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DPT 730/1: MSK > Exam 3- knee > Flashcards

Exam 3- knee Flashcards

1
Q

how much ROM for knee during the swing phase

A

60 deg

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2
Q

what compensates for knee if full ext is not acquired

A

ankle becomes hypermobile

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3
Q

why does the hip not compensate for loss of knee ext

A

hip is IR

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4
Q

why is tibial ER needed

A

complete screw home mechanism
maximal congruency
cover larger articular cartilage surface area

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5
Q

what is the ROM goal for TKA

A

120 flx

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6
Q

what is ROM for stair descent

A

90-120 flx

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7
Q

what is ROM for sit to stand

A

105 flx

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8
Q

what is the ROM and arthro for kneeling and deep squat

A

90-150 flx
femoral ER and post glide
ABD
lat glide

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9
Q

what are characteristics of ligament and capsule

A

dense connective tissue
type 1 collagen
low elastin
fibrocytes
multidirectional

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10
Q

what sprain, extraarticular or intraarticular needs sx

A

intraarticular within joint space

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11
Q

what is the healing phase for sprains

A

initial tensile strength - 3-5 weeks
dense connective tissue- 12 weeks
normal strength- 10-12 months

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12
Q

what should be the purpose needing to achieve following a sprain

A

stabilization
tissue proliferation

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13
Q

how can we treat sprains

A

POLICED
MET

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14
Q

how does the ACL run

A

superior
posterior
lateral

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15
Q

how are the cruciate ligaments named

A

where they are attached on the tibia

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16
Q

what does the ACL resist

A

anterior tibial glide
IR

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17
Q

for a noncontact ACL injury what are the nonmodifable RF

A

gender - F
2 weeks following menstruation
bony morphology
congenital hypermobility

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18
Q

for a noncontact ACL injury what are the modifable RF

A

high shoe surface friction (wrong shoe for surface)
high BMI

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19
Q

how does m strength play into ACL tears as a RF

A

lower overall
ham to quad ratio- predicts LE control

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20
Q

why are hams so important to the ACL

A

decrease ant. tibial translation produced by quads

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21
Q

what visual alignment can show low impaired LE control and be a risk for ACL tears

A

knee valgus
hip ADD
trunk lean
trunk RT

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22
Q

why does decreased knee flx with increase GRF be a problem

A

pt creates more stability for protection

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23
Q

why does greater visual motor strategy for balance be a RF for ACL tears

A

they use more of their eyes for visual stability rather than sensory control to stabilize more= impaired LE

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24
Q

what are the RF for 2nd ACL injury and what m needs to be addressed

A

same RF
ER of hip

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25
Q

what are symptoms of ACL tear

A

effusion
pop
giving way
WB activities limited

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26
Q

what can be found in a SCAN for ACL tears

A

ROM- limited and painful, hyperext and IR
RST- weak
ST- + distraction

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27
Q

what sp test can be positive for an ACL tear

A

Anterior drawer
lachmans
pivot shift

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28
Q

why might ACL sp test have false negatives

A

swelling- distending capsule
hamstring guarding
mensical tear

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29
Q

what can create the arthrogenic m inhibition to the quads after an ACL tear

A

pain
effusion
jt laxity
m weakness/incoordination

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30
Q

how can we test arthrogenic changes in the knee after an ACL tear

A

observation
palpation
m testing

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31
Q

what are the 3 primary early goals for ACL Rx

A

full to nearly full ROM, EXT- no later 4 weeks
minimal to no swelling
quad activation/coordination/endurance

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32
Q

what does full ROM for an ACL at 4 weeks depend on

A

if thats the only thing torn

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33
Q

why is full ROM important

A

overall healthier joint

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34
Q

what should be achieved for quad activation

A

SLR without extension lag

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35
Q

how can a quad set that is >90 of uninvolved side be misleading

A

uninvolved side is having side effects from pain, jt laxity, and swelling from involved side so both are inhibited

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36
Q

what is the PT Rx for ACL recovery

A

early WB
POLICED
functional bracing
MT
MET

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37
Q

how might NMES benefit an ACL recovery

A

significant increase in quad strength
isometric varying angles

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38
Q

what is our end goal for MET for an ACL recovery

A

intense resistive training without inducing pain

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39
Q

what MET should be emphasized for recovery of an ACL recovery

A

concentric and eccentric training

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40
Q

why is non WB activity have more load than WB early on

A

all loading is through the quads where as WB activities involves more groups of m
greater moment arm

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41
Q

for early ACL recovery, what range should OC and CC activities be performed in to not put as much load on the ACL

A

OC- 90-45
CC- 0-45

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42
Q

why does walking have the same amount of load as non WB activities

A

terminal knee ext

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43
Q

when are OC and CC activities okay to be performed

A

walking with correct form, correct trunk and LE control

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44
Q

why should HS be strengthen and coordinated with ACL recovery

A

decrease ant tibial glide produced by quads

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45
Q

besides knee proprioception, what else needs to be addressed for ACL recovery

A

trunk proprioception to minimize twist and lean

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46
Q

with neuromuscular training, what are we trying to minimized/decrease with ACL recovery

A

minimize frontal and transverse plane motion
decrease GRF

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47
Q

with neuromuscular training, what are we trying to promote/increase with ACL recovery

A

promote sagittal plane and trunk flx
progress speed and difficulty
emphasis on jump and balance

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48
Q

what is the MET prescription for an ACL recovery

A

2-3x for 6-10 months

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49
Q

how does BFR benefit ACL recovery

A

similar strength and hypertrophy as high intensity training
increased growth hormone
decreased myostatin

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50
Q

how does a vertical drop jump have a similar loading to non WB ext

A

increased loading with rate of deceleration

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51
Q

how does ACL recovery change if pt had partial meniscetomy

A

no change

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52
Q

how does ACL recovery change if pt has a meniscal repair

A

slower progression due to greater protection needed for meniscal healing

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53
Q

how does ACL recovery change if pt has a bone bruise

A

delays that leads to more difficulty reaching full ext and proper quad function

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54
Q

how does an MCL tear change ACL recovery

A

most often not surgically repaired

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55
Q

what are precautions for MCL recovery

A

only sagittal plane activity for 4-6 wks
limite tibial ER and valgus stress

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56
Q

how does articular cartilage debridement change ACL rehab

A

WBAT 3-5 days
no ACL delays

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57
Q

how does the articular cartilage sx compare

A

debridement
OATS and ACI
microfx

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58
Q

what are the grafts for ACL sx

A

BPTB auto and allograft
SGT

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59
Q

what pre op RF can limit prognosis

A

weakness= poor outcomes

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60
Q

what is the healing phase for BPTB autograft

A

initial weakening - first 4 wks
graft into bone- 6-8 wks
dense fibrous tissue- 8-12 wks

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61
Q

why is the first 4 weeks of the BPTB autograft weak

A

blood vessels are weakened until new blood vessels can form

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62
Q

why do BPTB autograft pt have anterior knee pain

A

patellar tendinitis/osis
more demand on less supply

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63
Q

what are the advantages of BPTB allograft

A

symptoms improve faster
pre pubescent population
avoids ant knee pain

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64
Q

what is the healing phase for BPTB allograft

A

graft to bone- 8-12 wks
dense fibrous tissue- 8-12 wks

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65
Q

what are the advantages of SGT graft

A

prepubescent to avoid epiphyses disruption
avoid ant knee pain

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66
Q

as a result of STG graft, when should pure HS strengthening start

A

6-8 wks
delay heavy strengthening for 12 wks

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67
Q

what is the prognosis of ACL recovery

A

18-24 months
all grafts continue to heal

68
Q

what can we still expect to see from ACL pts 2-4 years out

A

m weakness
impaired neuromuscular control

69
Q

how does the PCL compare to ACL

A

less injured
stronger
resist post glide and IR

70
Q

how does PCL run

A

superior and anterior

71
Q

whats in the scan for PCL tear

A

ROM- limited and painful in FLX, EXT, IR
least ER
+ PCL sp test

72
Q

what can cause a PCL tear

A

hyperflexion primary
hyperextension

73
Q

what are the PCL sp tests

A

quads active
post drawer
post sag

74
Q

what excessive motions are limited by MCL

A

valgus
ER

75
Q

what are scan findings for MCL tear

A

ROM- impaired and painful FLX, EXT, IR
+ MCL test, possible med meniscus
TTP

76
Q

what are sp test for MCL

A

valgus stress at 0 and 30 deg

77
Q

what is the PT Rx for MCL

A

early protection with valgus and ER stress and end range FLX and EXT

78
Q

what does the LCL resist

A

varus
ER

79
Q

what are the scan findings for LCL

A

ROM- limited and painful EXT and ER
+ LCL test
TTP

80
Q

what are the sp. test for LCL

A

varus stress for 0 and 30 deg

81
Q

what is the PT Rx for LCL

A

early protection with varus and ER
possible sx

82
Q

what is the MET for all sprains

A

combo of OC and CC
coordination training

83
Q

what part of the meniscus is most commonly injured

A

medial
posterior horn

84
Q

what is the function of meniscus

A

stability
deepen jt

85
Q

what are the S&S of meniscus tear

A

jt pain
limited and painful motion
WB catching or popping or locking

86
Q

what is in a scan for meniscus tear

A

ob- swelling, painful and asymmetric gait
ROM- limited and painful motion
RST- potential weak and painful
ST- + compression

87
Q

what are sp test for meniscus

A

McMurray
Apley
Ege
Thesally- lat meniscus

88
Q

what should be the ultimate purpose needing to be achieved with Rx for meniscal injury

A

integrity
stabilization

89
Q

what is the PT Rx for meniscal injury

A

POLICED
AD
JM
MET

90
Q

what are post op aspects of partial menisecctomy

A

no immobilization
early WB
RTP 2-6 wks

91
Q

what are post op aspects of meniscal repair

A

immobilization/limited ROM
TTWB for 4-6 weeks
RTP around 12 weeks

92
Q

why is RTP for meniscal repair around 12 weeks

A

more dense tissue has filled in

93
Q

what is a bakers cyst

A

excessive swelling in popliteal space due to articular changes

94
Q

what is the bakers cyst due to

A

persistent inflammation
weakened capsule

95
Q

what are S&S for bakers cyst

A

asymptomatic until significant effusion
ROM- limited/painful EXT/FLX
RST- FLX painful
palpation- mass in popliteal space

96
Q

what is different in a scan between bakers cyst and meniscal tear

A

bakers cyst has no pain with compression

97
Q

what can a bakers cyst resemble if it ruptures

A

gastroc tear

98
Q

where is ARJC at in the knee

A

medial formal condyle and patella articular surface

99
Q

what are the RF of ARJC in the knee

A

greater than 50 yrs
previous injury resulting in jt laxity
increase BMI
demanding job
quad weakness

100
Q

how can quad weakness be a RF for ARJC

A

the more m strength the more unloading on the jt

101
Q

what are the symptoms of ARJC in the knee

A

gradual onset
pain with WB
rest relieves pain
stiffness in AM
limited and painful motion

102
Q

what can we see in a SCAN for ARJC in the knee

A

ob- painful/asymmetric gait, genu varum
ROM- limited/painful FLX and EXT (CPP)
CM- consistent block
ST- + comp

103
Q

what is in a BE for ARJC in the knee

A

hypomobile
AM glides
sp test- meniscus
impaired walking distance, gait velocity decrease
palpation- jt tenderness

104
Q

what is the PT Rx for ARJC

A

POLICED
orthotics/brace
AD
JM
MET
weight management
pt edu

105
Q

how can a lateral heel wedge help ARJC in the knee

A

lateral orthotic decreases pressure on med condyle by everting the foot

however, creates more pressure on lateral condyle and LE discrepancy

106
Q

what should be our targeted m group for MET with ARJC of the knee

A

quads
anti gravity hip m

107
Q

what MET activities help with ARJC in the knee

A

aerobic
aquatic
tai chi
coordination and balance activities

108
Q

what are beneficial meds of ARJC in the knee

A

NSAIDs- inflammation, pain and fever
Tylenol- pain and fever

109
Q

what are non beneficial meds of ARJC in the knee

A

narcotics
cortisone injections
hyaluronic acid injections

110
Q

what MD Rx is not recommended for any knee ARJC

A

cleaning arthroscopy

111
Q

what is the prognosis of a TKA

A

12 wks PT

112
Q

when should a pt receive a TKA

A

moderate to severe OA

113
Q

what is in a prehab visit for TKA

A

AD training
planning recovery- HEP
expectations

114
Q

what does early rehab do for a TKA

A

decrease hospital stay and number of sessions
greater ROM/strength
faster autonomy and normal gait

115
Q

what are the goals for TKA

A

0 deg ext- 1-2 wks
110 deg flx- 6 wks
120 overall flx

116
Q

what are RF for PFPS

A

military recruits
dynamic pronation
females- q angle, differing hip strength/coordination

117
Q

what can cause PFPS

A

trauma- rare
idiopathic
PF malalignment

118
Q

what can PF malalignment cause

A

femur can IR creating more force on patella with less contact due to impaired LE control of hip and quad

119
Q

what is the pathology of PFPS

A

overload of subchondral bone
tissue ischemia
loss of tissue hemostasis
neural ingrowth

120
Q

what are symptoms of PFPS

A

gradual onset
anteromedial knee pain
pain increases with stairs, squatting, or kneeling or prolong sitting

121
Q

how can prolong sitting contribute to PFPS

A

more pressure on the less contact of displaced patella

122
Q

what can be observed with PFPS

A

increased Q angle
OC maltracking patella
quad atrophy
impaired LE control

123
Q

why is impaired LE control a problem for PFPS

A

dynamic excessive pronation by tibial IR (impaired anti gravity hip) leading to genu valgus and impaired DF

124
Q

if DF is impaired, what is more likely to occur with a pt that has PFPS

A

more eversion leading to more pronation

125
Q

what m are incoordinated/weakness with PFPS

A

glute med/max
hip ext, ER, ABD
quads

126
Q

can L4-S1 regional interdependence lead to PFPS

if so why

A

RI inhibits the hip ext, ABD, and ER which causes impaired LE control
letting the tibia IR and leading the patella to maltrack

127
Q

what is in the SCAN for PFPS

A

ROM- limited and painful, FLX (PF comp) and EXT (fat pad irritation)
RST- weak and painful, HS, quads weak, anti gravity hip m
ST- PF comp
Neuro- possible femoral n

128
Q

how is accessory motion for the patella with PFPS

A

excessive lateral PF motion and limited medial
or
all glides are excessive

129
Q

what sp test are + for PFPS

A

medial patella plica test
pain with knee ext
hoffas sign
apprehension test

130
Q

what m length test could be positive and indicate PFPS

A

thomas- rectus short= patella alta
obers- TFL= connects to patella pulls lateral
SLR- HS and gastroc= too tight, more knee flx, more pressure on less surface area

131
Q

how can the patella be positioned if PFPS is present

A

patella alta- above jt line
patella baja- below jt line

132
Q

what direction does the patella need to be stabilized if PFPS is present

A

medial for better surface contact

133
Q

how can taping the arch help PFPS

A

limit excessive pronation

134
Q

what is the PT rx for PFPS

A

POLICED
taping
orthotics- foot and knee
DN
STM/JM
MET

135
Q

what should be avoided with PFPS in OC and CC

A

OC- 45-0
CC- >45 flx

136
Q

what exercises are best for PFPS and what are the benefits

A

quads and hip exercises
improve neuromuscular control

137
Q

how does verbal feedback help PFPS

A

helps control movement patterns

138
Q

how can PFPS lead to OA

A

sedentary
patella maltracking causing increased stress on surrounding structures

139
Q

what is the RF for ITB syndrome

A

running
training errors
impaired LE control- weak ER/ABD, excessive pronation, increased hip ADD/IR, trunk lean

140
Q

what can cause ITB syndrome

A

abnormal mechanical loading
lumbar hypermobility/instability- excessive TFL recruitment

141
Q

what are symptoms of ITB syndrome

A

gradual onset of lateral knee pain
worse with repetitive activities knee motion, grades, running

142
Q

what is in a scan for ITB syndrome

A

ob- impaired LE control
ROM- pain with hip ADD, not consistent with knee flx or ext
RST- weak hip ABD/ER, not consistent with knee flx or ext

143
Q

what is in a BE for ITB syndrome

A

sp test- + obers
palpation- TTP over lat femoral condyle and gerdys tubercle

144
Q

what MET should be done for ITB syndrome

A

tendinosis prescription
ABD

145
Q

what are RF for patellar tendinopathy

A

athletes
males
jumping sports

146
Q

what are symptoms of patellar tendinopathy

A

overuse or gradual onset of pain
increased with jumping, lunging, and squatting (quad dominant)

147
Q

what is in the scan for patellar tendinopathy

A

ob- thicken tendon, impaired LE control
ROM- possible pain and limitation with end range flx
RST- pain with knee ext

148
Q

what is in the BE for patellar tendinopathy

A

AM- limited inf glide
sp test- thomas for short rectus
palpation- TTP

149
Q

patient has patella alta what two conditions can the patient have due to this palpation

A

PFPS
patellar tendinopathy

150
Q

what is the PT Rx for patellar tendinopathy

A

pt edu- soreness rule, load management, movement cues
POLICED
Orthotic
JM
MET

151
Q

what MET should be done for patellar tendinopathy

A

isometrics
eccentric with stretching for quads and hs
heavy to mod resistance
increased trunk flx

152
Q

how does increasing trunk flexion limit tendon stress of knee

A

hips go back keeping the knee from going over the toes and becoming a quad dominant position

153
Q

who is most common for osgood schlatters disease

A

12-15 yrs of age

154
Q

what are RF for osgood schlatters disease

A

growth spurt
high activity
shorten quad and HS
weak quads
high BMI
reduced core

155
Q

what is the pathology of osgood schlatters disease

A

bone growth exceeds quads length
increased tendon tension
growth plate is weak
mostly inflammation

156
Q

what are symptoms of osgood schlatters disease

A

gradual onset of ant knee pain with overuse
pop= avulsion
possible loss of vertical jump

157
Q

what is in a SCAN for osgood schlatters disease

A

ob- impaired LE control, large tibial tuberosity
ROM- possible pain and limitation with end range flx
RST- pain with knee ext

158
Q

what is in a BE for osgood schlatters disease

A

AM- limited inf glide
sp test- thomas for short rectus
palpation- TTP over tibial tuberosity

159
Q

what is the PT Rx for osgood schlatters disease

A

Pt edu- soreness rule, load management, movement cures
POLICED
JM
Stretch- no symptoms at painful area
orthotic
MET

160
Q

what MET could be done for osgood schlatters disease

A

trunk and hip stabilization
do not overuse the tendon

161
Q

how do you know to use an orthotic

A

have them do an activity that creates symptoms
do the same activity with orthotic
if improves symptoms= use
if increases symptoms= do not

162
Q

what are functional strains

A

fatigue or neurogenic dysfunction without structural change

163
Q

what are structural strains

A

tearing

164
Q

what is the RTP for functional strains

A

grade 1- 1-2 weeks

165
Q

what is the RTP for structural strains

A

grade 2- 5-6 weeks
grade 3- > 8 weeks

166
Q

what is the PT Rx for strains

A

pt edu
compression wrapping to help m action
MET

DPT 730/1: MSK (11 decks)

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