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Musculoskeletal I (second exam/practical) > Knee > Flashcards

Knee Flashcards

1
Q

Why do such huge forces travel through the knee?

A
  • Largest joint in the body between the 2 longest levers
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2
Q

What type of movement is required for the knee to function osteokinematically?

A
  • Rotation around 2 axis
  • Slides in both direction
  • Rocking
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3
Q

What is the main type of stability across the knee joint?

A

Ligamentous

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4
Q

What is the close packed position of the knee?

A

Maximal extension with ER

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5
Q

What is the loose packed position of the knee?

A

25 degrees flexion.

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6
Q

What is the capsular pattern of the knee?

A
  • More limited flexion than extension
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7
Q

How is the medial meniscus shaped?

A
  • Shaped like a C

- Thicker posteriorly

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8
Q

How is the lateral meniscus shaped?

A
  • O shaped

- Uniform thickness

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9
Q

How are both menisci shaped in cross-section?

A
  • Wedge shaped
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10
Q

What are the 3 roles of the mensici of the knee?

A
  • Shock absorption
  • Joint nutrition
  • Guide motion
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11
Q

How well are the menisci innervated?

A

poorly

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12
Q

What type of effusion occurs with meniscal injury?

A
  • Clear/ synovial effusion
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13
Q

Which meniscus is more frequently injured?

A
  • Medial meniscus
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14
Q

What are the 3 zones of the meniscus?

A
  • Interior: White
  • Middle: White/Red or Pink
  • Peripheral: Red
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15
Q

Which joint has the thickest articular cartilage in the body?

A

Patellofemoral joint

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16
Q

What are the 2 functions of the patella?

A
  • Increase moment arm of quads

- Protects articular cartilage

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17
Q

Which part of the patella is usually affect first by pathology? Why?

A
  • Odd facet affected due to its contact with the femur during the greatest angles of knee flexion
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18
Q

What are the plica?

A
  • Remnants from when the knee joint had many components
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19
Q

Which plica causes the most problems? How does it present?

A
  • Medial plica causes problems
  • Painful to palpation at medial condyle
  • Can be palpated
  • Pops or snaps
  • Hurts most in flexion
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20
Q

How are plica impairments treated?

A
  • Address inflammation

- Correct biomechanical faults

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21
Q

Can the plica be stretched?

A
  • No
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22
Q

How are plica and patellar pathology differentiated?

A

Palpation

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23
Q

How much GRF does the superior tib-fib joint bear?

A

Up to 10 %

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24
Q

What type of superior tib-fib impairment can lead to knee pain?

A

Hypomobility

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25
Q

What is the pittsburgh knee rule?

A 
-Blunt trauma or fall
AND
- Inability to take 4 steps immediately and in clinic
OR
- < 12 yo
OR
- > 50 yo
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26
Q

What is the ottawa knee rule?

A

Any of the following:

  • Age > 55
  • Tenderness at fibular head or patella
  • Inability to flex knee > 90 due to pain
  • Inability to take 4 steps immediately and in clinic
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27
Q

How sensitive and specific is the Pittsburgh knee rule?

A

Sn: 100
Sp: 70

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28
Q

How sensitive and specific is the Ottawa Knee Rule?

A

Sp: 92
Sp: 50

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29
Q

Are the ottawa and pittsburgh knee rules more specific or sensitive? Why?

A

More sensitive; don’t want to miss any fractures/

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30
Q

What is injured in a varus or valgus force at the knee?

A
  • Collateral ligaments

- Some possible cruciate ligament damage

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31
Q

What is injured in an anterior or posterior force at the knee?

A
  • Cruciate ligaments

- Some possible secondary collateral damage

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32
Q

What is injured in a noncontact hyperextension or deceleration of the knee?

A
  • ACL

- Possible menisci damage

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33
Q

What is injured in a rotary force of the knee?

A
  • Menisci
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34
Q

What does a pop in the knee typically indicate in an injury?

A

ACL tear

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35
Q

What are 4 key questions during the history taking portion of the exam for a knee injury?

A
  • Has it been injured before?
  • What functional limitations do you have?
  • Pain?
  • Does the knee lock or “give way”?
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36
Q

What is implicated by a knee locking?

A
  • Internal derangement or menisci injury
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37
Q

What is meant by a lock?

A
  • A blocked ROM of flexion or extension that can be shaken out
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38
Q

What is meant by the knee giving way?

A

Quad inhibition due to a SHARP pain

- Feels like a dis- and re-location

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39
Q

What can be implicated by a “giving way”?

A
  • Menisci
  • ACL
  • Patellofemoral pain
  • Plica
  • Arthritis
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40
Q

How can the giving way of the knee be further investigated during the subjective portion?

A

During what phase of gait does it occur?

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41
Q

What are 4 common subjective scales of the knee?

A
  • Cincinnati knee score
  • Lysholm score
  • Knee outcome survey
  • Lower extremity functional score
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42
Q

What does the cincinnati knee score assess?

A
  • General/ everyday activities
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43
Q

What does the lysholm score assess?

A
  • Ligamentous/ meniscus injury
44
Q

What does the knee outcome survey assess?

A
  • General/ funcitonal limitaitons
45
Q

What does the lower extremity funcitonal scale assess?

A
  • General
  • TKR
  • THR
46
Q

What 7 factors are assessed in the observation portion of a knee exam?

A
  • Alignment
  • Leg lengths
  • Equal weight bearing (shoes on and off)
  • Atrophy/ hypertrophy
  • Swelling, scars, redness, hair loss
  • Gait deviations
47
Q

What 3 alignments are assessed at the knee?

A
  • Varus/ valgus
  • Toe in/ out
  • Patellar position (standing/ sitting)
48
Q

What angle is measured by varus/ valgus alignment, and what is implicated by an unusual finding?

A
  • Q angle

- Hyperextension

49
Q

What is being assessed during toe in/ toe out alignment, and what is implied by an unusual finding?

A
  • Tibial torsion

- Hip anteverison

50
Q

What are 5 unusual patellar positions?

A
  • Alta/ baja
  • Gliding/ shifting
  • Tilt/ “Squinting”
  • Rotation
  • A/P displacement
51
Q

What is 7 things are palpated during a knee exam?

A
  • Temperature
  • Swelling
  • Tenderness of:
  • Bony prominences
  • Joint line
  • Muscle insertions
  • Ligaments
  • Fat pads
52
Q

What is normal AROM flexion of the knee?

A

0 - 135

53
Q

What is normal AROM extension of the knee?

A

0 - 15

54
Q

What is normal AROM IR and ER of the knee at 90 degrees?

A

IR: 0 - 30
ER: 0 - 40

55
Q

What active patellar motion is assessed during motion testing?

A

Patellar excursion

56
Q

What specific movements are testing during motion testing of the knee if necessary?

A
  • Repetitive motions
  • Sustained end-range positions
  • Combined movements
57
Q

What is PROM of knee flexion? Endfeel?

A

0 - 140, soft

58
Q

What is PROM of knee extension? Endfeel?

A

0 - 15, firm

59
Q

What is PROM of knee IR and ER? Endfeel?

A

IR: 0 - 35, Firm
ER: 0 - 45. firm

60
Q

How is passive motion of the patella assessed at the knee?

A
  • Knee extended 0 degrees
  • Glide laterally and medially
  • Shouldn’t go past midline
61
Q

What muscles that cross the knee are tested for flexbility?

A
  • Hamstrings
  • Rectus femoris
  • ITB
  • Gastroc
62
Q

What resisted motions are assessed during a knee exam? Which should only be done if the patient complaints indicate their testing?

A
  • Flex/ extension
  • Ankle plantar flexion and dorsiflexion
  • IR and ER performed if necessary
63
Q

What types of resisted motions of the knee are performed when necessary besides simple planar motions?

A
  • Repetitive motions

- Combined movements

64
Q

Describe a 10 step functional test progression of the knee from benign to aggressive.

A
  • Walking
  • Ascending/ descending stairs
  • Squatting
  • Squatting with bounce at ER
  • Running straight
  • Running straight with a quick stop
  • Vertical jump
  • Figure 8/ carioca running (keep feet pointed forward)
  • Jumping with full squat
  • Cuts, twists, pivots
65
Q

What are 4 measurable functional tests of the knee?

A
  • Single hop for distance
  • Triple hop for distance
  • Crossover triple hop for distance
  • Timed 6 minute hop
66
Q

What is chondromalacia patellae

A
  • A premature softening/ degeneration of the cartilage under the patella
67
Q

What is the 4 stage process of chondromalacia patellae? What is the symptom associated with each stage?

A

I: Cartilage softening with blebs (blisters)
- Pain after activity
II: Fissures in cartilage
- Pain during activity, but does not prevent the activity
III: Fibrillation (crabmeat) (strains of fibrous stringy material)
- Pain prevents activity
IV Full cartilage defects
- Pain constant on compressoin

68
Q

What is the only way for chondromalacia patellae to be assessed? Is this a reliable way to judge stage?

A
  • Visualization

- Poor correlation between findings and symptoms

69
Q

What is the cause of retropatellar pain syndrome?

A
  • Overuse by poor lower extremity alignment, microtrauma, or direct trauma to the patella
70
Q

What 2 activities typically provoke retropatellar pain? What are the 2 other factors that diagnose retropatellar pain?

A
  • After prolonged sitting
  • Descending or ascending stairs
  • Little efussion or ROM deficit
  • Crepitis
71
Q

What type of exercises can be performed with retropatellar pain syndrome?

A
  • Pain free
  • Low intensity, high repetition
  • Isometrics
  • Flexibility
72
Q

What is used for immediate pain relief of retropatellar pain symptoms?

A
  • Ice

- NSAIDs

73
Q

What 3 methods can be used to help correct malalignment causing retropatellar pain?

A
  • Orthotics
  • Patellar brace
  • Hip stability strengthening
74
Q

What adjunctive agent can be used with retropatellar pain syndrome?

A

McConnel taping.

75
Q

What are 3 treatments for plica?

A
  • Physical agents to reduce pain and swelling
  • Friction massage
  • Flexibility exercises
76
Q

What type of ligament sprains indicate conservative treatment?

A
  • Partial sprains
77
Q

What treatment can be provided to protect the healing ligament from excessive stress?

A
  • Crutches
  • Braces
  • Activity modification
78
Q

What 7 methods are used for treatments of ligament sprains?

A
  • Protect healing ligament
  • Pain relief/ swelling reduction
  • Strengthening (open/closed chain)
  • Neuromuscular re-education
  • Proprioceptive training
  • ROM/ flexibility
  • Functional retraining when full painfree ROM is accomplished
79
Q

What is the 2 step treatment of a partial menisectomy? When can the patient return to full function?

A
  • Pain/ swelling reduction

- Strengthening - return to full function in 3 weeks

80
Q

What is the 4 step treatment for a patient who is post-op meniscal repear?

A
  • Protected weight bearing with crutches
  • Pain/ swelling reduction
  • Avoid flexion past 90 degrees for 6 weaks
  • Strengthening
81
Q

How long is a patient on crutches following a mensical repair who for the NWB phase, and PWB phase?

A

NWB: 1 -2 weeks
PWB: 3 - 4 weeks

82
Q

What is the 3 step strengthening progression following meniscal repair?

A
  • Isometrics
  • Straight plane
  • Diagonals (transverse plane motions)
83
Q

What is the 5 step process for tendonitis of the patella and hamstring?

A
  • RICE
  • US/ IFC/ Friction massage
  • Flexibility
  • Posture/ alignment correction
  • Activity modificaiton
84
Q

What is RICE?

A
  • Rest
  • Ice
  • Compression
  • Elevation
85
Q

What are the 2 methods of posture/ alignment correction following tendonitis?

A
  • Orthotics

- Hip stability

86
Q

What can be used in a patellar tendonitis specifically?

A

A patellar strap

87
Q

What is ITB syndrome?

A
  • Overuse injury

- Pain during activity and on compression of lateral femoral condyle

88
Q

What the treatment for ITB syndrome?

A
  • Pain/ swelling reduction
  • Stretching
  • Orthotics
  • Strengthening
  • Rollers
89
Q

What is Osgood-Schlatter’s “Disease”?

A
  • Tibial tubercle apophysitis
90
Q

What patients typically develop Osgood-Schlatter’s “Disease”?

A
  • Adolescents involved in sports
91
Q

What are the 2 symptoms of Osgood-Schlatter’s “Disease”?

A
  • Localized pain with activity, especially resisted knee extension
92
Q

What are the 3 treatments typically applied for Osgood-Schlatter’s “Disease”?

A
  • Activity modification
  • RICE
  • Flexibility
93
Q

When will Osgood-Schlatter’s “Disease” activities cease?

A
  • When the growth plate closes
94
Q

When is surgery indicated for Osgood-Schlatter’s “Disease”?

A

Almost never.

95
Q

What are the 4 general treatments of OA treatment?

A
  • Pain relief
  • Correcting biomechanical faults
  • Strengthening the lower quarter
  • Endurance
  • Activity modification
96
Q

What is typically used to reduce pain in OA of the knee?

A

Lower quarter joint mobilizations

97
Q

How are biomechanical faults of the knee typically corrected?

A
  • Orthotics or braces
  • Stretching/ flexibility/ ROM
  • Weight reduction
98
Q

How do you know if you have too aggressively exercised a patient knee OA for strengthening?

A
  • Joint pain lasting more than 2 hours after exercise.
99
Q

What are 3 endurance activities for a patient with OA of the knee?

A
  • Walking
  • Water aerobics
  • Bike
100
Q

What are 6 basic exercises for the knee?

A
  • Quad/ ham/ glute sets
  • Short-arc quads
  • Straight leg raise - 4 part
  • Squats, wall slides, leg press
  • Step-downs - controlled frontal plane motion
  • Lunges
101
Q

What exercises are particularly good following surgery?

A

`- Quad/ ham/ glute sets

102
Q

What can be used to make short arc quads easier?

A
  • Quad board
103
Q

What are some variations for squats, wall slides, and leg presses?

A
  • Uni/bilateral
  • 1/2 way, 1/4 way
  • Use of an exercise ball
104
Q

How can a lunge with advanced?

A
  • Matrix
  • With reach
  • Catch a ball
105
Q

What is knee extensor lag?

A
  • Inability to perform SLR while maintaining terminal knee extension
106
Q

What are 3 causes of extensor lag?

A
  • Quad weakness
  • Hamstring tightness
  • Joint ROM loss
107
Q

What are 3 possible causes of joint ROM loss causing extensor lag?

A
  • Capsular restriction
  • Meniscal blocking
  • Joint swelling

Musculoskeletal I (second exam/practical) (7 decks)

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