Exam 3- knee Flashcards
how much ROM for knee during the swing phase
60 deg
what compensates for knee if full ext is not acquired
ankle becomes hypermobile
why does the hip not compensate for loss of knee ext
hip is IR
why is tibial ER needed
complete screw home mechanism
maximal congruency
cover larger articular cartilage surface area
what is the ROM goal for TKA
120 flx
what is ROM for stair descent
90-120 flx
what is ROM for sit to stand
105 flx
what is the ROM and arthro for kneeling and deep squat
90-150 flx
femoral ER and post glide
ABD
lat glide
what are characteristics of ligament and capsule
dense connective tissue
type 1 collagen
low elastin
fibrocytes
multidirectional
what sprain, extraarticular or intraarticular needs sx
intraarticular within joint space
what is the healing phase for sprains
initial tensile strength - 3-5 weeks
dense connective tissue- 12 weeks
normal strength- 10-12 months
what should be the purpose needing to achieve following a sprain
stabilization
tissue proliferation
how can we treat sprains
POLICED
MET
how does the ACL run
superior
posterior
lateral
how are the cruciate ligaments named
where they are attached on the tibia
what does the ACL resist
anterior tibial glide
IR
for a noncontact ACL injury what are the nonmodifable RF
gender - F
2 weeks following menstruation
bony morphology
congenital hypermobility
for a noncontact ACL injury what are the modifable RF
high shoe surface friction (wrong shoe for surface)
high BMI
how does m strength play into ACL tears as a RF
lower overall
ham to quad ratio- predicts LE control
why are hams so important to the ACL
decrease ant. tibial translation produced by quads
what visual alignment can show low impaired LE control and be a risk for ACL tears
knee valgus
hip ADD
trunk lean
trunk RT
why does decreased knee flx with increase GRF be a problem
pt creates more stability for protection
why does greater visual motor strategy for balance be a RF for ACL tears
they use more of their eyes for visual stability rather than sensory control to stabilize more= impaired LE
what are the RF for 2nd ACL injury and what m needs to be addressed
same RF
ER of hip
what are symptoms of ACL tear
effusion
pop
giving way
WB activities limited
what can be found in a SCAN for ACL tears
ROM- limited and painful, hyperext and IR
RST- weak
ST- + distraction
what sp test can be positive for an ACL tear
Anterior drawer
lachmans
pivot shift
why might ACL sp test have false negatives
swelling- distending capsule
hamstring guarding
mensical tear
what can create the arthrogenic m inhibition to the quads after an ACL tear
pain
effusion
jt laxity
m weakness/incoordination
how can we test arthrogenic changes in the knee after an ACL tear
observation
palpation
m testing
what are the 3 primary early goals for ACL Rx
full to nearly full ROM, EXT- no later 4 weeks
minimal to no swelling
quad activation/coordination/endurance
what does full ROM for an ACL at 4 weeks depend on
if thats the only thing torn
why is full ROM important
overall healthier joint
what should be achieved for quad activation
SLR without extension lag
how can a quad set that is >90 of uninvolved side be misleading
uninvolved side is having side effects from pain, jt laxity, and swelling from involved side so both are inhibited
what is the PT Rx for ACL recovery
early WB
POLICED
functional bracing
MT
MET
how might NMES benefit an ACL recovery
significant increase in quad strength
isometric varying angles
what is our end goal for MET for an ACL recovery
intense resistive training without inducing pain
what MET should be emphasized for recovery of an ACL recovery
concentric and eccentric training
why is non WB activity have more load than WB early on
all loading is through the quads where as WB activities involves more groups of m
greater moment arm
for early ACL recovery, what range should OC and CC activities be performed in to not put as much load on the ACL
OC- 90-45
CC- 0-45
why does walking have the same amount of load as non WB activities
terminal knee ext
when are OC and CC activities okay to be performed
walking with correct form, correct trunk and LE control
why should HS be strengthen and coordinated with ACL recovery
decrease ant tibial glide produced by quads
besides knee proprioception, what else needs to be addressed for ACL recovery
trunk proprioception to minimize twist and lean
with neuromuscular training, what are we trying to minimized/decrease with ACL recovery
minimize frontal and transverse plane motion
decrease GRF
with neuromuscular training, what are we trying to promote/increase with ACL recovery
promote sagittal plane and trunk flx
progress speed and difficulty
emphasis on jump and balance
what is the MET prescription for an ACL recovery
2-3x for 6-10 months
how does BFR benefit ACL recovery
similar strength and hypertrophy as high intensity training
increased growth hormone
decreased myostatin
how does a vertical drop jump have a similar loading to non WB ext
increased loading with rate of deceleration
how does ACL recovery change if pt had partial meniscetomy
no change
how does ACL recovery change if pt has a meniscal repair
slower progression due to greater protection needed for meniscal healing
how does ACL recovery change if pt has a bone bruise
delays that leads to more difficulty reaching full ext and proper quad function
how does an MCL tear change ACL recovery
most often not surgically repaired
what are precautions for MCL recovery
only sagittal plane activity for 4-6 wks
limite tibial ER and valgus stress
how does articular cartilage debridement change ACL rehab
WBAT 3-5 days
no ACL delays
how does the articular cartilage sx compare
debridement
OATS and ACI
microfx
what are the grafts for ACL sx
BPTB auto and allograft
SGT
what pre op RF can limit prognosis
weakness= poor outcomes
what is the healing phase for BPTB autograft
initial weakening - first 4 wks
graft into bone- 6-8 wks
dense fibrous tissue- 8-12 wks
why is the first 4 weeks of the BPTB autograft weak
blood vessels are weakened until new blood vessels can form
why do BPTB autograft pt have anterior knee pain
patellar tendinitis/osis
more demand on less supply
what are the advantages of BPTB allograft
symptoms improve faster
pre pubescent population
avoids ant knee pain
what is the healing phase for BPTB allograft
graft to bone- 8-12 wks
dense fibrous tissue- 8-12 wks
what are the advantages of SGT graft
prepubescent to avoid epiphyses disruption
avoid ant knee pain
as a result of STG graft, when should pure HS strengthening start
6-8 wks
delay heavy strengthening for 12 wks
what is the prognosis of ACL recovery
18-24 months
all grafts continue to heal
what can we still expect to see from ACL pts 2-4 years out
m weakness
impaired neuromuscular control
how does the PCL compare to ACL
less injured
stronger
resist post glide and IR
how does PCL run
superior and anterior
whats in the scan for PCL tear
ROM- limited and painful in FLX, EXT, IR
least ER
+ PCL sp test
what can cause a PCL tear
hyperflexion primary
hyperextension
what are the PCL sp tests
quads active
post drawer
post sag
what excessive motions are limited by MCL
valgus
ER
what are scan findings for MCL tear
ROM- impaired and painful FLX, EXT, IR
+ MCL test, possible med meniscus
TTP
what are sp test for MCL
valgus stress at 0 and 30 deg
what is the PT Rx for MCL
early protection with valgus and ER stress and end range FLX and EXT
what does the LCL resist
varus
ER
what are the scan findings for LCL
ROM- limited and painful EXT and ER
+ LCL test
TTP
what are the sp. test for LCL
varus stress for 0 and 30 deg
what is the PT Rx for LCL
early protection with varus and ER
possible sx
what is the MET for all sprains
combo of OC and CC
coordination training
what part of the meniscus is most commonly injured
medial
posterior horn
what is the function of meniscus
stability
deepen jt
what are the S&S of meniscus tear
jt pain
limited and painful motion
WB catching or popping or locking
what is in a scan for meniscus tear
ob- swelling, painful and asymmetric gait
ROM- limited and painful motion
RST- potential weak and painful
ST- + compression
what are sp test for meniscus
McMurray
Apley
Ege
Thesally- lat meniscus
what should be the ultimate purpose needing to be achieved with Rx for meniscal injury
integrity
stabilization
what is the PT Rx for meniscal injury
POLICED
AD
JM
MET
what are post op aspects of partial menisecctomy
no immobilization
early WB
RTP 2-6 wks
what are post op aspects of meniscal repair
immobilization/limited ROM
TTWB for 4-6 weeks
RTP around 12 weeks
why is RTP for meniscal repair around 12 weeks
more dense tissue has filled in
what is a bakers cyst
excessive swelling in popliteal space due to articular changes
what is the bakers cyst due to
persistent inflammation
weakened capsule
what are S&S for bakers cyst
asymptomatic until significant effusion
ROM- limited/painful EXT/FLX
RST- FLX painful
palpation- mass in popliteal space
what is different in a scan between bakers cyst and meniscal tear
bakers cyst has no pain with compression
what can a bakers cyst resemble if it ruptures
gastroc tear
where is ARJC at in the knee
medial formal condyle and patella articular surface
what are the RF of ARJC in the knee
greater than 50 yrs
previous injury resulting in jt laxity
increase BMI
demanding job
quad weakness
how can quad weakness be a RF for ARJC
the more m strength the more unloading on the jt
what are the symptoms of ARJC in the knee
gradual onset
pain with WB
rest relieves pain
stiffness in AM
limited and painful motion
what can we see in a SCAN for ARJC in the knee
ob- painful/asymmetric gait, genu varum
ROM- limited/painful FLX and EXT (CPP)
CM- consistent block
ST- + comp
what is in a BE for ARJC in the knee
hypomobile
AM glides
sp test- meniscus
impaired walking distance, gait velocity decrease
palpation- jt tenderness
what is the PT Rx for ARJC
POLICED
orthotics/brace
AD
JM
MET
weight management
pt edu
how can a lateral heel wedge help ARJC in the knee
lateral orthotic decreases pressure on med condyle by everting the foot
however, creates more pressure on lateral condyle and LE discrepancy
what should be our targeted m group for MET with ARJC of the knee
quads
anti gravity hip m
what MET activities help with ARJC in the knee
aerobic
aquatic
tai chi
coordination and balance activities
what are beneficial meds of ARJC in the knee
NSAIDs- inflammation, pain and fever
Tylenol- pain and fever
what are non beneficial meds of ARJC in the knee
narcotics
cortisone injections
hyaluronic acid injections
what MD Rx is not recommended for any knee ARJC
cleaning arthroscopy
what is the prognosis of a TKA
12 wks PT
when should a pt receive a TKA
moderate to severe OA
what is in a prehab visit for TKA
AD training
planning recovery- HEP
expectations
what does early rehab do for a TKA
decrease hospital stay and number of sessions
greater ROM/strength
faster autonomy and normal gait
what are the goals for TKA
0 deg ext- 1-2 wks
110 deg flx- 6 wks
120 overall flx
what are RF for PFPS
military recruits
dynamic pronation
females- q angle, differing hip strength/coordination
what can cause PFPS
trauma- rare
idiopathic
PF malalignment
what can PF malalignment cause
femur can IR creating more force on patella with less contact due to impaired LE control of hip and quad
what is the pathology of PFPS
overload of subchondral bone
tissue ischemia
loss of tissue hemostasis
neural ingrowth
what are symptoms of PFPS
gradual onset
anteromedial knee pain
pain increases with stairs, squatting, or kneeling or prolong sitting
how can prolong sitting contribute to PFPS
more pressure on the less contact of displaced patella
what can be observed with PFPS
increased Q angle
OC maltracking patella
quad atrophy
impaired LE control
why is impaired LE control a problem for PFPS
dynamic excessive pronation by tibial IR (impaired anti gravity hip) leading to genu valgus and impaired DF
if DF is impaired, what is more likely to occur with a pt that has PFPS
more eversion leading to more pronation
what m are incoordinated/weakness with PFPS
glute med/max
hip ext, ER, ABD
quads
can L4-S1 regional interdependence lead to PFPS
if so why
RI inhibits the hip ext, ABD, and ER which causes impaired LE control
letting the tibia IR and leading the patella to maltrack
what is in the SCAN for PFPS
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
how is accessory motion for the patella with PFPS
excessive lateral PF motion and limited medial
or
all glides are excessive
what sp test are + for PFPS
medial patella plica test
pain with knee ext
hoffas sign
apprehension test
what m length test could be positive and indicate PFPS
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
how can the patella be positioned if PFPS is present
patella alta- above jt line
patella baja- below jt line
what direction does the patella need to be stabilized if PFPS is present
medial for better surface contact
how can taping the arch help PFPS
limit excessive pronation
what is the PT rx for PFPS
POLICED
taping
orthotics- foot and knee
DN
STM/JM
MET
what should be avoided with PFPS in OC and CC
OC- 45-0
CC- >45 flx
what exercises are best for PFPS and what are the benefits
quads and hip exercises
improve neuromuscular control
how does verbal feedback help PFPS
helps control movement patterns
how can PFPS lead to OA
sedentary
patella maltracking causing increased stress on surrounding structures
what is the RF for ITB syndrome
running
training errors
impaired LE control- weak ER/ABD, excessive pronation, increased hip ADD/IR, trunk lean
what can cause ITB syndrome
abnormal mechanical loading
lumbar hypermobility/instability- excessive TFL recruitment
what are symptoms of ITB syndrome
gradual onset of lateral knee pain
worse with repetitive activities knee motion, grades, running
what is in a scan for ITB syndrome
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
what is in a BE for ITB syndrome
sp test- + obers
palpation- TTP over lat femoral condyle and gerdys tubercle
what MET should be done for ITB syndrome
tendinosis prescription
ABD
what are RF for patellar tendinopathy
athletes
males
jumping sports
what are symptoms of patellar tendinopathy
overuse or gradual onset of pain
increased with jumping, lunging, and squatting (quad dominant)
what is in the scan for patellar tendinopathy
ob- thicken tendon, impaired LE control
ROM- possible pain and limitation with end range flx
RST- pain with knee ext
what is in the BE for patellar tendinopathy
AM- limited inf glide
sp test- thomas for short rectus
palpation- TTP
patient has patella alta what two conditions can the patient have due to this palpation
PFPS
patellar tendinopathy
what is the PT Rx for patellar tendinopathy
pt edu- soreness rule, load management, movement cues
POLICED
Orthotic
JM
MET
what MET should be done for patellar tendinopathy
isometrics
eccentric with stretching for quads and hs
heavy to mod resistance
increased trunk flx
how does increasing trunk flexion limit tendon stress of knee
hips go back keeping the knee from going over the toes and becoming a quad dominant position
who is most common for osgood schlatters disease
12-15 yrs of age
what are RF for osgood schlatters disease
growth spurt
high activity
shorten quad and HS
weak quads
high BMI
reduced core
what is the pathology of osgood schlatters disease
bone growth exceeds quads length
increased tendon tension
growth plate is weak
mostly inflammation
what are symptoms of osgood schlatters disease
gradual onset of ant knee pain with overuse
pop= avulsion
possible loss of vertical jump
what is in a SCAN for osgood schlatters disease
ob- impaired LE control, large tibial tuberosity
ROM- possible pain and limitation with end range flx
RST- pain with knee ext
what is in a BE for osgood schlatters disease
AM- limited inf glide
sp test- thomas for short rectus
palpation- TTP over tibial tuberosity
what is the PT Rx for osgood schlatters disease
Pt edu- soreness rule, load management, movement cures
POLICED
JM
Stretch- no symptoms at painful area
orthotic
MET
what MET could be done for osgood schlatters disease
trunk and hip stabilization
do not overuse the tendon
how do you know to use an orthotic
have them do an activity that creates symptoms
do the same activity with orthotic
if improves symptoms= use
if increases symptoms= do not
what are functional strains
fatigue or neurogenic dysfunction without structural change
what are structural strains
tearing
what is the RTP for functional strains
grade 1- 1-2 weeks
what is the RTP for structural strains
grade 2- 5-6 weeks
grade 3- > 8 weeks
what is the PT Rx for strains
pt edu
compression wrapping to help m action
MET
