KNEE Flashcards
1
Q
what is the unhappy triad
A
ACL, MCL, medial meniscus
2
Q
foot planted, rotational force with hyperext, think
A
ACL
3
Q
ACL injury, max swelling occurs within ___
A
12 hours
4
Q
typically, with ACL injury, will the pt be able to walk without assist
A
no
5
Q
return to sport with ACL is usually
A
6-9 mos
6
Q
where is autograft for ACL usually taken from
A
gracilis, semitendenosis, or patellar tendon
7
Q
issue with allographs
A
higher failure rate
8
Q
restriction associated with meniscus repair
A
very limited flexion for sev weeks
9
Q
with ACL rehab, what is a must
A
get full ext in 2 weeks
10
Q
with ACL, you want to get full ROM for all within ___ - ___wks
A
3-4
11
Q
what ex do you avoid with ACL rehab
A
do not do any open chain short or long arc quads
12
Q
what is one issue to look at week 4 with ACL rehab
A
the tissue is more compromised at ths time bc the tensile strength changes, increasing change for re-injury
13
Q
why might you question graph type with rehab ex choices for ACL
A
ex: dont do hamstring/heel slides if hamstring tendon was uses
14
Q
pts are usually braced for how long after ACL repair
A
1 full week
15
Q
about mid to late rehab for ACL, avoid open chain and closed chain (what degrees)
A
60-90 closed
30-0 open
16
Q
tibiofemoral joint usually causes px with increase in stairs bc of the concentric forces, but px going down stairs is due to
A
compression and eecentric
17
Q
bow legged
A
genu varus
18
Q
knocked knees
A
genu valgus (associated with RA)
19
Q
with genu recurvatum, what needs stretched/strengthed
A
everything post needs strengthened, everything ant needs stretched
20
Q
ant knee px (especially with squatting or stairs) think
A
patello femoral
21
Q
beneficial ex for patellarfemoral interventions
A
strengthen hip ER and quads, ITB stretches
22
Q
patellar tendonitis is aka
A
jumpers knee
23
Q
explain jumpers knee
A
associated with eccentric over loads and deceleration
px with active contraction or passive stretch
valgus knee with pronation
24
Q
persistant pain that follows the medial and lateral joint line with swelling at sometimes catching may be
A
art cart issue
25
chondromalacia patella is aka
patellofemoral OA
26
where is px with patellofemoral OA
retropatellar (worse with sitting and stairs)
27
what is "True" chondromalacia patella
softening of the cart on the post patella
28
what age usually has true chondromalacia patella
12-35 women
29
patella baja restricts what motions (low riding)
restricts extension
30
high patella (alta) may lead to what issue
subluxation or dislocation
31
what motion pinches the fat pads causing px
hyper ext
32
normal q angle
10-15
33
how to meausre q angle
asis to center of patella
| center of patella to tibial tuberosity
34
q angle measures the tendency of what
tendency of patella to track laterally
35
the higher the q angle, the higher the chance that the patella will track
laterally
36
meniscus moves with what structures
femoral condyles
37
during IR, which part of the meniscus is primarily compressed
lateral
38
during the last 15 degrees of extension, the tibia does what
ER
39
greatest PF contact is at __ degrees of flexion
60 of knee flexion
40
best range for OKC ex for pts with PF probs
below 60 degrees flexion
41
best range for CKC ex for pts with PF probs
0-30
42
which of the ligg heal well dt good bld supply
MCL
43
LCL resists ___ and ___
varus force and ER
44
85% of medial rotation force is resisted by ACL at what angles
30 and 90 degrees of
45
during IR, what ligg are getting most stress
ACL/PCL
46
during ER, what ligg are getting most stress
MCL/LCL
47
what makes up the arcuate complex
```
arcuate lig
LCL
popliteus
lateral gastroc
biceps femoris
```
48
why is healing an issue with the meniscus
lack of bld supply (poor)
49
what part of meniscus is injured more often and why
medial, it is less mobile than lateral
50
knee going out or buckling and compression hurts, think
meniscus
51
what 2 structures attach to the medial meniscus
MCL, semimebranosis
52
what 2 structures attach to the lateral meniscus
popliteus and PCL
53
glut med strain is often felt at the
GT
54
If ITB is tight, the femur often _____ rotates and the patella goes ____
IR of femur pushing the patella laterally
55
movement dx with ITB friction syndrome
TF rotation syndrome (IR)
56
capsular pattern for knee
Flexion greater than ext
57
closed packed knee
full ext
58
open packed knee
25 degrees of flexion
59
when knee flexes, the tibia glides
post
60
3 functions of the patella
provides articulation
protects femur
improves moment arm
61
hoffas syndrome is aka
infrapatellar fat pad syndrome
62
for hoffas syndrome, where is the px usually
ant knee
63
bakers cyst, the px is usually
post
64
what motion is usually very pxful with bakers cyst
flexion
65
hoffa's syndrome, what motion causes px
ext
66
apophysitis at the inf pole of the patella
sinding larson johansons syndrome
67
apophysitis at the tibial tuberosity
oschgoods
68
superficial fibular nerve innervates (motor to )
fibularis longus and brevis
69
sensation for fibular N is at
dorsum of foot and ant lower leg
70
meniscus may not always have an MOI, but pts often report a feeling of
giving way or locking during gait and stairs
71
if PCL is injured, is it typical for it to swell
not usually
72
Ottowa knee rules are highly sensitive to
fx
73
list the Ottowa knee rules
```
over 55
pinpoint patellar tenderness
fib head tenderness
cant flex to 90
cant WB
```
74
common MOI for PCL tear is
MVA where knee gets driven into dash
75
unstable meniscus tear where the knee often locks
bucket handle
76
type of meniscal tear that can lead to DJD
horizontal
77
if meniscus is repaired, they are usually braced and limited to 90 degrees of flexion for ___ wks
3
78
normal knee flexion
0-145
79
you want to achieve full ROM for meniscus rehab within
4 wks
80
common with athletes, appears as large soft mass behind knee, achy px
bakers cyst
81
ITB friction syndrome, how might you rule out hamstring strain instead
with ITB friction syndrome, the px usually is localized at lateral femoral condyle, resisted contraction doesn't reproduce px
82
need to find out from christina about spin snout numbers
ok
83
where is palpation of knee OA commonly pxful
medial knee
84
reoccuring swelling, may or may not have an MOI, sharp x with buckling or giving out
meniscus
85
2 special tests for meniscus
mcmurrays and apleys
86
how valid are mcmurrays and apley
both have low sensitivity and specificity
87
which lig injury MOI is usually non contact
ACL
88
quad dominance over hamstrings, which can increase q angle, sets up an increase of injury for which lig
ACL
89
deep achy pain, especially if walking/running down hill
patellafemoral issue
90
ant drawer and lachmens and pivot shift are for
ACL test
91
```
increased q angle
IR
pronated foot
tight IT band (IR femur)
all of these set a pt up for which type of disorder
```
patellofemoral
92
how can ITB cause an issue with the medial side of the knee
subpatellar area bc if ITB is really tight, it can pull on the patella
93
prepatellar bursitis is often caused by
repetitive hitting of the knee or kneeling and hitting floor
94
conditions related to tibiofemoral rotational syndrome
```
• Meniscal injury
• MCL/LCL sprain
• Patellofemoral joint dysfunction
• ITB friction syndrome
• Hamstring strain/tendinopathy
LMMHIP
```
95
conditions related to knee hypomobility
* OA/DJD
* Patellofemoral joint dysfunction
* Knee contracture
96
conditions related to knee ext syndrome
```
• Jumper’s knee
• Osgood-Schlatter disease
• Patellofemoral joint dysfunction
• Patellar tendonitis
• Quadriceps strain
POP Q
```
97
conditions related to knee hyperext syndrome
```
• Patellofemoral joint dysfunction
• Fat pad syndrome
• Baker’s cyst
• Anterior knee pain
F B P A
```
98
conditions related to patellar lateral glide syndrome
```
• Patellofemoral joint dysfunction
• Anterior knee pain
• Patellar dislocation
• Plica syndrome
PAD
```
99
this syndrome is described by excessive strength of the quads (dominance) so something is being pulled
knee ext syndrome
100
In this movement dysfunction, knee pain is associated with impaired knee extensor mechanism. Dominance of the hamstrings (for extension) and poor functional performance of the glut max and quadriceps muscles result in this condition which places excessive stresses on the knee
hyper ext of the knee syndrome
101
all knee movement dx have what as a possible pathology
patello femoral dysfunction
102
with tibiofemoral rotational dysfunction, the tibia rotates ___ while the femur rotates ___
tibia goes lateral while femur can go either way
103
patellar tendonitis is aka
jumpers knee
104
px with activity that requires repetitive knee ext would make you think what mvmt dx
knee ext syndrome
105
patellar lateral glide syndrome pathologies
P P A D
| plica, pf dysfunction, ant px, dislocation
106
in this movement dysfunction, knee pain results from impaired patellar relationship with the trochlear groove.
patellar lateral glide syndrome
107
list all of the mvmt sx dx
```
tibiofemoral rotation syndrome - L M M H I P
hypomobility -djd, OA, PFD
Knee ext syndrome - P O P Q
Knee hyper ext syndrome - F B P A
Lateral patellar glide - P P A D
```
108
plica is what mvmt dx
lateral patellar glide
109
this mvmt dx is Often seen in ballet dancers, soccer players, skaters, and swimmers
tibiofemoral rotation syndrome
110
explain tibiofemoral px vs patella femoral px (stairs)
Tibial femoral joint usually increases pain going upstairs (b/c concentric pull muscles)
patellofemoral problems usually worse going downstairs (b/c compression and eccentric pull)
111
what are some interventions for PatelloFemoral px
```
Strengthen hip lateral rotators
Quadriceps strengthening
ITB stretching (also retinaculum mobilization)
Patellar bracing/ taping
Foot orthosis
```
112
with a tendonitis, there is usually px with active contraction and ____
passive stretch
113
Autologous osteochondral mosiacplasty grafting –taking bone parts out of a cadaver and implanting it or
Autologous chondrocyte implantation may be a tx for
art cart defect
114
Often times, there is ___ noted with knee OA
swelling (also, remember that the medial compartment of knee degenerates faster than lateral)
115
ACL/PCL innervated by
tibial N
116
with ITB friction syndrome, resisted muscle tests are usually
neg
117
recurrent swelling with sharp px, may report locking or catching think
meniscus
118
explain how do do assessment distraction for tib femoral joint
their leg is off table, you stabalize their lower leg btwn your legs and pull down
119
remember for knee, the assessment includes distraction, ant glide, post glide, patella glide and tilts
yes
120
to increase knee ext, you glide tibia
ant
121
to increase knee flexion, you glide tibia
post
122
list all ways to increase knee flexion with mobs
1. post drawer type mob
2. ant glide of femur prone (pillow under thigh as you hold thigh, push femur down- slight knee flexion)
3. seated posterior glide of tibia (add some distraction as you push post, towel under knee)
4. Unicondylar, they are seated and you push on medial condyle like you are internally rotating them as you push post)
123
List all ways to increase knee ext with mobs
1. ant drawer type mob
2. post femoral glide (they are supine -use towel under knee (your mobbing hand is above the patella) and you push the femur post
3. ant glide (short seated) towel under knee and add distraction
4. Unicondylar glide (for lateral unicondylar they need to be supine bc knee needs to be in ext -push on lateral condyle as you push post)
124
flexion main concepts (mobs)
flexion : post glide of tibia or ant glide of femur
125
extension main concepts (mobs)
ant glide of tibia or post glide of femur
126
patellar glides, superior is for
ext (superior is the only one for ext, all others are for flexion)
127
patellar glides, superior is for
ext (superior is the only one for ext, all others are for flexion)
128
explain the convex/concave of tibia femur
The femur is convex on the concave tibia
129
resting position of knee
25 degrees flexion
130
knee distraction should not exceed a grade
II
131
ant fibular head glide helps with knee
ext
132
ant fibular head glide can be done
prone, sidelying, all 4s
133
tib/femoral angle (what degrees are valgum/varum)
Genu valgum: “knock knees”; angle less than 165°
| Genu varum: “bow legs”; angle approaches or exceeds 180°
134
tib/femoral angle (what degrees are valgum/varum)
Genu valgum: “knock knees”; angle less than 165°
| Genu varum: “bow legs”; angle approaches or exceeds 180°
135
ottawa knee rules
o In an acute injury, if one of 5 variable identified are present, radiographs are required.
Age >/= 55 years
Isolated patellar tenderness without other bone tenderness
Tenderness of the fibular head
Inability to flex knee to 90 degrees
Inability to bear weight immediately after injury and in the ED
136
how to grossly check tibial torsion
they are seated, you use your fingers around the malleoli (like you draw a line btwn) keep in mind the angle of the malleoli when placing your fingers
137
how can you objectively determine patella baja/alta
measure the length of the patella, then compare that to the length of the tibial tub to bottom of patella
138
2 special tests for knee edema
ballotable (top and bottom of knee joint and push togeher)
| milking -move it around to 1 spot
139
pes anserine is located
medial and distal to tib tub
140
how to check a pts screw home mech
With patient sitting with knee flexed to 90, palpate the tibial tubercle and a point on the patella so the two points form a vertical line. Patient actively extends the knee. You should observe the tibia laterally rotating on the femur.
141
how to check a pts screw home mech
o With patient sitting with knee flexed to 90, palpate the tibial tubercle and a point on the patella so the two points form a vertical line. Patient actively extends the knee. You should observe the tibia laterally rotating on the femur.
142
if ant drawer is pos, what do you do next
slocums
| like ant drawer but turn foot in and test then turn foot out and test
143
explain pivot shift
```
supine
hip flexed, knee mostly ext
your hand makes a C over calf as your thumb is behind fibular head
you IR knee
slightly flex knee and add valgus force
clunk = pos
```
144
main features of valgus/varus testing
make sure and start in opposing position
| do at 5 and 30 degrees both
145
main features of valgus/varus testing
make sure and start in opposing position
| do at 5 and 30 degrees both
146
explain mcmurrays
meniscus
2 components
pt is supine
you ER tibia
their hip is flexed and knee flexed as you hold foot
and apply valgus force (from lat knee line) as you take the knee into ext
then IR knee and do varus force
147
explain thessaleys test
they stand, bend knee, hold your hands and twist trunk
148
explain thessaleys test
they stand, bend knee, hold your hands and twist trunk
149
pivot shift, starts in knee
ext
150
mcmurrays starts in knee
flexion
151
explain patella apprehension test
start with full ext, you move their patella lat as you flex knee and ext it back
then repeat with medial patellar glide
152
Clarke's sign
mean patella one
153
What is the BEST range to do open-kinetic chain knee exercises if patient has patellofemoral joint problems or a recent ACL injury?
Avoid 0-30 degrees of extension
| Want to do 40-90 degrees of flexion
154
What is the BEST range to do closed-kinetic chain knee exercises if patient has patellofemoral joint problems?
0-30 degrees of knee flexion
