Knee Flashcards
Knee swelling/effusion measurements important to determine? What nerves can be compressed in the popliteal fossa?
Internal knee damage
Tibial and/or common peroneal nerves
Varus stress test(s?)
LCL, lateral joint capsule, possible ACL/PCL at 0*
LCL @ 20-30*
Valgus stress test(s?)
MCL, medial joint capsule, ACL/PCL @ 0*
MCL @ 20-30*
Stroke/sweep/bulge
3-4 strokes medial and upward
1 stroke down laterally
0 - no effusion
Trace - small wave on medial side w/ downstroke
1 - large bulge on medial side w/ downstroke
2 - swelling spontaneously returns
3 - too swollen to move effusion
Acute phase of healing
Reduce pain and swelling
Control inflammation
Regain ROM (close to unaffected side)
Minimize muscular weakness and atrophy
Achieve early NM control
Maintain/develop CV fitness
Functional phase of rehab (subacute - chronic)
Attain full and pain free ROM
Restore normal joint kinematics
Increase muscular strength
Improve NM control
Incrementally progress joint-loading activities, restore force-couple relationships
Intrinsic factors for ACL injury
Narrow intercondylar notch
Weak ACL
Generalized joint laxity
LE malalignment
Female
Extrinsic factors for ACL injury
Quad/HS imbalance
Altered NM control
Playing surface
Athlete’s playing style
Terrible triad force
Valgus, rotation, fixed foot
-MCL, ACL, meniscus
PF pain exam - DD (3)
Osteochondritis dissecans - part of bone and cartilage separating from rest of bone
Slipped capital femoral epiphysis - head of femur separating from shaft at growth plate
Legg calf perthes - femoral head loses blood supply
PF instability req? (5)
Surgery?
Small patella, shallow trochlear groove, abnormal position of patella, ligamentous laxity
Important functional considerations/exam for PFP, MMTs
Eccentric control, landing pattern in running
Hip musculature (abd and ext rot), VMO (important for proper tracking of patella)
Least amount of tension in knee during OKC?
45-90*
Least amount of shear force at knee during CKC?
0-60*
Tibiofemoral OA - what special tests might be positive?
Girth measurement, stroke/sweep/bulge, patellar ballottement, Clarke’s sign
Loading tests - Thessaly - false positive?
Greater loss of flexion or extension w/ knee OA?
Flexion
Hemarthrosis - definition, time to swelling post-injury, co-dx
Bleeding within join/joint capsule
1-2 hrs post injury
ACL tear, patellar dislocation
Synovial effusion - time to swelling post-injury, symptoms
6-12 hrs
Dull, aching pain due to joint capsule
Young pts with unicompartmental OA good candidates for?
Distal femoral osteotomy
Proximal tibial osteotomy
Following TKA, what is a main concern regarding strength?
Quad strength can drop as much as 60% of pre-op level and persist
PCL intervention - important to strengthen? Delay strengthening?
Quads and gastroc to reduce posterior tibial translation
Delay HS strengthening by 6-8 weeks
How is knee brace positioned for someone post-op meniscal tear?
Full extension
MOI for MCL sprain
Valgus and/or tibial ER
Patellar tendinopathy characteristic pain findings (5)
Pain w/ tendon palpation
Pain w/ instant loading, no pain when load is removed
Pain is dose-dependent
Pain is not present at rest
Pain may improve w/ repeated loading (Warmup)
Grade I bruise (4) & general healing time
Mild bruising, localized tenderness, 90+* of knee flexion, gait is normal
Normal activities as tolerated
Grade II bruise (5) & general healing time
Moderate bruising, localized swelling and tender MMT??, <90* flexion, antalgic gait, discomfort with sit-to-stand/stairs
3 days to 3 weeks
Grade III bruise (5) & general healing time
Severe bruising, marked tenderness and swelling throughout, <45* knee flexion, needs assistive device/aid for gait
3 weeks - 3 mo.
In extreme contusions, what is a primary concern?
Compartment syndrome - buildup of fluid causing compression on musculature and nerves, prevents nutrients and O2 from reaching these tissues
Baker’s cyst - location, exam findings
Popliteal fossa, can be above or below joint line
Pain w/ AROM/PROM
Cyst may be visible
Pain w/ knee flex MMT & WB
Meniscal tests (4)
Thessaly
McMurrays
Apley
Bounce home
Patellofemoral joint tests (3)
Clarke’s
Patellar stability tests: medial, lateral gliding, patellar tilt
Fairbank/Patellar Apprehension
Ligamentous Tests/Rotational Instability (3)
Lateral pivot shift
Jerk test of Hughston
External rotation recurvatum
Ligamentous tests/ one plan instability (6)
Varus
Valgus
Lachman
Anterior drawer
Posterior drawer
Godfrey’s/Posterior Sag sign
Effusion (3)
Girth measurement
Patellar ballottement
Stroke/sweep/bulge
