing pain in patellarfemoral knee pain?

A

Soft tissues:
synovial tissue
retinaculum
fat pad
capsule

38
Q

What are the 3 subgroups for patellarfemoral pain?

A

Strong
Weak and tight
Weak and pronated

38
Q

What type of collagen are ligaments and what type are they replaced with when injured?

A

Type 1 = designed to resist tension
Type 3 = scar tissue, not as strong

39
Q

What are some negative effects of immobilization for more than 1-2 wks?

A

Lig. will atrophy
decreased tensile strength
boney attachments weaken
6 wks can lead to 50% loss of strength

40
Q

Meniscus tear pathophysiology

A

Twisting injury
Pain worse with movement better with rest
Locking
Joint line tenderness
Acute effusion

41
Q

Good prognosis for meniscus tear

A

Age < 35
Peripheral damage
longitudinal tear
short tear
bloody effusion

42
Q

Hallmark objective findings for meniscus tear

A

Joint line tenderness
Effusion
Positive entrapment test
Quad inhibition

43
Q

What do we need to be careful of when rehabing a meniscal repair?

A

Semembranosus inserts on the medial meniscus so avoid straining the hamstring.
Don’t push ROM

44
Q

Grade 2 articular cartilage lesion

A

lesion extending down to < 50% of cartilage depth

45
Q

Grade 3 articular cartilage lesion

A

Defect extending down to > 50% of cartilage depth. Down to but NOT through the subchondral bone

46
Q

Signs of articular cartilage damage

A

Malalignments
painful crepitus
quad atrophy
pain and swelling after use
deep, dull ache

47
Q

Who is microfracture treatment indicated for?

A

Less active more sedentary individuals

48
Q

What is an ACI?

A

Autologous chondrocyte implantation
Small biopsy of cartilage is harvested
Digested to release chondrocytes
Re implanted
PROM is key

49
Q

What is an OATS

A

Osteochondral autograft transplantation system
Remove plug from NWB surface
Fit into lesion
PRPOM is key

50
Q

Kellgren Lawrence Classification for Knee OA

A

Grade 2 = mild (definite osteophyte, normal joint space)
Grade 3 = Moderate (joint space reductions)
Grade 4 = Severe (joint space greatly reduced, subchondral sclerosis)

51
Q

Patient presentation of OA

A

gradual onset, stiffness and crepitus
Too much or too little activity hurts
progressively worsens overtime
Swelling
Bony enlargement

MSK II (1 decks)

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