Knee Flashcards
knee, closed pack pos.
full extension
during extension, tibia glides ____ on femur
anteriorly
during felxion, tibia glides_____ on femur
posteriorly
tibiofemoral joint is a con____ on con____
convex on concave
describe screw home mech.
> from 30-15 degrees of extension= ER of tibia w/ anterior glide
from 15-5 degrees of ext. =more ER less ant. glide
from 5-0 degrees of ext=pure ER, no glide
patellofemoral joint glides_____with flex and ____ with ext.
cuadally/inferior and medially with flexion, superiorly and laterally with extension
with moving into flexion, what parts of the patella contact the femur?
inferior (20 deg. flxn) –>medial (60 degrees)–>superior patella (90 degrees flxn)
when does the patella have most play (least contact with condyles) and least play (most contact with condyles)
most play= full extension
least play= 60-90 degrees flexion
common causes of anterior knee pain?
patellofemoral pain, quadriceps tendonitis, patellar tendonitis, patellar fat pad irritation (FPI)
causes of lateral knee pain?
LCL, lateral meniscus, IT band, spine referral?
causes of medial knee pain?
MCL, med. meniscus, pes anserine, bursitis, L3 referral, plica
posterior knee pain?
bakers cyst, PCL, hamstring strain, spine referral
diff. diagnose “locking” in the knee
meniscus flap caught= lacking 20-30 degrees of motion and its not so painful.
> loose bodies/ chondromalacia/ osteophytes= lacking last 5 degrees and will be SUPER PAINFUL
special tests for ACL
ant. drawer, lachmans (more sensitive)
how much should knee be bent for lachman’s
30 degrees
PCL sp. tests
posterior drawer, post. sag
should u do PCL or ACL tests first?
PCL, bc if PCL is the prob, u might get false positives on anterior drawer and ACL tests even though ACL is fine
LCL test?
varus test
MCL test?
valgus stress test
what angles do u test LCL and MCL at?
at 5-10 degrees and again at 30 degrees to take cruciates out of it
so if a valgus test is positive at 15 degrees, what does that mean?
it may either be the MCL or the ant/post. cruiciate ligaments.
If u then repeat the valgus test at 30 degrees and it is positive again, what does that mean?
that the cruciates are not involved and it really is most likely the MCL
tests for meniscus?
- Apley’s compression
- Apley’s distraction (collaterals)
- McMurrays
- single leg squat and rotate (Thessaly’s)
- toes in/out squatting
patello-femoral tracking tests
- apprehension test (knee at 20 degrees of flexion, go to glide patella laterally), watch for quad contraction and grimace
- critical test
- patellar tap test (for effusion)
how to measure knee ?
measure 2 cm above and below joint line to measure swelling
*measure 10 cm above and 20 cm above joint line for quad atrophy and measure 10 cm below for gastroc atrophy
involved leg must be ____% of uninvolved leg to go back to sport
90 %
back to sport tests for knee
one legged squat percentage leg press one leg balance one leg cycling one leg triple hop for distance one leg hop for distance timmed one leg hop on minitramp
femoral condyle injury- osteochondritis dessicans
focal injury to articular cartilage of femoral condyle or on back of patella
symps of femoral condyle injury
pain, swelling, catching, pain with palpation
how to treat osteochondritis dessicans
carticel transplant surgery, rehab
Bursitis in knee
overuse injury, bursa between tendon and bone or skin and tendon
where can u get bursitis in the knee? (6)
subcutaneous prepatellar bursa, subcut. infrapatellar bursa, deep infrapatellar bursa, suprapatellar bursa, pes anserine bursa, semimembranosus bursa
PT tx for bursitis
PRICE, pt education,
sx tx for bursitis
fluid aspiration
s&s of bursitis
obvious inflammation, swelling, pain with palpation.
fat pad irritation of knee
irritation of the infrapatellar fat pad behind the patellar tendon
causes of FPI
knee hyperextension (fat pad gets pinched between tibia and patella), overuse, or traua/direct blow
how do u differentiate patellar tendonitis vs. FPI?
with patellar tendonitis it is painful with palpation to the tendon itself, with FPI, all around the tendon will be painful but not the tendon itself
acute treatment of, FPI?
no quads, modalities (ionto) and NSAIDS, tape superior pole to relieve pressure on inferior pole, mm lengthening of quads
knee instability
when the knee translates out of its ligamentous and muscular boundaries and the articular cartilages are partially or completely disengaged
test for knee instability
ACL, PCL, MCL< LCL, tests. MMT, mm length tests
Rehab goals for knee instability
strengthen surrounding musculature, stretch areas that need it without stressing the ligature to create balanced ROM
what results from a dashboard injury?
PCL injury
what results from excessive valgus force?
MCL injury
What results from excessive varus forces?
LCL injury
what results from blow to a planted foot while cutting,
ACL injury
Placement of ACL in knee
medial lateral femoral condyle to the lateral medial tibia
MOI for ACL injury
cutting, decelerating quickly, hyperextension, valgus force, axial rotation with foot planted
S&S ACL injury
popping, giving out, pain, swelling, instability, inability to walk, quad atrophy, hemarthrosis (bleeding into the joint spaces)
PCL placement in knee
medial condyle of femur to lateral tibia
MOI PCL injury
fall on hyperflexed knee, hyperextension, varus/valgus forces with planted foot, dashboard injury
S&S PCL injury
pain, pain with kneeling, squatting, running, slowing down, walking up or down stairs, minimal swelling/tenderness (bc its so deep), instability, popping, giving out, anterior tibia contusion, post. knee pain especially past 90 degrees of flexion
S&S MCL injury
pain over ligament, swelling, bruising, instability
MOI MCL
valgus force, hyperextension
which is described as a “clipping injury”
MCL
LCL S&S
pain, swelling, stiffness, catching/locking,Numbness/weakness in foot if peroneal nerve is stretched or compressed
MOI LCL
varus force, hyperextension
Meniscal injury
sharp pain, pop, giving way, locking/catching, clicking/snapping
aggrivating factors of meniscal injuries
stairs, squatting, sit to stand, WBing in general, joint line tenderness with palpation, swelling
MOI meniscus tear
flexion, compression, rotation
patellofemoral pain syndrome
anterior knee pain, under patella, imbalance of forces pulling patella
Tests for patellar femoral pain syndrome?
Q angle
mod. obers for IT band tightness,
pes planus?
critical test
tx for PFPS
patellar mobs, mm strengthening to correct imbalances,
IT band flexibility
gold standard tests for meniscal tears?
joint line pain and thessaly’s
Knee OA tests
compression test mcmurrays joint girth crepitus? MMT Knee CPR? (flex>ext)
Tx knee OA
distraction glides to inc. ROM ice ultrasound mobility (50 reps) and unweighted exercise (aquatics, bike)
pain behavior for knee OA
intermittent stiffness <30 mins in morning
IT band syndrome tests
lat. knee pain with flex/ext.
weak abductor on MMT
trendelenburg?
palpate band-tender,tight
IT Band syndrome tx
ice med patellar mob to stretch? massage foam roller doorway stretch clams SLS monster walks
Osgood schlatter’s: test
palpate tibial tub.
pain with kneeling
obvious deformity
osgood schlatters: tx
ice
ultrasound to inc. flexibility of tissues?
sup. patellar glide to lengthen tendon, massage
strengthen hammys, change up routine, lengthen quads
Baker’s cysts
obvious deformity in post. knee that is tender to palpation, measure knee girth, restricted flexion with goni
Tx for baker’s cyst
ice, ROM, treat underlying cause (most likely meniscus)
bike, low resistance high reps
Plica syndrome: tests
palpation
limited flex/ext due to swelling
grind test
plica Tx
mobs for area of restriction ice ultrasound ionto bike low load high reps
patellar tendinosis: tests
pain with resisted knee extension
pain reproduced with squatting, lunging, jumping
treatments for patellar tendinosis
mobs to inc. extension in tendon, lengthen quads, eccentric strengthening
4 stages of patellar tendinosis
1) pain after activity
2) pain before and after activity
3) pain before,after and during activity but performance still ok
4) pain before, after, during and performance not ok
