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MSK II > Knee 3 (test 3) > Flashcards

Knee 3 (test 3) Flashcards

1
Q

prevalence of meniscus injury

A

2nd most common knee injury

medial is injured more than lateral

posterior horn > anterior horn

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2
Q

risk factors for meniscus injury

A

acute injury = all WBing sports

degenerative injury
-older age
-male > female
-work related kneeling/squatting/stair climbing

a greater time elapsed from any knee injury

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3
Q

describe the meniscus

A

nearly circular wedge shaped fibrocartilage disks on tibial plateau

attached to tibia via horizontal coronary ligaments

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4
Q

function of meniscus

A

stability > shock absorption

deepen joint surface for stability

outer 1/3 is 80% type 1 collagen

inner 1/3 is 60% type II and 40% type I

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5
Q

describe the medial meniscus

A

more O shaped

torn more frequently

attachment to MCL

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6
Q

describe the lateral meniscus

A

more C shaped

greater mobility without ligamentous attachment

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7
Q

symptoms of meniscal injury

A

joint pain; could refer to shin

limited and painful motion

limits with WBing + possible catching/locking

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8
Q

onset of meniscus

A

if acute = trauma; probably weight bearing sport

chronic = gradual/unkown; usually with older people and w/o prior injury

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9
Q

signs of meniscal tear

A

swelling
asymmetrical/antalgic gait
limited/painful ROM (depends on where tear is)
weak and painful resisted testing
pain with compression

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10
Q

special tests for meniscus

A

meniscal CPR
McMurrays
Eges
Thessaly’s (lateral only)

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11
Q

findings indicated by Apleys test

A

distraction = ligament

compression = high specificity for meniscus

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12
Q

what would MMT and palpation show if meniscus is involved

A

possible joint line tenderness with palpation

inhibited quads with MMT

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13
Q

effectiveness of an MRI

A

in a study with 44 asymptomatic 20-68 year olds 98% had a meniscal abnormality and 61% had abnormalities in 3/4 meniscal regions

**some people can have majority of meniscus changed and still have no symptoms…

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14
Q

PT Rx for meniscus

A

POLICED = WEAK support
assistive device to prevent limp
JM
MET

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15
Q

purposes of JM for meniscus

A

pain modulation via descending pathways

meniscal integrity

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16
Q

purposes of MET for meniscus + effectiveness compared to sx

A

meniscal integrity and stabilization

NMES has moderate support for strength

equally as effective as sx in regards to pain with degenerative tears

less anxiety/depression vs sx

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17
Q

what is a partial meniscectomy + the associated post op aspects

A

removal of tear

post op:
-no immobilization
-earlier WBing
-return to play within 2-6 weeks

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18
Q

what is a meniscal repair + associated post op aspects

A

sutured

post op:
-primarily with tears in outer 1/3
-immobilization and/or limited ROM initially
-toe touch WBing for 4-6 weeks
-return to play in ~ 12 weeks (dense healing)

19
Q

effectiveness/support of sx for degenerative tears

A

sx no better at 2, 6, or 12 months vs sham (placebo) sx without ARJC

strong recommendation against sx for nearly all degenerative tears even in the presence of age related joint changes

20
Q

what is a bakers cyst

A

excessive swelling in popliteal space often due to articular changes (i.e. ARJC)

fluid filled cyst due to persistent inflammation and subsequent weakening of capsule

a herniation of fluid through posterior capsule

21
Q

signs and symptoms of a bakers cyst

A

asymptomatic until there is significant effusion

mimics degenerative meniscus tear

ROM limited and painful with flexion and extension

resisted/MMT into flexion is painful

palpable popliteal protrusion just medial to medial gastroc head

22
Q

PT Rx for bakers cyst

A

like degenerative meniscal tear/ARJC

precautions with forceful activities

big picture = reduce swelling to get better stability/ROM/etc

**stretch of capsule cant be addressed conservatively

23
Q

prognosis for bakers cyst

A

difficult to manage in active individuals

complication: rupture may occur and mimic a gastroc tear

24
Q

MD Rx for bakers cyst

A

aspiration and/or surgical repair

25
Q

incidence/prevalence of ARJC at the knee

A

most commonly of the medial femoral condyle and patellar articular surface

seen with 60-80% of knee scopes

greater prevalence in elite level sports

similar prevalence in non-elite athletic and non-athletic populations

26
Q

risk factors for ARJC

A

older age

previous joint injury

increased BMI

occupational activities

weak quads

27
Q

symptoms of ARJC

A

gradual/unknown onset

pain relief with non-WBing

stiffness <30 min after prolonged position

limited/painful motion

28
Q

severity of ARJC symptoms is associated with what (and what is it NOT associated with)

A

bone edema with subarticular bone attrition

synovitis

NOT associated with:
-osteophytes or reduction in joint space

29
Q

signs of ARJC

A

observation of asymmetrical/antalgic gait with possible genu varum

ROM = limited with firm end feels; especially pain with ext CPP

capsular pattern of restriction flx > ext

consistent block

30
Q

stress tests and acessory motion findings for ARJC

A

distraction = relief
compression = pain
AM = hypomobile

31
Q

special tests for ARJC

A

possible + meniscal tests

impaired walking distance and gait velocity with 6 minute walk tests and timed up and go

32
Q

MMT/palpation findings for ARJC

A

inhibited quads and hip abductors

palpation = joint line tenderness

33
Q

in the study with 44 asymptomatic 20-60 year olds what % had cartilage lesions or osteophytes/spurring

A

17% had cartilage lesions

27% has osteophytes/spurring

34
Q

effectiveness of STM for ARJC

A

massage improved pain and function but less than JMs

better than usual care when individualized with JM

**additive is best

35
Q

modalities effectiveness of ARJC

A

continuous passive motion = weak/inconclusive

Estim, acupuncture, and electromagnetic devices may help

US = short term pain relief

36
Q

dry needling effectiveness for ARJC

A

unclear

37
Q

orthotics/bracing effectiveness for ARJC

A

lateral heel wedges are common but NOT recommended

unloader knee brace could be helpful

38
Q

effectiveness of joint mobilizations for ARJCs

A

greater immediate pain and functional benefits vs massage (at knee and ankle)

immediate change in ext ROM when combined with STM and MET

short term pain and functional benefits

long term and greater pain relief with equal or greater gains when added to exercise

39
Q

MET effectiveness for ARJC

A

strong supportive evidence

increase in anti inflammatory markers and chondroprotective properties

NMES = moderate support for strength

long term benefits with pain and function

40
Q

what muscles should be targeted with ARJC

A

quads

hip exercises; especially anti gravity mm

41
Q

MET for ARJC

A

aerobic to help pain and disability

aquatic to help disability

Tai Chi = not clinically important

coordination/balance activities help pain and function

42
Q

other PT Rx components aside from MET and MT

A

weight management

pt edu and self management

43
Q

timing of MET + effectiveness

A

12 PT sessions over a year are better than 12 sessions over 9 weeks

MSK II (18 decks)

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