Knee 2 Flashcards
prevalence of Patellafemoral pain syndrome (PFPS)
40% of adults with reported knee pain (25% of all running injuries)
-overuse type injuries
what facet of the patella is most commonly associated with chondromalacia patella
odd facet (most medial)
what mechanical advantage does the patella provide
improves efficiency of extensor mechanism (last 30 degrees of extension)
Biomechanics of the patella @ flexion/ext
At 0 degrees- no contact of patella in femoral groove
at 120 degrees- odd facet makes contact in femoral groove (sitting tends to aggravate petelofemoral pain)
patella fx exam findings
- trauma hx
- swelling
- inability to weight bear
- Bony tenderness/ palpable cleft
- inability to perform aslr
- decreased knee flexion
what is the criteria to make a dx of PFPS
- Presence of retropaterllar/ peripatellar pain
- reproduction of pain w squatting, stair climbing, prolonged sitting
- patellar tilt test with the presence of hypo mobility
clinical stages of chondromalacia patella (4)
- softening, swelling, blistering of articular cartilage
- Fissuring of articular cartilage (clefts)
- Fibrillation (crabmeat sign)
- Thinning of articular cartilage
theory of causes of chondromalacia
- abnormal patella excursion
- abnormal patellofemoral pressure
- trauma
- genu valgus
- patella alta
or just normal
signs/symptoms of chondromalacia patella- mc cohort
runners 20-30
s/s- recurrent effusion, coarse creapatis, night pain, pain with prolonged sitting
chondromalacia patella exam findings
+ patella compression
+squatting
+Clarks sign
+ resisted knee extension
conservative management and prognosis of chondromalacia patella
- CKC exercises: semi squats to stegthen VMO
- ITB stretching
- US
- Infrapatellar strap
6-8 weeks conservative= good in >50% pts.
Patellaofemoral malalignment syndrome
-tracking problem (pain in retropatellar area*)
Postural characteristics associated with patellofemoral malalignment syndrome
- femoral anteversion
- increase q angle
- hyperextension @ knee
- tibia varum (angled in)
- tibial tortion
Signs of patellofemoral malalignment syndrome
\+ patella compression crepatus \+ pain on ascending/descending stairs \+ clarks sign \+ patellar tilt test \+ resisted extension
normal q angle males + females
males= 13-18
females 18
what does a patellar tilt test indicate usually
inability to lift lat border of patella (indicates tight lat reticulum + likely lat tracking)
tx and prognosis of patellofemoral malalignment syndrome
-isometric ex for VMO
-stretch ITB/hams/quads
-6-8w
good prognosis
What is the most common ethology of patellar sublet/dislocation and moi
inadequate quadriceps strength
moi- Ext rot of leg, contraction of quad and ext of knee. Pivoting to one side
s/s of patella dislocation/sublux
-loud sound @ time of injury
-may spontaneously reduce
-swelling occurring rapidly within minutes (large hemarthrosis)
+aprehension sign
tender medial retinaculum
fat pad impingement ethology
- sudden forced knee extension
- with repeated activity, there may hypertrophy so a portion of the tissue becomes pinched between the patella and the femur
- overload syndrome
S/S of fat pad impingement
- tenderness on either side of patella
- petellar compression + in lower pole
- soft creates
- faber
- swelling/effusion
patellar tendinitis (jumpers knee)- what is it, eitology
-Inflamation of the distal tendon of the quads (/anywhere along the extensor mechanism of knee)
- overuse/overtraining
- eccentric forces
- running to fast/worse during running
s/s of patellar tendinitis
- ant knee pain
- *pain and tenderness localized to the infra patellar pole (quad tendon)
- clarks sign +
- knee flexion is painful
what hip rehab is beneficial in PFPS
improve hip flexion strength combined with increased IT band and iliopsoas flexibility
Triad of symptoms in osgood shlater
- Swelling over tibial tubercle
- point tenderness of tibial tubercle and patellar tendon
- xray-irregular ossification
tx of osgood shlater
modify activity (but continue sport)
infra patellar strap
STT, PNF stretching
(US contra)
2-3m
What is Larsen Johanssen disease (onset, pop, signs)
juvenile osteochondrosis that disturbs the patellar tendon attachment to the inf pole of the patella
- adolescent boys
- insideous
- tenderness over inf pol
What is osteochondritis dissicans- pathology and location
- focal van of bone- lat part of medial femoral condyle, can cause a jt mouse
- knee pain jt effusion, giving away catching, decreased rom, adolescent
tx and prognosis of osteochondritis dissicans
prevent partial or complete detachment (pinning surg)
strengthening
good prognosis
IT band syndrome eitology/predisposing factors
friction of repetitive knee flex/ext causing inflammation of bursae underlying distal portion of the ITB\
predisposing= old shoes, leg length, lack of stretching
s/s of IT band syndrome
sharp pain over lateral femoral epicondyle posteriorly (superficial pain)
synovial plica syndrome- which is most clinically sig + symptoms
medial patellar plica
- anteromedial knee pain
- pain aggravated by reparative activity
- pain w sitting long
synovial plica syndrome signs
medial parapatellar pain pain or palpable band over medial condyle snap or grinding w mcmurrays test quad atrophy effusion
definite indicators of synovial plica
- present on orthography, ct, Sri
- pain relieved by medial intracapsular cortisone
- prolonged releif w medial intracasular cortisone
symptoms of popliteus syndrome
- pain, stiffness, fullness on back of knee
- posterolat jt line pain
- aggrevated by heal strike**
