Injuries of the Knee and Lower Leg Flashcards
what is supination of the foot
combo of plantaeflexion, inversion, and adduction that causes foot to face medially
what is pronation of the foot?
combination of dorsiflexion, eversion, and abduction which causes sole to face laterlly
what are the muscles of the anterior leg compartment?
tibialis anterior, extensor hallicus longus, extensor digitorum longus, fibularis tertius (peroneus tertius)
what does the anterior compartment of the lower leg do?
extensor (dorsiflection) group
what are the muscles of the lateral compartment of the leg?
peroneus longus (inserts on big toe) and peronus brevis (inserts on pinky)
what muscles make up the deep posterior compartment of the leg?
Tom Dick and Harry
Tibialis posterior, flexor digitorum longus, flexor hallicus longus
what does the deep posterior compartment of the leg do?
work together to dynamically help stabilize medial ankle
plantarflexion
what muscles are in the superifical posterior compartment of th eleg
gastrocemius, soleus, achilies tendon (gastrocnmius and soleus insert here)
what are the intracapsular structures of the knee
ACL, PCL, medial and lateral meniscus, cartilage, joint surface
what is the wipe test used for
to identify intracapsular (inside capsul of knee) swelling
what does the wipe test look like?
sweep swelling on inside of knee upwards
push swelling down lateral side
look for a “bubble” on the medial part of knee
which quad muscles pull laterally on patella?
rectus femoris and vastus lateralisa and vastus intermedius
which quad muscles pull medially on the patella
vastus medialis
what muscles make up the medial hamstrings?
semimembranous and semitendonosus
which muscles make up the lateral hamstring?
biceps femoris
which muscles make up the pes anserine
semi-tendonous, gracilis, and the sartorius
what does the gluteus medius do?
hip abduction
internal and external rotation of the hip
Hip externsion
eccentrically control IR of femur in weight bearing
prevent pelvis from dropping during gait
what is the ideal quads to ham ratio
3:1
what is the technical name for shin splints
medial tibial stress syndrome
what does shin-splints involve?
exercise-induced pain over the anterior tibia and is an early stress injury
what is compartment syndrome?
excessive pressure within a muscle/fascial compartment
how does one get compartment syndome?
acute: trauma or folowing long bone fracture
overuse
what are compartment syndrome signs and symptoms
red, hot, shiny, painful, weak, numb, faint pulse distal to site
how is compartment syndrome managed
no pressure, lympth drainage to reduce inflammation, no return to play, non weight bearing, occasional need for fasciotomy to release pressure
what does the posterior cmpartment of the lower leg do?
it is the flexor group
what is MOI for a soleus strain?
overstretch in dorsiflex with knee extended
what are S and S for gastroc/soles strain
pop or pill, sharp pain, swelling, bruising
what are the ST for gastroc/soleus sprain
kendals test for gastrocs and soleus
thompson test to rule out achiles rupture
toe raiss
what is RTP for gastroc/soleus strain?
once rehabbed, can tape heel lift for initial RTP, gradually lower as time passes
what is MOI for achilles rupture
sudden forceful contraction
what is S and S for achilles rupture
sudden sharp pain (partial rupture) or feeling of being kicked in back of leg, unable to plantarflex or tippy toes, swelling, delayed onset bruising
what is ST for achilles rupture?
thompson test, two foot 1 toe raise
what is acute management for achilles rupture
PIER, NWB, pressure pad over injured tissue with tensor, educate, refer to sport med oc
what is MOI for patellofemoral pain syndrome (PFPS)?
unaligend knee cap movement
“poor tracking of patella in femoral condyle”
what are the S and S of PFPS
Pain on post aspect of patella, antalgic gate (limp), can’t flex knee
what does insidious mean
we don’t know what the onset is
what is MOI for patellae dislocation
valgus force with foot planted causing IR of femur
S and S for patellar dislocation
patella positiond on lateral side of knee, significant pain with knee flexion
special tests for patellar dislocation
apprehension (press on medial patela + if displacement and pain)
what is acute management for patellar dislocation?
PIER and refer
what is longterm management for patellar dislocation
brace ROM, and strenghtneing
what is MOI for tendonitis
excessive traction on patellar tendon
what is S and S for patellar tendonitis
swelling and heat over tendon, pain with running and jumping and fast change in directions
what is the ST for patellar tendonitis
thomas test (lie suping,patient pulls knee to chest, if pain = +)
what is bursa
fluid filled sacs that lay flat btw areas of friction
what is MOI for knee bursitis
direct trauma, friction from tight muscles/tendons
what is signs and symptoms for knee bursistis
rebound pain, visible fluid filled sac
what is RTP management of knee bursities
protect bursa with padding to avoid repeated injury
what is MOI for stress fractures?
overuse/poor mechanicsw
what is MOI for patellar fracture
direct blow, patellar dislocation
what is MOI for tibial plateua fraction
valgus (external) or varus (internal) load, direct blow, acl/pcl rupture
medial meniscus shape
C
laterla miniscus shape
O
function of meniscus
cushion joint during loading
what are the 6 types of meniscus tears?
verticle,transverse, peripheral, buckethandle, parrot-beak, flap
MOI for meniscus tears
plant and twist, contact, wear and tear/degeneration
S and S for meniscus tears
sharp pain at specific ROM, when rotating/squatting feeling catching, clickign, locking, and swelling
ST for meniscus tear
McMurrays (patient supine, bend leg internal and external rotation while bending and straightening leg) Apley (patient lies on belly, leg up, rotate leg) duck walk
acute managemnt for meniscus tear
PIER, NWB, educate
is bracing good for meniscus tears
bracing is not that effective as it won’t stop rotation BUT It will bring awareness to the area
what action does ACL prevent
anterior translation of tibia on femur and limits IR of tibia
what is MOI for ACL sprain
sudden cut or pivot, movement into valgus hyperextension
what are S and S of ACL spreain
swelling, pain, difficulty/unable to WB< delayed onset bruising
special tests for ACL
anterior drawer, lachmans, pivot shift
acute mangement ACL
PIER, NWB, educate
PCL sprain MOI
hyperflexion forced posterior translation of tibia on femur
S and S PCL sprain
swelling, extrejme pain, difficulty/unable to weight bear, delayed onset bruising
what are special tests for PCL sprain?
posterior drawer, Sag sign (does fibula driop when lying on back with knee bent at 90)
MCL sprain MOI
dirct blow to outside of knee (valgus stress), plant and tiwst (lateral roation of femur on tibia)
ST for MCL tear
valgus stress
acute management for MCL tear
PIER, NWB, pressure pads to approx ends
LCL sprain MOI
varus stress to the knee
LCL sprain S and S
lateral knee pain, swelling, stiffness
ST for LCL
varus stress
acute managemtn for LCL
PIER, NWB,, prssure pad to approx ends
what does wipe test test
intracapsular swelling
what does valgus at 0 test
superficial fibers of MCL
what does valgus at 30 test
deep fibers of MCL
what does varus at 0 test
superficail (and only) fibers of LCL
what does lachmans test
ACL
what does anterior drawer test
ACL
what does posterior drawer test
PCL
what does sag sign test>
PCLw
what does mcmurrays test
meniscus
what does apleys test
meniscus and ligamentous
