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Ortho 1- second half > Knee > Flashcards

Knee Flashcards

1
Q

functional anatomy review

A
  • largest joint in the body
  • interposed between 2 longest levers
  • requires freedom to rotate around 2 axes, slide in 2 directions
  • ligamentous, not bony stability

capsular pattern- greater limitation in flexion than extension

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2
Q

close packed

A

max extension with ER

“screw home”

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3
Q

loose packed

A

25 deg flexion

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4
Q

menisci aid in

A
  • shock absorption
  • joint nutrition
  • guide motion
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5
Q

medial meniscus

A

C shaped

thicker posteriorly

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6
Q

lateral meniscus

A

O shaped
same thickness
less frequently injured (less attached)

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7
Q

menisci

A
  • no (poor) innervation
  • injury often results in clear (synovial, not bloody) effusion

3 zones:

  • interior= white
  • middle= white/red
  • peripheral= red
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8
Q

patellofemoral joint

A

-thickest articular cartilage in the body

patella:
- increases moment arm of quads
- protects femoral articular cartilage
- odd facet often affected first-contact at greater angles of knee flexion

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9
Q

plica

A

can cause clinical problems
=a reminant from then the knee capsule used to have several components now has 1 large continuous capsule

Typically medial side (medial to patella) pt will pt to femoral condyle medial to patella with pain on palpation and with flexion
Can actually strum the plica and that will cause pain.
Evolutionary thing not developmental- ppl are either born with it or not
Will act like patella pathology, should be able to differentiate though

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10
Q

proximal tib-fib joint

A

can weight bear up to 10% ground reaction force

-hypomobility can lead to knee pain

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11
Q

pittsburgh knee rule

A

sn=100; sp=70

  • blunt trauma or fall and
  • inability to take 4 steps immediately and in clinic or
  • age 50
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12
Q

ottawa knee rule

A

sn=92; sp=50

  • age>55
  • tenderness at fib head or patella
  • inability to flex knee >90 bc of pain not ROM
  • inability to take 4 steps immediately and in clinic
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13
Q

Mechanism of Injury

A

Planar forces:

  • varus/valgus= collaterals (2* cruciates)
  • ant/post= cruciates (2* collaterals)
  • noncontact hyperextension or deceleration= ACL +/- meniscii

Rotary forces involve the menisci

was there a pop?? (prob ACL snap)

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14
Q

patient exam- history

A
  • has the knee been injured before?
  • functional limitations?
  • pain now? (where? type? rating now? at worst? 24 hour pattern? what makes better/worse?
  • locking or giving way?

Have ROM, suddenly blocked from going into further flexion/extension
Could have periods of block and then in another position unlocks
Indicates flap of meniscus that flaps into and out of the joint space: sometimes in place sometimes out

“giving way” :weak quad strength? Or sublux/relux??

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15
Q

common subjective knee scales

A

cincinnati knee score: general/pt’s usual activities

Lysholm score: ligs/meniscus injury

knee outcome survey: general/functional limitations

LEFS: general/TKR/ THR

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16
Q

patient exam

A
  • systems review
  • OBSERVATION:
  • PALPATION:
  • MOTION TESTING
  • functional testing
  • special tests
17
Q

OBSERVATION:

A

Alignment:

  • varus/valgus- Q angle- hyperextension
  • toe in/out- tibial torsion- hip anteversion
  • patellar position (standing/sitting): alta/baja; glide (shift); tilt “squinting”; rotation; A/P
  • leg lengths
  • equal WBing (with/without shoes)
  • atrophy/hypertrophy
  • swelling, scars, redness, hair loss
  • gait deviations
18
Q

palpation

A
  • temp
  • swelling (ballotment)
  • tenderness of bony prominences, joint line, muscle insertions, ligs, fat pad
19
Q

motion testing

A

Active:(sitting or supine): flexion, ext, ER, IR, patellar excursion

  • repetitive motions (if necessary)
  • sustained end range positions (if necessary)
  • combined movements (if necc)

Passive: sitting/supine

  • flex, ext, IR, ER
  • patellar med/lat glide with knee at 0; should not extend past 1/2 patella width
  • flexibility: hams, rectus femoris, ITB, gastroc

Resisted: sit/supine

  • flex, ext, IR, ER, ankle PF/ DF
  • repetitive motions
  • combined movements
20
Q

functional testing

A

(benign to aggressive)

  • walking (did this during observation)
  • ascending/descending stairs
  • squatting –> w/ bounce at end range
  • running straight
  • running straight then quick stop
  • vertical jump
  • figure 8, carioca running
  • jumping with full squat
  • hard cuts, twists, pivots
  • single hop for distance
  • triple hop for distance
  • crossover triple hop for distance
  • timed 6 meter hop

side to side comparisons of 80-85% considered normal

21
Q

chondromalacia patellae

A

=premature softening/degeneration of cartilage under patella

I: cartilage softening with blebs (blisters)
-pain after activity

II: fissures appear in cartilage
-pain during activity- does not prevent activity

III: fibrillation (crab meat)
-pain prevents activity

IV: full cartilage defects
-pain constant on compression

*note can only diagnose by visualization- poor correlation of visual findings to symptoms

22
Q

retropatellar pain syndrome

A
  • pain after prolonged sitting
  • pain on descending > ascending stairs
  • crepitus
  • little effusion or ROM deficit

Causes:
-overuse by poor LE alignment, micro trauma, direct trauma to patella

Treatment:

  • exercise intensity ^ w/o symptoms ^
  • low intensity, high rep
  • isometrics
  • pain relief (NSAIDS, ice, etc)
  • McConnell taping
  • correct malalignment (orthotics, brace, hip stability strengthening
  • flexibility
23
Q

plica

A
  • physical agents to decrease pain and swelling
  • friction massage
  • flexibility
  • if conservative treatment fails- surgery
24
Q

ligament sprains

A

conservative if partial
surgery of complete ACL? or PCL

  • protect healing ligament from excessive stress (crutches, brace, activity mod)
  • pain relief/ swelling reduction
  • strengthening (open/closed chain)
  • neuromuscular re-ed
  • proprioception training
  • ROM/flexibility
  • functional re-training (sports specific) when full painfree ROM
25
Q

meniscal tears

A

partial menisectomy

meniscal repair-protocol by surgeon

26
Q

partial menisectomy

A
  • pain/swelling reduction

- strengthening-return to full function in 3 weeks

27
Q

meniscal repair- protocol by surgeon

A
  • depend on location/orientation of tear and repair
  • protective WB with crutches: NWB weeks 1-2, PWB weeks 3-4
  • avoid flexion >90 for 6 weeks
  • strengthening: isometrics, straight plane, diagonals (transverse plane motions)
28
Q

tendonitis (patellar, hamstring)

A
  • RICE
  • US/IFC/friction massage
  • flexibility
  • posture/alignment correction (orthotics, hip stability)
  • activity mod
  • patellar strap
29
Q

ITB syndrome

A
  • overuse
  • pain during activity and on compression over lateral femoral condyle

conservative treatment:

  • pain/swelling reduction
  • correct alignment/biomechanical faults (stretching, orthotics, strengthening)
30
Q

Osgood-Schlatter’s disease

A
  • tibial tuberal apophysitis
  • adolescents involved in sports

symptoms:
- localized pain with activity, resisted knee extension
- can have an enlarged tubercle when chronic

treatment:
- stop aggravating activity
- RICE
- flexibility
- symptoms will disappear when growth plate closes
- surgery rarely indicated

31
Q

OA tx for acute stage

A
  • pain relief- jt mobs
  • correct biomechnical faults: orthotics, braces, stretching/ flexibility/ROM, wt reduction
  • lower 1/4 strengthening: joint pain should not last >2 hrs after exercise
  • endurance: walking, water aerobics, bike
  • activity mod: joint protection

Refer to arthritis foundations for programs and info

32
Q

basic knee exercises

A

quad/ham/glut sets: excellent post op (regain quad activation)

short arc quads: open chain with quad board

straight leg raise: 4 part

squats, wall slides, leg press

  • uni/bilateral
  • 1/2, 1/4, with or w/o ball

step downs: control frontal plane motion

lunges:

  • matrix
  • with reach, catch ball
33
Q

extensor lag

A 
=inability to perform SLR while maintaining terminal knee extension
?quad weakness
?hamstring tightness
?joint ROM loss
-capsular restriction
-meniscal blocking
-joint swelling

Ortho 1- second half (5 decks)

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