final Flashcards
In the modified hinge joint of the knee what movements are involved
Flexion/ Extension
Rotation of the tibia
The knee joint is the connection of 2 long bones and it is the _____ stable joint in the lower extremity
Least
When the foot is in contact with the ground surface it sin ____ kinetic position
closed
How do you measure the Q angle?
measured from ASIS to center of the patella and the tibial tuberosity to the center of the patella
What are the normal ranges for the Q angle in both male and females
males 10
what is considered an unstable Q angle
> 20
Chondromalacia Patella AKA
Patella- Femoral Syndrome
What is the most common injury for Chondromalacia Patella
Due to non- trauma in the knee…. overuse, degenerative issue
Chondromalacia Patella causes damage to what area?
the retropatellar articular cartilage (Hyline)
Causes for a chondromalacia patella ?
cumulative biomechanics micro/macro trauma to cartilage
What can chondromalacia lead to?
problems with tracking of the patella in the trochlear groove of the femur, OA
What is the presentation of Chondromalacia Patellae
- Knee pain increases with sustained knee flexion (movie sitting sign)
- retro- patellar crepitus
- decrease joint space on x-ray
- Abnormal Patellar Tracking
What is movie sitting sign?
Knee pain is increased with sustained knee flexion
What is the better way to evaluate the knee
have patient do a squat and looking for the patella to go superior to inferior the last 15-20 degrees of knee extension
What is the recommendation for management for Chondromalacia Patella
increase water glucosamine sulfate 500mg/50ibs CHO-Pat support orthotics adjust spine/knee/lower extremity
What are the diff dx for chondromalacia patella
- jumper’s knee ( pain above the patella)
- oshgood schlauer(pain below the patella)
- Bursitis
- the 3 C’s (collaterals, cruciate, meniscus)
where are the most common bursae located
- pre patellar
- infra patellar
- pes anserine
What sign is to confirm a PCL tear
Godfrey test aka sag sign
How do you perform Godfrey test
bent knee in air - flex knee and flex hip - push down on tibia
Torn cruciate= sags
Intact cruciate= straight
pain increased on medial knee behind knee cap going up steps/hills this indicates what .. and what is this called
weak vastus lateralis
medial patellar tracking syndrome / patellar femoral arthralgia
______ test and weakness of the ____ muscle are indicators pf the post. tibia that may stimulate meniscus involvement and inability to fully extend the knee
- Bounce Home
- Popliteus
What are the new terms for anterior / posterior shin splints
- medial and lateral tibial stress syndrome
Irritation of the _______ is due to shin splints
periosteum of tibia
What are some causes of medial/lateral tibial stress syndrome
- Talo-tibial dysfunction leading to lateral stress on the fibula stressing the interosseous leg. insertion site of the tibia
- Imbalance b/w dorsiflexors and plantar flexes
- Gait- hyperpronation
- over-training
- running surface- camber of road
when pain on the lateral side of tibia, what should you rehab
- tip. anterior/ext. hallux longs/ ext. digitorum longus
when pain on the medial side of tibia , what should you rehab
- tip. post./ flexor hallux/ flexor digitorum longus
what should the management protocol be for shin splints
- exercise dorsiflexors = heel walk, rocker board
- exercise plantarflexors= toe walk/ rocker board
- adjust spine
- alter activity
- alter footwear
- wrapping /ice
What should the Diff Dx should be for shin splints
- stress fx
- compartment syndrome
- tendonitis
Hip pain is ___ in nature from ____ ____ or ____ ___ , hypertonicity which may also cause ____ knee pain along with _____ snapping hip sound
- trochanteric
- piriformis syndrome
- IT band
- lateral
- external
_______ is a lateral stabilizer of the knee
ITB
____ may affect hip and create an internal snapping hip condition
Psoas
____ ___ is the time interval or sequence of motions occurring between 2 consecutive initial contacts of the same foot
Gait Cycle
_____ phase = 60 to 65% of walking cycle
_____ phase= 35 to 40% of walking cycle
stance
swing
as velocity _____ the cycle length or stride length ____ -
- increases
- decreases
jogging gait cycle =____ of walking
Running gait cycle= ____ of walking
70%
60%
wha is involved in stance phase
- foot on ground and bearing weight
- allows lower leg to support weight of body
acts as shock absorber - acts as shock absorber
- allows for advancement of body over supporting limb
- 60% of gait cycle
Subphase 1 of stance phase includes:
- weight loading of stance leg
- AKA double support of double leg stance
- 10% of gait cycle
both feet in contact with floor = toe of one leg and heel of other
Sub phases 2 and 3 includes:
- load response and mid stance of single support
- AKA single -lg stance
- 40% of gait cycle
- one leg carries weight and other leg swings through swing phase
Subphase 4 and 5 includes:
- Terminal stance and pre- swing instants
- AKA weight unloading period
- 10% of gait cycle
- During period= stance leg unloading body weight to opposite leg
Swing Phase Includes
occurs when non weight- bearing
- 40% of gait cycle
- 3 sub phases
the 3 sub phases of swing phase
- initial swing= acceleration ( foot lifted off floor, knee flexion and ankle dorsiflexion, occurs to allow swing limb to accelerate forward
- Mid Swing= Swing leg beside weight- bearing leg in mid stance
- Terminal swing= deceleration ( more injuries occur, during running stance phase decreases, Float phase=double unsupported phase)
Double leg stance occurs when both feet on ground and occurs ___ of cycle
25%
Single- leg stance when only leg occurs and occurs twice during normal gait cycle and is ___ of total cycle
30%
List the alterations of gait cycle
- rearfoot varus
- forfeit varus
- forefoot valgus
- Equines syndrome
- Hallux limitus/rigidus
- Plantar flexed 1st ray
tibia vacuum
tibial torsion - narrow base gait
- angle of gait toe out
- Q- angle
leg length inequality
Neutral Gait :
- Zero rear foot and zero forefoot
Normal forefoot is considered to be what
4 to 6 varus angle
normal rear foot is considered to be what
0 degrees
Under - Pronation Gait AKA
supination
under pronation gait occurs when
- with a forefoot deformity
- less than 10% have it
- not enough pronation to allow for adequate shock absorption and foot adaption to surface which leads to limit proper rotation of lower extremity , stress on lateral tibial plateau and squeaky know that leads to TFL problems
Posterior tibia modified drawer
DS= at the foot of the table soft tissue stabilizes over patient foot P.P= supine with involved leg flexed, foot on table SCP= posterior proximal tibia and fibula CP= palm of dominant hand interlocked fingers with opposite fingers and hand LOC= take the joint to tension from AP and gently pulse P-A
Post. tibia pump or wedge
DS= side of involved knee PP= supine with involved leg in flexion and foot in the air SCP= posterior proximal tibia and fibula with hands and the anterior distal tibia with elbow CP= palms and interlocked fingers on proximal end tibia/fibula and forearm across the distal tibia LOC= take the joint to tension by pushing anterior to posterior with the elbow
Posterior tibia prone
DS= same side of affected knee , stabilizing anterior tibia with shoulder Pt= prone with knee flexed and foot in the air SCP= posterior proximal tibia and fibula CP= interlocked fingers and hands , elbows tucked in body LOC= take the joint out of tension and impulse P-A
____ is used to reset the joint and the muscles surrounding the joint can test for a medial or a lateral plateau
wobble
LOD for wobble
impulse into direction of restriction with thenar pads, stabilize pts. slightly flexed leg with doctors knee
Fibular- checking motion side of involvement
what is the fibular head criteria
symtoms, decreased motion, chronic knee, foot or ankle problems
Check ROM
Fibular head visualization
look and palpate from the tibial tubercle to anterior aspect of the fibula- check the measurement from side to side
Short Side= anterior
Long side= posterior
what is the criteria for a fibular head fingertip pull
- symptoms
- decreased motion
- chronic knee
- foot problems
_____ creates internal snapping hip
iliopsoas
____ creates external snapping hip
ITB
____ creates a figure 8 type motion through complete gait cycle
ITB
what is the management of the external hip
- adjust
2. stretch
correct gait
give advice for possible associated trochanteric bursaae
Management for internal hip
- adjust spine
- stretch posts
- correct gait
what is the result of cane use
- decrease compressive forces into the hip
interaction of gluteus medium on pelvic leveling
support side opposite problem
cane use for foot or knee problems is ____ side of injury
same side
Anterior talus:
- alters function of arch
- increases internal rotation
- affects tibial alignment, patellar tracking, knee stability
- reflects to ITB
- progresses to SI joint
- impacts lumbosacral relationship
initial injury to 2 weeks for Grade 1 (knee flow chart)
- pain with no instability
- adjust knee and spine
- heal=> 2 weeks
- taping/ mild support
- avoid position of pain
- no crutches
- ice 15 2x per day
- ROM=> weight bearing
- keep upper body active
initial injury to 2 weeks for a Grade 2 (knee flow chart)
- pain with moderate instability
-adjust knee and spine - Heal 2-6 weeks
- bracing with activity
- avoid position of pain
- crutches= 2 days per week, wean off 1 to 2 weeks
- ice 15 min 4 X per day
ROM = weight as tolerated in water - keep upper body active
initial injury to 2 weeks for a Grade 3 (knee flow chart)
- pain with severe instability
- adjust knee and spine
- heal => 36 weeks
- full-time brace
- avoid position of pain
- Crutches => 2 weeks
- ice 15 minutes 6X per day
- ROM => without weight 2 weeks in water tub/pool
- Keep upper body active
2 weeks to 4 weeks for a grade 1 (knee flow chart)
- full activity
- taping maybe
2 to 4 weeks for a grade 2 knee flow chart
- moderate to full activity
- wear brace
2 to 4 weeks for a grade 3 knee flow chart
- weight bearing walking with support
- wear brace to avoid pain exercise non- weight unless in pool with chest at water level
4 to 8 weeks for a grade 1 knee flow chart
should be normal
4 to 8 weeks for a grade 2 knee flow chart
- brace during activity
- no crutches
- full strength workouts
4 to 8 weeks for a grade 3 knee flow chart
brace when weight bearing ]
- no crutches
- gradually increase non weight bearing exercise
8 to 12 weeks for a grade 1
should be normal
8 to 12 weeks for a grade 2
should be normal
8 to 12 weeks for a grade 3
- brace when weight bearing
- start weight bearing exercises
- non- painful ROM=> cycling, run in water chest level, mild to moderate weights
after 12 weeks for a grade 3
- recheck orthopedic tests
- do gentle adhesive releases in knee flexion to restore complete complete knee flexion and extension
- start stretching regimen
- work up to full strength weight bearing exercises
The _____ reflects A to P at the greater trochanter and lateral femoral condyle, creating a figure”8” type motion through the complete gait cycle.
ITB
The _____ may also affect the hip and create an ‘internal snapping hip’ condition when the tight psoas pulls over the lesser trochanter.
iliospoas
The Tibia must accomplish up to ___ degrees of relative external rotation from internal rotation in order to accomplished closed pack/ full knee extension.
20
_______________-pain behind knee cap lateral side while walking or running down hills or down steps. Usually associated with a weak Vastus Medialis. (VMO)
excessive lateral patellar syndrome
______________pain behind knee cap medial side while walking or running up hill or up steps usually associated with a weak Vastus Lateralis.
medial patellar tracking syndrome ( patellar femoral arthralgia)
