Knee 3: Patellar Dislocation-End Flashcards
risk factors for patellar dislocation
pre-extisting hypermobility
more common with shallow sulcus angle or trochlear groove
more common with large positive congruence angle or laterally located patella
etiology of patellar dislocation
trauma iwht lateral patellar displacement
can be more likely with prior instability
structures involved in patellar dislocation
patella
medial retinaculum
S&S of patellar dislocation
traumatic/worse case of PFPS
+ patellar apprehension
PT Rx for patellar dislocation
non-WBing to PWB up tot 3 weeks
immobilizer
-can allow 60 flex for 3 weeks
-90 til 6 weeks
-full ROM after 6 weeks
taping after 1 week of immobilization for protection and muscular control
MET for PFPS
CC prior to OC extercises
quads - isometrics then isotonics
extensibility/elasticity of postlat structures (hams, IT band, and gastroc)
re-dislocation rate of patellar dislocation
44%
higher w/o sx
what is IT Band syndrome
tendinopathy of distal IT band
prevalence of IT Band syndrome
5-14% runners
2nd leading cause of knee pain in runners
males = 50-80% of cases
risk factors for IT band syndrome
running
training erros
weak hip ERs and ABDs
excessive pronation
increased hip add and IR
trunk lean in U stance
associated with GTPS and PFPS
etiology of IT band syndrome
not entirely well understood
abnormal mechanical loading
consider lumbar hypermobility/instability with impaired LE control and excessive recruitment of TFL
structures involved with IT band syndrome
TFL/IT band
lateral femoral epicondyle
gerdys tubercle insertion (lateral)
associated bursae and fat pad
symptoms of ITB syndrome
gradual onset lateral knee pain
worse with activities involving repetitive knee motion, grades, and dynamic U stance (i.e. running)
signs of ITB syndrome
impaired LE control
pain with hip add likely (stretch)
general ROM is not consistent; could be pain with both bending and straightening due to multi function of TFL
possibly weak hip ER
weak hip ABD with pain (especially in a lengthened position)
signs for ITB syndrome
possible + obers
TTP over lateral femoral condyle and gerdy’s tubercle
PT Rx for ITB syndrome
other associated impairments
tendon proliferation and stabilization = primary purpose
tendinosis Rx
what is patella tendinopathy
jumpers knee or anterior knee pain
incidence/risk factors for patellar tendinopathy
up to 50% athletes
males > females
more common in jumping sports
structures involved in patellar tendinopathy
patellar tendin
infrapatellar bursae and fat pad
what are the bursae involved with patellar tendinopathy/where are they
superficial infrapatellar = between skin and patellar tendon
deep = between patellar tendon and tibia
etiology of patellar tendinopathy
abnormal mechanical loading
symptoms of patellar tendinopathy
overuse and gradual onset of pain
increased with activity, jumping, lunging, and squatting
signs of patellar tendinopathy
observation = possibly thickened tendon and impaired LE control (knees past toes)
ROM = possible pain and limits with end range flexion, especially if hip is extended
MMT = pain with knee ext, especially from lengthened
AM = impaired patellar motion
special tests = possible + thomas test for rectus femoris
palpation = TTP localized; patella alta adds tendon tension/compression
PT Rx for patellar tendinopathy
pt edu on soreness rule, load management, and movement cues
POLICED
JMs
effectiveness of exracorporeal shockwave therapy
no additional benefit when added to MET
MET for patellar tendinopathy
purpose = tendon proliferation and stabilization
tendinosis Rx
increased trunk flexion with landing/jumping/squat/lung takes tension off of tendon
MD Rx fro patellar tendinopathy
platlet rich plasma injections = minimal benfit
cortisone = should not be used
prognosis for patellar tendinopathy
50-70% improvement at 3-6 months with MET
what is tibial tubercle apophysitis
aka Osgood schlatter’s disease
prevalence of osgood schlatters disease
most common cause of anterior knee pain in kids
peaks at 12-15 years
structures involved with osgood schlatters disease
tibial tuberosity apophysitis or epiphyseal plate
patellar tendon
risk factors for osgood schlatters
growth spurt
high activoty
shortened quads and hamstrings
weak quads
high BMI
reduced core stability
etiology of osgood schlatters disease
overuse
pathomechanics of osgood schlatters
bone growth exceeds quad lengthening
increased tendon tension
growth plate is the weal spot as opposed to tendon in the adult
most often inflammaiton
complications = avulsion or premature closure
symptoms of osgood schlatters
gradual onset knee pain with overuse
pop may indicate avulsion
possible loss of vertical jump
signs of osgood schlatters
impaired LE control
enlarged tibial tuberosity
ROM = possibly pain with end range flexion especially with hip ext
MMT = pain with ext; especially lengthened
AM = possible patellar hypo
special tests = + thomas test for RF shortening
TTP over tibial tuberosity
possible patella alta
Rx for osgood schlatters
pt edu on soreness rule, load management, and movement cues
POLICED
JMs (PF glides, likely for inf glide)
careful with stretching quads if pain occurs
stretch of hams/gastroc
effectiveness of orthotics for osgoods schlatters
sleeve may cause compression
strap on tendon may cause traction pain
foor orthotics can help control LE
MET for osgood schlatters
possibly trunk and hip stabilization
caution with muscle/tendon attached to growth plate to avod overuse
prognosis for osgood schlatters
PT 90% successful
can become recurrent/persistent
characteristics of skeletal muscle
transmits mechanical forces
striated
voluntary contractile tissue
actin and myosin myofilaments make up sarcomere
hypervascular
enveloped by fascia
characteristics of fascia
continuous loose connective tissue throughout body
minimal contractile properties vs muscle
surrounds/permeates all tissues and organs
can scar and harden following injury
prevalence of quad/hamstring strain
quads = less common
hams = more common
risk factors for strains
abnromal ham/quad ratio may be a predisposition to injury (may use ACL criteria)
lack of warm up
etiology/pathomechanics of strains
can be injured directly or indirectly (external vs internal)
can be functional (i.e. fatigue/neurogenic dysfunction without structural changes) = majority (70%) of strains in professional soccer
can be structural = structural changes; overestimayed in professional soccer (30%)
symptoms of strains
localized pain
sudden onset with forceful activity
possible limited motion and WBing
signs of a strain
obs = asymmetrical gait/possible ecchymosis
ROM = likely pain with lengthening
MMT = pain and weakness for mid range (grade I) and lengthened range (grade II)
special tests = shortened muscle length
TTP over muscle
return to play timeline for strains
functional or grade I = about 1-2 weeks
structureal = 5-6 weeks for grade 2 and over 8 weeks for grade 3
distinct Rx for strains
pt edu on soreness rule and load management
compression wrapping to help muscle action
MET for strains
focus = tissue integrity and muscle characteristics including progressing to agility and power activities
max contractions held until 8 weeks with structural change of grade II and III strains
what are the ottawa knee rules
get an x-ray if any of the following things present after trauma:
over 55
fibular head tenderness
isolated patellar tenderness
inability to flex knee past 90
inability to bear weight immediately and take 4 steps
** DO NOT USE if over 7 days from injury
PT Rx for fractires
treating consequences of immobilization with other tissues
