Knee Flashcards
how would you decrease risk for ACL injury
- focus on strength, neuromuscular control, balance
- series of different programs which address balance board training, landing strategies, plyometric training, and single leg performance
examples of acute knee injuries
- ligamentous sprains
- mm strains
- contusions
- meniscal tears
- patellar dislocation
- fracturess
examples of chronic knee conditions
- patello-femoral pain syndrome
- bursitis
- patellar tendonitis
- Osgood Schlatter’s disease
general ligamentous sprains - grade 1
- no tearing
- no laxity
- mild stretching
general ligamentous sprain grade 1 - management
- rest from sport 7-10 days
- RICE
- therapeutic modalities
- ROM and strengthening ex
- balance and prop ex
- maintain CR fitness (first thing that starts to deteriorate)
- tape for support
general lig sprain - grade 2
- moderate damage with partial tearing
- some joint laxity present, but solid end feel noted
- slight swelling and increased pain
- moderate to severe joint tightness, decrease ROM
management of general ligamentous sprain - 2nd degree
- POLICE 48-72 hours
- crutch use during acute phase
- rest from sport 2-4 weeks
- may brace prior to initiation of ROM ex
- gradual progression from isometric ex to closed kinetic chain progression activities
- maintain/regain CV conditioning/balance
general ligamentous sprain - 3rd degree
- complete tear of supporting ligaments
- complete loss of stability during motion
- loss of motion due to effusion & guarding
- immediate pain that builds as swelling increase
- no ligamentous end feel at passive end range
management ligamentous sprain, 3rd degree
- RICE
- conservative vs surgical approach
- limited immobilization with a brace
- progressive wbing and increase ROM over 4-6 weeks
- progress as per 1st and 2nd degree sprains
MCL sprain - etiology
result from blow to lateral side causing tension on medial knee (valgus force)
S&S MCL sprain
- swelling and pain dependent on severity
- pain on medial aspect of knee
Etiology - LCL sprain
- result of varus force, generally w/ tibia internally rotated
S&S LCL sprain
- pain, tenderness and swelling lateral joint line over LCL
- may cause irritation of peroneal nerve
ACL sprain etiology
- caused by direct contact or by a non-contact mechanism
- 80% of cases result of non-contact
ACL sprain - MOI
- deceleration
- hyperextension
- foot contacts the ground with the heel, or in a flat foot
- unhappy triad
- anterior force to tibia with the knee flexed to 90
- IR of leg w/ body in ER
- leg ER with valgus force
- cutting
sex differences - ligamentous sprains - ACL
- female athletes are 3-5 more likely to suffer an isolated ACL injury compared to men
- 1 - hormonal influence
- 2 - anatomical- women smaller ACL than men, smaller intercondylar notch
- 3 - neuromuscular risk factors: these include things like core stability, strength, proprioception, or inter-muscular coordination and firing rate
S&S ACL sprain
- experience pop w/ severe pain and disability
- sudden giving away and inability to WB
- positive special tests
- rapid swelling at the joint line peaking 24 - 48 hours after
S&S Meniscal injuries
- effusion developing over 48 - 72 hour period
- joint line pain and loss of motion
- intermittent locking and giving way
- pain w/ squatting
- portions may become detached causing locking, giving way or catching within the joint
- if chronic, recurrent swelling or mm atrophy may occur
patellar dislocation - etiology
- deceleration w/ simultaneous cutting in opposite direction (valgus force at knee)
- direct blow to patella when knee is flexed and planted
- quad pulls patella out of alignment
- some individuals may be predisposed
- increased Q angle
- repetitive subluxation will stress medial restraints
S&S patellar dislocation
- pain and swelling
- restricted ROM
- results in total loss of function
patellar dislocation management
- immobilize
- RICE
- immediate medical attention
- immobilization 4-6 weeks with crutches
- muscular strengthening
fracture - patella etiology
- direct or indirect trauma (severe pull of tendon)
- semi flexed position with forcible contraction (falling, jumping, or running)
S&S fractured patella
- generalized joint swelling
- pain, disability, and potential deformity
patella fracture
management
- x ray necessary for confirmation of findings
- RICE and splinting if fracture is suspected
osgoode-schlatter’s disease - etiology
- traction injury
- repetitive stress on immature tibial tuberosity from quad contractions
S&S osgoode-schlatter’s disease
- swelling
- point tenderness at tuberosity
- enlarged and bony deformation
- pain with kneeling, jumping, running
management osgoode-schlatter’s disease
- RICE
- activity modification
- Cho Pat brace
- isometric for quads and hams
patellofemoral pain syndrome etiology
- joint aggravation d/t flexion/extension stresses
- underside of patella or femoral condyles
- result of lateral deviation of patella while tracking in femoral groove
- tight structures, pronation, increased Q angle, insufficient medial musculature
S&S patellofemoral pain syndrome
- tenderness of medial facet during running, jumping, squatting, stairs
- dull ache in center of knee
- patellar compression will elicit pain and crepitus/grinding
- move goer’s sign
- overpronation
patellofemoral pain syndrome - management
- RICE
- activity modification
- wearing patellar brace or McConnell tape job
- correct biomechanical issues/strength/flexibility
patellar tendonitis -
• “Jumper’s knee”
• Results in pain in one or more of the following:
a) The inferior pole of the patella
b) The mid tendon region
c) The insertion at the tibial tuberosity
patella tendonitis - etiology
Etiology • Jumping or kicking • Over-pronation • Running on hard surfaces; rapid increase in running • Sudden or repetitive extension
S&S Patellar tendonitis
- 1) pain after activity,
- 2) pain during and after,
- 3) pain during and after (possibly prolonged) and may become constant
management of patellar tendonitis
- RICE
- therapeutic modalities (heat)
- exercise
- patellar tendon bracing
- transverse friction massage
- eccentric strengthening - stop and drops
ITband friction syndrome etiology
- caused by repetitive/overuse conditions; structural mal-alignment, structural asymmetries , training errors
- leg length discrepancy
- genu varum
- over pronation
- sudden TFL/glute max
- hip weakness
MOI OITband syndrome
compressive and friction forces to lateral femoral condyle
S&S ITB syndrome
pain after running, going up or down stairs, point tenderness at Gerdy’s tubercle
ITB friction syndrome - management
- RICE
- correction of mal alignment
- proper warm up and stretching
- activity modification
- orthotics
