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hip and knee final Flashcards

0
Q

anatomically compound

A

more than 2 joint surfaces

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1
Q

anatomically simple

A

2 bones, 1 capsule

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2
Q

complex

A

has a meniscus

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3
Q

mechanically simple

A

moves 3 axes at 90 degree angles to eachother

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4
Q

unmodified ovoid

A

ball and socket

a sphere with three axes and 3 degrees of freedom

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5
Q

modified ovoid

A

ellipse shape
2 axes, 2DF
(MCP)

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6
Q

unmodified sellar

A

saddle, 2 axes and 2 DF

thmb

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7
Q

modified sellar

A

hinge joint
1 axis
1DF

(IP, Elbow)

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8
Q

synarthrosis

A 
no genuine joint space
no fluid (synovium)
divided by tissue in between
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9
Q

syndesmosis

A

has fibrous tissue between it

ankle, tib, and fib

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10
Q

synchondrosis

A

has cartilage between joint surfaces

costochondral joints

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11
Q

synostosis

A

bonytissue between (sutures in skull)

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12
Q

diarthrosis

A

divided according to amount of movement

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13
Q

sympheses

A

half joints
connective tisssue partly fills the joint
ie pubic symphesis

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14
Q

synoviales

A

movable joints with all characteristics of synovial joints

  • amphiarthrosis: less than 10 degrees of movement
  • articulations: more than 10 degrees of movement
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15
Q

amphiarthrosis

A

less than 10 degrees of movement

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16
Q

articulations

A

more than ten degrees of movement

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17
Q

degrees of freedom

A

the number of axes a joint moves in

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18
Q

osteokinematics

A

movement of the bones

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19
Q

spin

A

pure rotation around a mechanical axis

rotation of a long bone in place–internal and external rotation

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20
Q

pure or cardinal swing

A

the shortest route between two points

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21
Q

arcuate or impure swing

A

spin and swing

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22
Q

spin

A

rotation around a stationary mechanical axis

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23
Q

gliding or sliding

A

one point on moving surface comes into contact with a new points on a stationary surface

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24
Q

rolling

A

both surfaces move, new points on each surface come into contact with new surfaces all the time

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25
Q

gliding or translation

A

one surface (arc surface) slides over another surface without adding another component

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26
Q

angulation

A

increase or decrease in angle formed between two adjacent bones (knee)

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27
Q

movement of joint in opposite directions hurt: passive extension and active flexion

A

If bicep: hurts to contract and to stretch it

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28
Q

passive and active movement hurts in the same direction

A

it is the joint itself

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29
Q

what happens in resting position

A

maximallly relaxes the noncontractile structures

we want to eliminate those when we test contractile structures

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30
Q

fabella

A

an extra joint some people have that is sesamoid and on the lateral femoralcondyle

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31
Q

Femoral Tibial Joint

-joint type

A
  1. complex joint (meniscus)
  2. modified hinge joint since mostly 1df
  3. dual condylar (two condyles)

largest joint in the body

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32
Q

knee joint

degrees of freedom

A

one: flexion and extension (x axis)

accessory second degree of freedom that occur with flexion and extension

  • rotation: long axis with knee flexed: IR/ER
  • angulation: abduction/adduction: need external torque (if land on foot can create valgus but it does not occur independently)
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33
Q

femoral patella joint

  • joint type
  • what can go wrong
A

sellar joint/modified plane joint

–has a little peak, convex and concave and sits in groove between femoral condyles–propriotracking: if not–patellofemoral syndrome
ultimately osteochondritis or osteomalasia patella where there is wearing away of cartilage under patella causing pain

  • -patella femoral syndrome is the mal-alignment
  • -chondromalasia is when it becomes soft and erodes
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34
Q

Knee

  • resting position
  • closed packed position
  • capsular pattern
A

Knee
-resting position: 25-40 degrees of flexion
allows maximal laxity of the noncontractile structures
-closed packed position: full extension WITH MAXIMAL EXTERNAL ROTATION OF THE TIBIA (screw home mechanism)
-capsular pattern: limitation of FLEXION to 90 degrees more than extension 5 degrees

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35
Q

why is the capsular pattern of the knee 90 degrees of flexion > 5 degrees of extension?

A

capsular pattern is not related to the contractile structures it is related to the noncontractile strucutres—has nothing to do with contractures

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36
Q

arthrokinematics of the knee:
when is it stable
when is it flexible

A

mechanically designed for stability in extension: if someone has instability of the knee they buckle. screw hoem mechanism is a lock

flexible in flexion
femoral neck over hangs the shaft 170-175 degrees–this creates physiological valgus–angulation from pelvis to the knee is greater in women so the angulation of the knee is also greater

femur angled off 5-10 degrees from the vertical–a degree of valgus is built into the knee

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37
Q

retroversion of the knee

A

tibial condyle inclined posteriorly

–the top of the tibia plateau is not vertical
retroversion of the tibial plateau because it is inclined posteriorly (5-6 degrees inclined posteriorly)

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38
Q

retroflexion of the knee

A

tibia bent to be concave posterioly

–there is a bowing effect, a gapping arc on the posterior aspect of the tibia

–this creates a space for the hamstring and gastrocnemius belly when the knee is in flexion

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39
Q

femoral condyles

what are their shape
where are they longer and shorter

A

biconcave-pulley shaped

medial and lateral aspect of the convexity
anterior and posterior aspect of the convexity
longer in the anterior posterior than in the medial lateral

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40
Q

medial femoral condyle

A

juts out more and is more narrow

it is longer distally and allows the knee to be horizontal because of the angle of inclination on the femur

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41
Q

lateral femoral condyle

A

is more directly in line with the shaft than with the medial femoral condyle, secondary to the obliquity of the shaft of the femur

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42
Q

which femoral condyle has more stresses?

A

WB stresses evenly distributed between the medial and lateral condyles in bilateral stance

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43
Q

tibial condyles

A

curved to the femur

–reciprocally curved to the femur with blunt eminence running A/P, intercondylar tubercles

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44
Q

medial tibial condyle surface

A

BICONCAVE

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45
Q

LATERAL TIBIAL CONDYLE SURFACE

A

Concave in frontal plane

Convex in saggital plane

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46
Q

difference in TIBIA articular surface: medial and lateral condyle

A

medial condyle articular surface is 50% larger and articular cartilage is 3x thicker

TIBIA MEDIAL CONDYLE 2x larger articular surface
medial tibial condyle cartilage is 3X thicker

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47
Q

axial rotation of the tibia - how it works

A

modified intercondylar tubercles of the tibia act as a pivot (fulcrum) to allow for rotation

tibia lodges in the intercondylar notch of the femur for ER/IR and to rotate in screw home mechanism

when we go into screw home mechanism in full extension we lock out the knee and do not have IR/ER, need to unlock the knee and bring it into flexion for active IR/ER to allow the little tubercle to sit in the groove and rotate

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48
Q

OKC: tibia rotate on femur

A

WE TREAT IN OPEN CHAIN

when go into extension the tibia ER on the femur

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49
Q

CKC: femur on tibia

A

we do not do manual therapy here, only exercise

when go into extension the femur internally rotates on the tibia
to squat

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50
Q

describe the roll/glide movement of femur on tibia

how big are the condyles
flexion and extension motions
which is used when

A

—femoral condyle is 2X as long as the tibial condyles

extension–> flexion
femoral condyles begin to roll (posterior) without gliding then slide anterior [needed at the end of the motion]
CKC: femur roll then glide on tibia
OKC: tibia roll then glide on femur

–flexion–>extension
femoral condyles roll anterior and then glide posterior
—PCL pulls posteriorly

in initial stage of rolling, the lateral condyle is 20 degrees and medial condyle is 15 degrees, since we only need 25 degrees of knee flexion in gait we do not even need the glide for ambulation

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51
Q

what makes the knee modified hinge joint

A

axis is not fixed but moves through ROM

in roll and glide the contact points change and the axis changes
this is why the knee joint replacement is polyaxial

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52
Q

Rotation in the knee

what happens at each condyle

what does femoral condyle contact in neutral position

A

ER rotation of the tibia on the femur: lateral femoral condyle moves forward over the lateral tibial condyle, medial femoral condyle moves backwards (ie tibia moves ER, femur moves IR)

in neutral position for axial rotation with knee flexed, posterior femoral condyles are in contact with the mid part of the tibial condyles

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53
Q

Superior Tibio-fibula joint
type
motion

A

plane synovial joint

ankle joint PF/DF causes upward and downward rotation of fibula on mortis

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54
Q

knee joint capsule

A

patella, tibia, femur: complex joint

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55
Q

knee fascial connections

A

these help maintain knee stability and serve as secondary supports
ITB
bicep femoris
extensor retinaculum
coronary ligaments
patellomensical fibers
patellotibial fibers
vastus medialis and lateralis link muscle to capsule
patellofemoral ligaments connect patella to femur

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56
Q

role of ITB at knee

A

ITB for stability runs around the lateral aspect of the capsule

it is NOT position dependent and maintains a certain tension throughout

ITB is secondary reinforcement for the MCL because of its angulation and where it is located

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57
Q

where do the ACL and PCL attach to the tibial plateau
to meniscus?

is it inside the capsule?

A

ACL and PCL attach distally to the tibial plateau
this distal attachment is extra-capsulaer–and as they come inside they become intracapsular
they are located in the middle of the knee joint within the capsule

MCL attaches to the medial meniscus
LCL DOES NOT ATTACH TO A MENISCUS

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58
Q

Bursa

name 6

A

fluid filled sac that can get inflamed (hot and swollen when inflamed)

suprapatella bursa
prepatellar bursa
infrapatella bursa
deep infrapatella bursa
gastracnemius bursa
popliteus bursa
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59
Q

plica

A

residual from embryonic development when synovial membrane developed in the knee
it had component parts from three sections that merged and the plica is the seam that merges the sections of the synovium
this seam is palpable in certain parts of the knee
one is easy that feels like a guitar string, if you strum it when it is irritated it is very uncomfortable

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60
Q

the 3 knee compartments

A
  1. SUPERIOR COMPARTMENT: suprapatellar bursa: Superior part of the plica
  2. INFRAPATELLA PLICA-infrapatellar fold-inferior part of the plica and is an empty space (bound by anterior intercondylar fossa of tibia, ligamentum patella anteriorly, and inferior aspect of patella surface of femur)
    - –infrapatella fatpad is filled with adipose tissue; infrapatella pad (Hoffa’s Pad) contains synovium. if this gets inflamed there is a significant amount of fluid that can be held since it is an empty space with a fat pad, and if extend your knee fluid gets pushed forward by the gastroc. if flex knee stretch quad and fluid gets pushed backwards
    - –edema in knee: extend knee and fluid moves anterior and flex knee and fluid moves to popliteal fossa in posterior knee
  3. mediopatella plica: CAN PALPATE IT
61
Q

suprapatella bursa

A

quadricep femoris bursa

locate up under the quadricep (can communicate with the knee capsule)

62
Q

prepatella bursa

A

under skin fold in front of patella

63
Q

infrapatella bursa

A

under skin anterior to the ligamentum patella/quadriceps tendon

64
Q

is the quadriceps tendon a tendon

A

even though it is btwn two bones it is a tendon
it is thought of as an attachment of muscle to bone it is a tendon and has tensile ability

it technically goes bone to bone and that would make it a ligament (ligaments are not designed to give, they are designd for support)

65
Q

deep infrapatella bursa

A

under the tendon/ligament anterior to the tibia

66
Q

gastrocnemius bursa

A

under lateral head of the gastroc

inflamed more than the popliteus bursa

gastroc bursitis (gold ball sized lump in the popliteal fossa)

67
Q

popliteal bursa

A

under the popliteus
under popliteal tendon in LATERAL femoral condyle
popliteal and gastroc can be hard to differentiate since both are in the same area

68
Q

lateral meniscus

A

horns are close together just shy of a full circle–rounder and smaller mensicus

69
Q

medial meniscus

A

half moon shape

larger meniscus

thicker periphery than the center to help with congruency to fill the void of the femoral condyle convexity

70
Q

what shape are the menisci

A

semilunar catilage

71
Q

purpose of the menisci, are they vascular

A
  1. increase radius of curvature of tibial condyles (tibial condyle is smaller than femoral condyle)
  2. distribute WB surfaces
  3. decrease friction
    shock absorbers

AVASCULAR STRUCTURES: in the inner 2/3
only the outer 1/3 is vascular on the periphery because it is bathed by synovium that provides nutrition

72
Q

3 surfaces of menisci

A

superior surface: concave and articulates with femoral condyles

peripheral surface: thickening that is adherent to capsule

inferior surface: almost flat, almost plane-rests on edge of medial and lateral tibial condyles

73
Q

force on the menici

A

menisci transmits:

50% of the forces in extension
85% of the forces in flexion

IF REMOVE THE MENISCUS INCREASES LOAD: 2X ON THE FEMUR AND 6-7X ON THE TIBIA–major issue for the bone

-if tear mensici this force goes to the cartilage

74
Q

Name the meniscal attachments

4

A
  1. intercondylar tubercles of the tibia attach to both mensici
  2. coronary ligaments attached round the periphery to the tibia by vertical coronary ligaments (meniscotibial ligaments) composed of fibers of joint capsule
  3. patellomeniscal ligaments: or patellotibial ligaments attach both mensici to patella–anterior capsule thickening
  4. transverse ligaments: attach menisci anterior horns–runs between them and connects medial and lateral menisci together
75
Q

ligaments that attach to LATERAL MENISCUS

A

PCL
popliteus muscle via coronary ligaments
posterior meniscofemoral ligaments which attach to femoral condyles

CONNECTIONS ARE LOOSE AND GIVE A FAIR AMOUNT OF MOBILITY ON THE LATERAL TIBIAL CONDYLE

76
Q

ligaments that attach to medial meniscus

A 
MCL
Semimembranosus
ACL 
FIRMLY ATTACHED, LESS MOVABLE, 
*******************TORN MORE FREQUENTLY
77
Q

unhappy triad

A 
triad of odanehu 
medial meniscus
MCL
ACL
need reconstructive surgery
78
Q

how does the Q angle affect the _____ part of the knee

A

if the Q angle (quadriceps angle) of the knee changes and the knee goes from valgus to varus
it loses 5 degrees of the angle
and increases compression of the medial knee about 50%

bow legged people have major problems at the medial part of the knee
the Q angle is needed to take pressure off the medial part of the knee

79
Q

movement of the meniscus

flexion and extension

A

Menisci move POSTERIORLY in FLEXION (pushed by femur)

mensici move ANTERIORLY in EXTENSION

80
Q

menisci move in flexion

A

!

81
Q

menisci move in extension

A

!

82
Q

menisci move in external rotation

A

lateral mensicus is pulled anteriorly

medial meniscus is pulled posteriorly

83
Q

lateral mensicus in external rotation

A

anterior

84
Q

medial mensicus in external rotation

A

posterior

85
Q

tibia external rotation: menisci movement

A

lateral menisci pull anterior
medial menisci pull posterior

this is due to the position of the femoral condyle to the tibial plateu
they attach to the TIBIA and not to the femur
they are fixed on the bottom and the femur give them a push

INJURED WHEN THE MENISCI DO NOT FOLLOW THE FEMUR (compression with sudden twist)

86
Q

lateral mensicus compared to medial meniscus movement in extension/flexion

A

LATERAL mensicus goes 2X as far as medial meniscus

87
Q

what causes mensical tears

A

menisci injured during movement if fail to follow femoral condyles

injured part fails to follow normal movements and become wedged between femoral and tibial condyles (ie unlocked flexion with rotation)

so if ER tibia the lateral meniscus should go anterior and medial meniscus is moved posteriorly

88
Q

patella

what shape
how many facets
how does it help the quads
where does it move and how far

A

triangle shape from anterior view

7 facets around the outside (some say 5): superior, inferior, medial, lateral, odd (odd is the vertical ridge on the top)

patella enhances the efficiency of the quadriceps muscle extension: INCREASE MECHANICAL ADVANTAGE 25%

patella moves superiorly in extension and inferiorly in flexion

in flexion the patella moves 2x its length

89
Q

in flexion the patella moves ___ its length

what needs to happen for patella to move

what can prevent it

A

2x

the infrapatellar fat pad moves out of the way to prevent effusion of the inferior fold

patella can only move if the soft tissue around it has enough length, the quad need to give enough leeway for the patella to move

bursa need to move out of the way to go from flexion to extension — articularis genu muscle comes off the vastus medialis and its job is to move the suprapatellar bursa out of the way when we extend the knee so that you do not pinch it
if there is inflammation adhesions can hold the patella in a fixed spot and then it is impossible to move the patella

90
Q

role of articularis genu

A

bursa need to move out of the way to go from flexion to extension — articularis genu muscle comes off the vastus medialis and its job is to move the suprapatellar bursa out of the way when we extend the knee so that you do not pinch it

91
Q

what prevents patellar dislocation

A

lip on the femur

92
Q

INSALL AND SALVATI RATIO

A

ratio of

patella: length of tendon

————–the ratio varies in gender, in females longer
this ratio is important. if it is not equal the patella can be displaced

patella alta: the tendon is 20% longer than patella size (it is longer inferiorly)

patella baja: patella inferiorly displaced when the tendon is 20% shorter than the patella size (it is shorter inferiorly)

93
Q

Patella displacements: 4

A

alta: patella displaced superiorly
baja: patella displaced inferiorly
squinting: patella displaced medially

bull frog eyes: patella displaced laterally*****

94
Q

Patella movement on the Tibia in IR/ER

A

ER: femur is medial to tibia, this pulls the PATELLA medially

IR: femur is lateral to patella when the tibia IR, therefore the PATELLA moves laterally

95
Q

Transverse Ligament

A

links the two anterior horns of the menisci

attached to the patella by strands of the infrapatella fat pad

96
Q

MCL

  1. its direction
  2. where it attaches
  3. what it supports
  4. what it is strengthened by
  5. how it helps the knee
  6. does it attach to a mensicus
A
  1. runs INFERIOR and ANTERIOR
  2. medial femoral condyle–> posterior to pes anserine on tibia
  3. helps support the ACL
  4. pes anserine strengthens (semimem, semiten, gracilis)
  5. takes stresses on medial knee: takes 57% of valgus stress at 5 degrees of flexion, 78% of the force at 25 degrees of flexion–bad to tear the MCL
  6. anterior fibers are seperate from capsule, posterior fibers blend with medial meniscus!!!
97
Q

Posterior oblique ligament

A

superficial bands of MCL blend with the posteromedial corner of the capsule

this adds more support

98
Q

MCL: what stress does it take

A

takes stress on medial knee: takes

57% of valgus stress at 5 degrees of flexion

78% of the force at 25 degrees of flexion

–bad to tear the MCL

99
Q

Name secondary supports on medial and lateral posterior knee

A

medial side: semimembranosus, semitendanosis, gracilis, popliteal complex

lateral side: biceps, ITB, arcuate complex

100
Q

LCL
1. its direction:

  1. where it attaches:
  2. distinct bands:
  3. forms the arcuate ligamentous complex –
  4. what it does in the knee:
  5. what it supports:
A
  1. its direction: INFERIOR and POSTERIOR
  2. where it attaches: outer lateral condyle–>head of fibula
  3. distinct bands: anterior, medial, posterior
  4. forms the arcuate ligamentous complex –additional support on the posterior lateral aspect of the knee (fibers that come off the capsule and ligement and couple with bicep femoris, ITB and popliteus)
  5. what it does in the knee: controls lateral rotation: if tibia ER then it creates tension on the LCL
  6. what it supports: it supports the ACL: preventing hyperextension and anterior glide!!!
101
Q

Transverse Stability of the Knee

A

femoral axis = inferior + medial
force on tibia is not vertical, it is both vertical and transverse (valgus position creates wider gap medial)

this creates some valgus, wider medial space

MEDIAL FORCE: increase valgus and can fx lateral tibial condyle and rupture the MCL

102
Q

bucket handle tear

A

menisci more firmly attached to the anterior and posterior horns and so if the transition is not smooth the mensici get caught in between the semicircular part can become distorted and the middle part of the mensicus is more movable than the 2 horns so
COMPRESSION and TWIST

103
Q

anteroposterior stability of the knee

A

when the knee is slightly flexed the force of BW behind the axis, and NEED QUADS

if not hyperextend when walking to move behind the axis to not need the quads and not buckle the knee

if hyperextend the knee the posterior capsule taut, but if stretch it can get genu recurvatum

104
Q

ACL

  1. where it runs
  2. is it in the capsule
  3. how much load it takes in anterior translation when knee is extended
  4. vascular supply
  5. proprioception
  6. what it is made of
  7. nerve
  8. when it is maximally taut
A

runs superior/posterior/lateral

starts on tibia extracapsular and goes into capsule (has an extrasynovial component throughout)

takes 87% of the load with anterior translation of the extended knee

extrasynovial and has rich vascular supply

has mechanoreceptors –so if you tear it you get partial deaffrentation of the joint because you do not know where your knee is in space and it will be easy to re-injure it

viscal elastic structure so it can adjust for load and length

supplied by posterior articular nerve

maximally taut at 70-90 degrees and 0-20 degrees

105
Q

When is the ACL maximally Taut

A

PLB: Posterior Lateral Band is maximally taut at 0-20 degrees: and lax in flexion

AMB: Anterior Medial Band is maximally taut at 70-90 degrees of flexion and lax in extension

RESTING POSITION: between these at 25-40 degrees of flexion

106
Q

PCL

  1. where it runs
  2. attachments
  3. ratio to acl
  4. amount of load it takes
  5. when is it taut
  6. when is flexed knee maximally displaced posteriorly
A
  1. runs medial/anterior/superior
  2. posterior rim of upper tibia–>lateral surface of medial femoral condyle
  3. shorter than the ACL, PCL: ACL ratio is 3:5
  4. STRONGEST STABILIZER IN THE KNEE, takes 90% of the load in the extended knee with posterior translation
  5. anterior band: taut 80-90 degrees of flexion and lax in extension
    posterior band: taut in EXTENSION and lax in 80-90 degrees of flexion
  6. flexed knee maximally displaced posteriorly at 75-90 degrees of flexion because tighter in the 80-90 degree range
107
Q

WHen is the PCL taut

A

anterior band: taut 80-90 degrees of flexion and lax in extension
posterior band: taut in EXTENSION and lax in 80-90 degrees of flexion

108
Q

Mechanical Role of the Cruciates for flexion/extension

A

stabilize knee in anterior/posterior direction
FLEXION: PCL vertical, ACL horiozontal

they pull the femoral condyles and make them slide on tibial plateaus in direction opposite rolling

Flexion–ACL is needed to slide femoral condyles anteriorly
Extension–PCL needed to slide femoral condyles posteriorly

MCL Is secondary restraint to the ACL: (because runs inferior anterior)

109
Q

ACL and PCL:

in femoral roll and glide

A

Posterior roll, anterior glide: ACL pulls femoral condyles anteriorly

Anterior roll, posterior glide of femur: PCL pulls femoral condyles posteriorly

110
Q

posterior knee capsule ligaments

A

oblique popliteal ligament: posteriormedial capsule reinforced by tendounous expansion of semimembranosus, also against valgus

arcuate popliteal ligament: posteriorlateral aspect of capsule, bicep femoris helps, arcuate also against varus

111
Q

ROTATIONAL STABILITY

CRUCIATES AND COLLATERALS

A

IR: collaterals relax (MCL and LCL), cruciates taut (ACL, PCL)

ER: collaterals taut (MCL, LCL), cruciates lax (ACL, PCL)

112
Q

knee pain scales

A

anterior knee pain scale
LE functional scale
GLobal rating of change form
KOOS

113
Q

OTTAWA KNEE RULES

A

raises suspision send for an xray (have a lot of pain, probably a fx)

used to determien necessity for ordering pt xray

  1. patient above age 55yrs
  2. isolated tenderness above fibular head
  3. isolated tenderness over patella
  4. unable to flex knee to 90 degrees
  5. unable to WB immediately and in the emergency room
114
Q 
angles needed to 
tie shoes
sit
go down stairs
go up stairs
knee flexion in gait
A 
tie shoes--106
sit---93
go down stairs---90
go up stairs--83
knee flexion in gait--67 (in accelerated gait)
115
Q

Helfet Test

A

dot the patella and tibial tubercle when knee in flexion and extend leg, tibial tubercle should rotate laterally

tibial tubercle should ER as tibia ER when goes into extension in the screw home mechanism

116
Q

Knee:

active/passive movement testing

A 
Active movement testing supine:
flexion: 135/140 degrees
extension: 10 degrees hypreextension
ER: 30/40 degrees
IR with knee flexed 15 degrees
Passive movement testing: 
flexion: soft tissue end feel
extension: hard/firm end feel
ER: capsular endfeel
IR with knee flexed: capsular endfeel
117
Q

analgesic

A

masks pain, will not get accurate reading during testing and may over treat because pain is masked

118
Q

why resting position is used

A

put the noncontractile structures on slack so that we can test the contractile structures

119
Q

muscle is strong but has pain

A

small tear

120
Q

what to do if a grade of 2/6 on mobility scale

A

it is hypomobile

do a 3-4 mobilization

121
Q

what do we do if a jt is not cleared in active movement testing?

A

do PROM

122
Q

if there is significant pain can we stretch?

A

NO

123
Q

If mobility restriction, how do we tx??

A

tx restriction to get to the end range and so grade 3-4 at the end of the barrier

124
Q

femoral triangle

A

base of the triangle is the INGUINAL LIGAMENT

lateral border is the sartorius

medial border is the adductor

FLOOR IS THE DEEP PART OF THE TRIANGLE AND THAT IS THE ILLIOPSOAS

125
Q

what do instability tests test?>

A

ligament integrity

126
Q

clinical prediction rule on MCL

A

prediction rules

  1. history of force to leg or rotational trauma and
  2. patient has pain and laxity with a valgus stress at 30 degrees

GOLD STANDARD: MCL on MRI
Test clinically with valgus stress tets

127
Q

kt1000

A

ACL
mild displaced: 5mm
moderate displaced: 5-10mm
severe displaced: 10mm

ANOTHER TIME SHE SAID >3mm is unstable

128
Q

what is most relaible knee test

A

lachman

129
Q

laxity vs instability

A

subjective complaint: unstable

objective measure: laxity

130
Q

Knee effusion prediction variables

A
  1. self noticed knee swelling
  2. positive ballotment test (=patella tap test where tap patella and fluid comes out)
  3. Standard reference MRI: with intraarticular fluid within the infrapatellar, medial, or lateral compartment
131
Q

patellafemoral dysfunction

A

patella doesnt track correctly in trochlear groove causing patellafemoral dysfunction which can lead to chondromalacia patella (softening, erosion of cartilage on posterior of patella-pain syndrome)

gold standard dx: xray to see if good alignment and if worn down

MRI to see cartilage pathology in chondromalacia patella

132
Q

Knee pain:

anterior
posterior

A

anterior: L2-L3
posterior: hip S1, S2, L3–on lateral butt so pt says butt pain (over medius)

disorders of the knee rarely refer pain posteriorly, usually it is anterior /medial/lateral pain

bursitis: posterior pain is usually bakers cyst–gastroc or popliteal bursitis

pt presentation of gold ball large localized effusion that looks like a golf ball in the popliteal fossa - it is firm and feel a fluid encapsulated area–creates posterior discomfort

133
Q

OA of the knee: American College of Rheumatology Criteria

A

knee pain and > 3 of the following:

  1. age above 50
  2. morning stiffness less than 30 minutes
  3. crepitus with active motion
  4. bony tenderness (when palpate along bones of joint)
  5. bony enlargement
  6. no palpable warmth
    - —not systemic or inflammatory, degenerative joint disease is not inflammatory. rheumatoid arthritis is inflammatory

gold standard for djd is xray (classic to have osteophyte on xray)

134
Q

patella tracking

A

should be center in anterior trochlear groove of femur in 30 degrees knee flexion

lateral overhang acceptable in extension

135
Q

factors that increase patella alignment

A
  1. increased Q angle
  2. tight lateral structures
  3. tight gastrocnemius/hamstrings
  4. excessive pronation
  5. patella
  6. alta
  7. vastus medialis oblique insufficiency (train with adductiona nd extension with resistance)
136
Q

patella glide

A

medial and lateral glide of patella mobility

glide it
see what happens when they contract quads

137
Q

patella tilt

A

Y axis
lateral tilt: lateral border lower
medial tilt: medial border lower (closer to bone)

138
Q

rotation

A

relationship of inferior and superior pole around the z axis

lateral rotation: inferior pole lateral
medial rotation: inferior pole goes medial

139
Q

anteroposterior patella

A

X axis

relationship of inferior and superior pole to rotate around the x axis

observe this from side of the patient

inferior pole is tilted posteriorly it irritates the fatpad in infrapatellar fold –hurts to squat and hyperextend

140
Q

treatment of patellafemoral pain

A

put patella into position to be able to train the muscles appropriately with the knee taped

stretch tight lateral structures
patient self stretch
passive position with tape

141
Q

training the VMO

A

sitting:

standing stance: pt stand and does mini lunge as pt bring WB force onto the leg it incorporates the vmo

shallow knee bends: mini squats concentrate on keeping knee to second toe and use VMO

steps: eccentrically going down while maintain knee control
gait: analyze gait

sport specific activity: ie ski, run, soccor

142
Q

training patellofemoral: VMO

A
  1. never treat through pain
  2. progression-load, endurance, increase step size 4–>6’, increase speed
  3. train eccentrically (eccentric mini squats, lunges, step downs.) and concentrically (sitting and gait)
143
Q

weaning McConell

A
  1. wear tape everyday 2 wks
  2. remove tape at night
  3. wean off tape when VMO is coming in first on biofeedback when step downs for one minute
  4. tape every 2nd day and then every 3rd day
  5. wear tape for sports activities
144
Q

ankle stability for

A
  1. provide base of support for body
  2. adapt to postural positions
  3. avoid excessive muscle activity or extra energy expenditure
  4. act as rigid lever for effective push off during gait
145
Q

ankle mobility for

A

dampen rotation imposed by proximal jts

  1. be flexible to absorbe shock of WB when foot hits ground
  2. allow foot to conform to terrains
146
Q

ankle foot functions

A
  1. terminal part of kinetic chain
  2. dissipate forces
    compression-HS to midstance
    shear: in gait transitions
    rotation: tib/fib
    tension: ligament/tendon/muscles
147
Q

ankle joint

A

do not distract it, want it to be stable
axis is oblique, not in cardinal planes
–DF, PF, Ad/abduction, Inversion/eversion

PF/DF: x axis
DF (is extension at toes)

Inversion/eversion: z axis
inversion: plantar foot moves to midline
(talar tilt)

abduction/adduction: Y axis
distal foot away from midline = abduction

pronation/supination: oblique axis, motion at subtalar joint

varus/valgus

148
Q

supination

A

NON WB
PF, inversion, adduction

WB:
Tibia ER
calcaneal inversion, abduction, DF

149
Q

PRONATION

A

NON WB
DF, eversion, abduction

WB:
tibia IR

calcaneal eversion, abduction, PF

150
Q

varus/valgus

A

valgus = calcaneal valgus = INCREASE medial angle of joint

varus = calcaneal valgus = decrease medial angle of joint

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