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MSK II > Knee 3: ARJC- PFPS (Test 3) > Flashcards

Knee 3: ARJC- PFPS (Test 3) Flashcards

1
Q

in the year prior to TKA over 50% of non-inpatient costs were associated with what

A

injections
PT
Orthotics
Prescriptions (about 30% of this is HA injections alone)

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2
Q

how much of a cost reduction would occur for knee patients if CPG treatments alone were used

A

cost associated with OA would be decreased by 45%

shows over utilization of ineffective interventions and less efficient use of visits

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3
Q

effectiveness of NSAIDs for ARJC

A

strong support
better than Tylenol
includes topical application

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4
Q

effectiveness of tylenol

A

stong support

NSAIDs better

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5
Q

effectiveness of narcotics for ARJC

A

adverse effects and not effective

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6
Q

effectiveness of injections for ARJC

A

cortisone = inconclusive; maybe short term relief

hyaluronic acid (synvisc) = claims to mimic synovial fluid; strong evidence against

platlet rich plasma = may help

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7
Q

effectiveness of arthroscopy for ARJC

A

strong recommendation against in nearly all patients

no clinically important benefits vs placebo in regards to pain, function, or quality of life

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8
Q

prognosis for ARJC for patients with TKA + PT vs PT alone for 12 months

A

greater pain relief/function with TKA, but higher risk of adverse events

non-surgical Rx delayed TKA

timing of TKA influences outcome (dont wait to long; may affect other parts of the body)

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9
Q

MD Rx for ARJC

A

partial knee arthroplasty

total knee arthroplasty
-more common
-mini-procedure
-increasing in prevalence

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10
Q

MD Rx prior to TKA

A

pre op PT reduced cost by $1215
-assistive device
-recovery plan
-expectations

better quality of life with 8 weeks of exercise 5x/week prior to sx

3x/week for 4-8 weeks increased strength and function for those with severe OA

3 week program accelerated functional recovery after a TKA

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11
Q

what does a TKA involve

A

incise capsule

collaterals remain and possibly the PCL

ACL always removed

forceps hold back adj structures

dislocate knee

add prosthetic

close capsule

full range ensured under anesthesia

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12
Q

importance of early rehab within 24 hours after a TKA compared to 48-72 hours after

A

earlier decreases mean hospital stay and number of sessions

greater progress with ROM/strength

faster autonomy and normal gait and balance with TKA

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13
Q

early and intense rehab variables to consider

A

higher intensity

spread visits over a longer duration

single leg training

higher level of functional exercises

results in better quad activity out to a year

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14
Q

ROM goals for PT after a TKA

A

0 degrees extension - 1-2 weeks

110 degrees flexion - 6 weeks

120 degrees overall

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15
Q

other names for patello-femoral pain syndrome

A

PFPS

anterior knee pain

retripatellar pain syndrome

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16
Q

describe the ground reaction forces associated with the patello-femoral joint for: walking, 30 deg flexion, stair climbing, squatting, and peak

A

walking = 50% BW

30 deg flex = BW

stair climbing = 3x BW

squatting = > 7x BW

peak = at 90 deg

forces are even greater with those who have patellofemoral pain syndrome

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17
Q

prevalence of PFPS

A

37% of military recruits

70-90% recurrent and persistent

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18
Q

risk factors for PFPS

A

military recruits

dynamic NOT static excessive pronation

females > males
-larger Q angle
-differing hip strength/coordination

patellar and femoral bone shape

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19
Q

etiology/pathomechanics of PFPS

A

trauma is rare

idiopathic is the largest % of pts

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20
Q

describe the idiopathic etiology of PFPS with the theory of malalignment or maltracking

A

patella glides and tilts more laterally relative to the femur

involves decreased surface area contact between the patella and femur due to:
-patellar and femoral bone shape
-femoral IR and add
-quad weakness/incoordination/atrophy
-unclear contribution from excessive pronation and tibial IR

21
Q

changes that take place with PFPS

A

overload of patellar subchondral bone, especially the lateral facet

tissue ischemia

loss of tissue homeostasis

neural ingrowth increase in substance P nerve fibers that transmit more pain

22
Q

structures involved with PFPS

A

subchondral bone of patella

infrapatellar fat pad
-behind patellar tendon/in front of capsule
-inflamed with excessive tibial IR and patellar hypermobility
-can refer to groin

bursae (superficial and deep)
-between skin and patellar tendon
-between patellar tendon and tibia

quad and patellar tendons

synovium

medial and lateral retinaculum (help hold patella and tendon in position)

23
Q

symptoms of PFPS

A

gradual onset

usually anterior medial knee pain (inhibition of VM)

pain increased with stairs, squatting, or kneeling or prolonged sitting

24
Q

observation of those with PFPS

A

increased Q angle

open chain maltracking of patella

quad atrophy

impaired LE control

25
Q

explain how impaired LE control may contribute to PFPS

A

proprioceptive deficits

dynamic excessive pronation

26
Q

concerns related to dynamic excessive pronation

A

possibly leads to IR

may contribute to greater genu valgus

possible contributions from impaired DF because of DF is limited then more EV may occur

27
Q

what might you observe related to impaired LE control associated with PFPS

A

abnormal planar motions (females especially)

frontal and sagittal plane: increased hip add
-glut med or max incoordination
-hip ext and abd weakness

transverse
-hip ER weakness/incoordination
-mixed conclusions with contributions from rotational impairments

28
Q

how is poor control defined related to PFPS during a squat

A

significant valgus movement

knee medial to foot

29
Q

how is reduced control defined related to PFPS during a squat

A

some valgus movement

knee NOT entirely medial to foot

30
Q

how is good control defined related to PFPS during a squat

A

no valgus movement

knee vertical to toes

31
Q

what might you observe with PFPS in other parts of the body

A

trunk weakness including excessive trunk lean

possible contributions form L4-S1 regional interdependence

32
Q

ROM findings for those with PFPS

A

limited and painful especially at end ranges

FLX = greater PF compression
EXT = more fat pad irritation

33
Q

resisted/MMT for PFPS

A

possibly pain with ext MMT and weakness

likely inhibited quad activity (especially VM)

potential anti gravity trunk and hip weakness

34
Q

stress test findings for PFPS

A

possible pain with PF compression

35
Q

possible neuro findings for PFPS

A

limited dural mobility of femoral nerve in 1/3 of patients

36
Q

accessory motion testing for PFPS

A

usually excessive lateral motion and limited medial motion

all glides could be hypermobile

37
Q

special tests for PFPS

A

medial patella plica test
pain with knee ext MMT
hoffa’s sign
apprehension test

38
Q

special tests for M length associated with PFPS

A

thomas for rectus
ober’s for TFL/IT band
SLR for hamstrings
gastroc

39
Q

palpation findings for PFPS

A

peri patellar TTP

position of patella
-patella alta
-patella balta
-WNL = inferior pole aligned with joint space at 90

40
Q

PT Rx for PFPS

A

POLICED
taping
Knee orthotics
foot orthotics
STM and JM
MET
verbal and visual feedback

41
Q

effectiveness of taping for PFPS

A

patellar taping most often medial or inferior to unload fatpad

improves posiitoning for better contact

good for pain, kinematics, and function

less efective with patients who have higher bMI or smaller Q angle

provides proprioceptive benefits

can also tape arch for excessive pronation

42
Q

effectiveness of knee orthotics/different types

A

neoprene sleeve with hole
-increases surface contact between patella and femur (30-40%) without changing alignment/tracking
-can help with function
-proprioceptive benefits

J-lat brace

none interfere with muscle activity

43
Q

effectiveness of foot orthotics for PFPS

A

effective immediately

effective in short and mid term

no difference at a year

44
Q

what would cueing a pt to “run softly” do

A

changes landing pattern from rearfoot to non rearfoot strike pattern

improves pain and function

also cue “dont let your knee fall in”

45
Q

how/why to cue to “contract glutes and keep knee pointed straight”

A

can use a visual of hip angle with mirror

improved pain and function

also helped hip mechanics

46
Q

prognosis for PFPS

A

80% of those who did rehab still had pain

74% had reduced PA in 5 year follow up

can lead to OA

47
Q

what is a lateral retinacular release

A

arthroscopic

longitudinal incision of lateral retinaculum

should be used in rare instances

48
Q

prognosis of lateral retinacular release and when to use

A

use only with 10% of cases unsuccessful with PT with hyperpressure of lateral facet without instability

can lead to medial instability if additional tissue is cut or used on the wrong pt

49
Q

what is an extensor mechanism realignment

A

repositioning of the insertion site

open procedure

long rehab

extensor lag issues

MSK II (18 decks)

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