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MSK II > Knee 3: Patellar Dislocation-End > Flashcards

Knee 3: Patellar Dislocation-End Flashcards

1
Q

risk factors for patellar dislocation

A

pre-extisting hypermobility

more common with shallow sulcus angle or trochlear groove

more common with large positive congruence angle or laterally located patella

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2
Q

etiology of patellar dislocation

A

trauma iwht lateral patellar displacement

can be more likely with prior instability

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3
Q

structures involved in patellar dislocation

A

patella

medial retinaculum

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4
Q

S&S of patellar dislocation

A

traumatic/worse case of PFPS

+ patellar apprehension

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5
Q

PT Rx for patellar dislocation

A

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

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6
Q

MET for PFPS

A

CC prior to OC extercises

quads - isometrics then isotonics

extensibility/elasticity of postlat structures (hams, IT band, and gastroc)

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7
Q

re-dislocation rate of patellar dislocation

A

44%

higher w/o sx

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8
Q

what is IT Band syndrome

A

tendinopathy of distal IT band

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9
Q

prevalence of IT Band syndrome

A

5-14% runners

2nd leading cause of knee pain in runners

males = 50-80% of cases

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10
Q

risk factors for IT band syndrome

A

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

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11
Q

etiology of IT band syndrome

A

not entirely well understood

abnormal mechanical loading

consider lumbar hypermobility/instability with impaired LE control and excessive recruitment of TFL

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12
Q

structures involved with IT band syndrome

A

TFL/IT band

lateral femoral epicondyle

gerdys tubercle insertion (lateral)

associated bursae and fat pad

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13
Q

symptoms of ITB syndrome

A

gradual onset lateral knee pain

worse with activities involving repetitive knee motion, grades, and dynamic U stance (i.e. running)

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14
Q

signs of ITB syndrome

A

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)

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15
Q

signs for ITB syndrome

A

possible + obers

TTP over lateral femoral condyle and gerdy’s tubercle

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16
Q

PT Rx for ITB syndrome

A

other associated impairments

tendon proliferation and stabilization = primary purpose

tendinosis Rx

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17
Q

what is patella tendinopathy

A

jumpers knee or anterior knee pain

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18
Q

incidence/risk factors for patellar tendinopathy

A

up to 50% athletes

males > females

more common in jumping sports

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19
Q

structures involved in patellar tendinopathy

A

patellar tendin

infrapatellar bursae and fat pad

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20
Q

what are the bursae involved with patellar tendinopathy/where are they

A

superficial infrapatellar = between skin and patellar tendon

deep = between patellar tendon and tibia

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21
Q

etiology of patellar tendinopathy

A

abnormal mechanical loading

22
Q

symptoms of patellar tendinopathy

A

overuse and gradual onset of pain

increased with activity, jumping, lunging, and squatting

23
Q

signs of patellar tendinopathy

A

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

24
Q

PT Rx for patellar tendinopathy

A

pt edu on soreness rule, load management, and movement cues

POLICED

JMs

25
Q

effectiveness of exracorporeal shockwave therapy

A

no additional benefit when added to MET

26
Q

MET for patellar tendinopathy

A

purpose = tendon proliferation and stabilization

tendinosis Rx

increased trunk flexion with landing/jumping/squat/lung takes tension off of tendon

27
Q

MD Rx fro patellar tendinopathy

A

platlet rich plasma injections = minimal benfit

cortisone = should not be used

28
Q

prognosis for patellar tendinopathy

A

50-70% improvement at 3-6 months with MET

29
Q

what is tibial tubercle apophysitis

A

aka Osgood schlatter’s disease

30
Q

prevalence of osgood schlatters disease

A

most common cause of anterior knee pain in kids

peaks at 12-15 years

31
Q

structures involved with osgood schlatters disease

A

tibial tuberosity apophysitis or epiphyseal plate

patellar tendon

32
Q

risk factors for osgood schlatters

A

growth spurt
high activoty
shortened quads and hamstrings
weak quads
high BMI
reduced core stability

33
Q

etiology of osgood schlatters disease

A

overuse

34
Q

pathomechanics of osgood schlatters

A

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

35
Q

symptoms of osgood schlatters

A

gradual onset knee pain with overuse

pop may indicate avulsion

possible loss of vertical jump

36
Q

signs of osgood schlatters

A

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

37
Q

Rx for osgood schlatters

A

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

38
Q

effectiveness of orthotics for osgoods schlatters

A

sleeve may cause compression

strap on tendon may cause traction pain

foor orthotics can help control LE

39
Q

MET for osgood schlatters

A

possibly trunk and hip stabilization

caution with muscle/tendon attached to growth plate to avod overuse

40
Q

prognosis for osgood schlatters

A

PT 90% successful

can become recurrent/persistent

41
Q

characteristics of skeletal muscle

A

transmits mechanical forces

striated

voluntary contractile tissue

actin and myosin myofilaments make up sarcomere

hypervascular

enveloped by fascia

42
Q

characteristics of fascia

A

continuous loose connective tissue throughout body

minimal contractile properties vs muscle

surrounds/permeates all tissues and organs

can scar and harden following injury

43
Q

prevalence of quad/hamstring strain

A

quads = less common

hams = more common

44
Q

risk factors for strains

A

abnromal ham/quad ratio may be a predisposition to injury (may use ACL criteria)

lack of warm up

45
Q

etiology/pathomechanics of strains

A

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%)

46
Q

symptoms of strains

A

localized pain

sudden onset with forceful activity

possible limited motion and WBing

47
Q

signs of a strain

A

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

48
Q

return to play timeline for strains

A

functional or grade I = about 1-2 weeks

structureal = 5-6 weeks for grade 2 and over 8 weeks for grade 3

49
Q

distinct Rx for strains

A

pt edu on soreness rule and load management

compression wrapping to help muscle action

50
Q

MET for strains

A

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

51
Q

what are the ottawa knee rules

A

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

52
Q

PT Rx for fractires

A

treating consequences of immobilization with other tissues

MSK II (18 decks)

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