Knee Flashcards
1
Q
Why do such huge forces travel through the knee?
A
- Largest joint in the body between the 2 longest levers
2
Q
What type of movement is required for the knee to function osteokinematically?
A
- Rotation around 2 axis
- Slides in both direction
- Rocking
3
Q
What is the main type of stability across the knee joint?
A
Ligamentous
4
Q
What is the close packed position of the knee?
A
Maximal extension with ER
5
Q
What is the loose packed position of the knee?
A
25 degrees flexion.
6
Q
What is the capsular pattern of the knee?
A
- More limited flexion than extension
7
Q
How is the medial meniscus shaped?
A
- Shaped like a C
- Thicker posteriorly
8
Q
How is the lateral meniscus shaped?
A
- O shaped
- Uniform thickness
9
Q
How are both menisci shaped in cross-section?
A
- Wedge shaped
10
Q
What are the 3 roles of the mensici of the knee?
A
- Shock absorption
- Joint nutrition
- Guide motion
11
Q
How well are the menisci innervated?
A
poorly
12
Q
What type of effusion occurs with meniscal injury?
A
- Clear/ synovial effusion
13
Q
Which meniscus is more frequently injured?
A
- Medial meniscus
14
Q
What are the 3 zones of the meniscus?
A
- Interior: White
- Middle: White/Red or Pink
- Peripheral: Red
15
Q
Which joint has the thickest articular cartilage in the body?
A
Patellofemoral joint
16
Q
What are the 2 functions of the patella?
A
- Increase moment arm of quads
- Protects articular cartilage
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
18
Q
What are the plica?
A
- Remnants from when the knee joint had many components
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
20
Q
How are plica impairments treated?
A
- Address inflammation
- Correct biomechanical faults
21
Q
Can the plica be stretched?
A
- No
22
Q
How are plica and patellar pathology differentiated?
A
Palpation
23
Q
How much GRF does the superior tib-fib joint bear?
A
Up to 10 %
24
Q
What type of superior tib-fib impairment can lead to knee pain?
A
Hypomobility
25
What is the pittsburgh knee rule?
```
-Blunt trauma or fall
AND
- Inability to take 4 steps immediately and in clinic
OR
- < 12 yo
OR
- > 50 yo
```
26
What is the ottawa knee rule?
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
27
How sensitive and specific is the Pittsburgh knee rule?
Sn: 100
Sp: 70
28
How sensitive and specific is the Ottawa Knee Rule?
Sp: 92
Sp: 50
29
Are the ottawa and pittsburgh knee rules more specific or sensitive? Why?
More sensitive; don't want to miss any fractures/
30
What is injured in a varus or valgus force at the knee?
- Collateral ligaments
| - Some possible cruciate ligament damage
31
What is injured in an anterior or posterior force at the knee?
- Cruciate ligaments
| - Some possible secondary collateral damage
32
What is injured in a noncontact hyperextension or deceleration of the knee?
- ACL
| - Possible menisci damage
33
What is injured in a rotary force of the knee?
- Menisci
34
What does a pop in the knee typically indicate in an injury?
ACL tear
35
What are 4 key questions during the history taking portion of the exam for a knee injury?
- Has it been injured before?
- What functional limitations do you have?
- Pain?
- Does the knee lock or "give way"?
36
What is implicated by a knee locking?
- Internal derangement or menisci injury
37
What is meant by a lock?
- A blocked ROM of flexion or extension that can be shaken out
38
What is meant by the knee giving way?
Quad inhibition due to a SHARP pain
| - Feels like a dis- and re-location
39
What can be implicated by a "giving way"?
- Menisci
- ACL
- Patellofemoral pain
- Plica
- Arthritis
40
How can the giving way of the knee be further investigated during the subjective portion?
During what phase of gait does it occur?
41
What are 4 common subjective scales of the knee?
- Cincinnati knee score
- Lysholm score
- Knee outcome survey
- Lower extremity functional score
42
What does the cincinnati knee score assess?
- General/ everyday activities
43
What does the lysholm score assess?
- Ligamentous/ meniscus injury
44
What does the knee outcome survey assess?
- General/ funcitonal limitaitons
45
What does the lower extremity funcitonal scale assess?
- General
- TKR
- THR
46
What 7 factors are assessed in the observation portion of a knee exam?
- Alignment
- Leg lengths
- Equal weight bearing (shoes on and off)
- Atrophy/ hypertrophy
- Swelling, scars, redness, hair loss
- Gait deviations
47
What 3 alignments are assessed at the knee?
- Varus/ valgus
- Toe in/ out
- Patellar position (standing/ sitting)
48
What angle is measured by varus/ valgus alignment, and what is implicated by an unusual finding?
- Q angle
| - Hyperextension
49
What is being assessed during toe in/ toe out alignment, and what is implied by an unusual finding?
- Tibial torsion
| - Hip anteverison
50
What are 5 unusual patellar positions?
- Alta/ baja
- Gliding/ shifting
- Tilt/ "Squinting"
- Rotation
- A/P displacement
51
What is 7 things are palpated during a knee exam?
- Temperature
- Swelling
- Tenderness of:
* Bony prominences
* Joint line
* Muscle insertions
* Ligaments
* Fat pads
52
What is normal AROM flexion of the knee?
0 - 135
53
What is normal AROM extension of the knee?
0 - 15
54
What is normal AROM IR and ER of the knee at 90 degrees?
IR: 0 - 30
ER: 0 - 40
55
What active patellar motion is assessed during motion testing?
Patellar excursion
56
What specific movements are testing during motion testing of the knee if necessary?
- Repetitive motions
- Sustained end-range positions
- Combined movements
57
What is PROM of knee flexion? Endfeel?
0 - 140, soft
58
What is PROM of knee extension? Endfeel?
0 - 15, firm
59
What is PROM of knee IR and ER? Endfeel?
IR: 0 - 35, Firm
ER: 0 - 45. firm
60
How is passive motion of the patella assessed at the knee?
- Knee extended 0 degrees
- Glide laterally and medially
- Shouldn't go past midline
61
What muscles that cross the knee are tested for flexbility?
- Hamstrings
- Rectus femoris
- ITB
- Gastroc
62
What resisted motions are assessed during a knee exam? Which should only be done if the patient complaints indicate their testing?
- Flex/ extension
- Ankle plantar flexion and dorsiflexion
- IR and ER performed if necessary
63
What types of resisted motions of the knee are performed when necessary besides simple planar motions?
- Repetitive motions
| - Combined movements
64
Describe a 10 step functional test progression of the knee from benign to aggressive.
- 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
What are 4 measurable functional tests of the knee?
- Single hop for distance
- Triple hop for distance
- Crossover triple hop for distance
- Timed 6 minute hop
66
What is chondromalacia patellae
- A premature softening/ degeneration of the cartilage under the patella
67
What is the 4 stage process of chondromalacia patellae? What is the symptom associated with each stage?
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
What is the only way for chondromalacia patellae to be assessed? Is this a reliable way to judge stage?
- Visualization
| - Poor correlation between findings and symptoms
69
What is the cause of retropatellar pain syndrome?
- Overuse by poor lower extremity alignment, microtrauma, or direct trauma to the patella
70
What 2 activities typically provoke retropatellar pain? What are the 2 other factors that diagnose retropatellar pain?
- After prolonged sitting
- Descending or ascending stairs
- Little efussion or ROM deficit
- Crepitis
71
What type of exercises can be performed with retropatellar pain syndrome?
- Pain free
- Low intensity, high repetition
- Isometrics
- Flexibility
72
What is used for immediate pain relief of retropatellar pain symptoms?
- Ice
| - NSAIDs
73
What 3 methods can be used to help correct malalignment causing retropatellar pain?
- Orthotics
- Patellar brace
- Hip stability strengthening
74
What adjunctive agent can be used with retropatellar pain syndrome?
McConnel taping.
75
What are 3 treatments for plica?
- Physical agents to reduce pain and swelling
- Friction massage
- Flexibility exercises
76
What type of ligament sprains indicate conservative treatment?
- Partial sprains
77
What treatment can be provided to protect the healing ligament from excessive stress?
- Crutches
- Braces
- Activity modification
78
What 7 methods are used for treatments of ligament sprains?
- 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
What is the 2 step treatment of a partial menisectomy? When can the patient return to full function?
- Pain/ swelling reduction
| - Strengthening - return to full function in 3 weeks
80
What is the 4 step treatment for a patient who is post-op meniscal repear?
- Protected weight bearing with crutches
- Pain/ swelling reduction
- Avoid flexion past 90 degrees for 6 weaks
- Strengthening
81
How long is a patient on crutches following a mensical repair who for the NWB phase, and PWB phase?
NWB: 1 -2 weeks
PWB: 3 - 4 weeks
82
What is the 3 step strengthening progression following meniscal repair?
- Isometrics
- Straight plane
- Diagonals (transverse plane motions)
83
What is the 5 step process for tendonitis of the patella and hamstring?
- RICE
- US/ IFC/ Friction massage
- Flexibility
- Posture/ alignment correction
- Activity modificaiton
84
What is RICE?
- Rest
- Ice
- Compression
- Elevation
85
What are the 2 methods of posture/ alignment correction following tendonitis?
- Orthotics
| - Hip stability
86
What can be used in a patellar tendonitis specifically?
A patellar strap
87
What is ITB syndrome?
- Overuse injury
| - Pain during activity and on compression of lateral femoral condyle
88
What the treatment for ITB syndrome?
- Pain/ swelling reduction
- Stretching
- Orthotics
- Strengthening
- Rollers
89
What is Osgood-Schlatter's "Disease"?
- Tibial tubercle apophysitis
90
What patients typically develop Osgood-Schlatter's "Disease"?
- Adolescents involved in sports
91
What are the 2 symptoms of Osgood-Schlatter's "Disease"?
- Localized pain with activity, especially resisted knee extension
92
What are the 3 treatments typically applied for Osgood-Schlatter's "Disease"?
- Activity modification
- RICE
- Flexibility
93
When will Osgood-Schlatter's "Disease" activities cease?
- When the growth plate closes
94
When is surgery indicated for Osgood-Schlatter's "Disease"?
Almost never.
95
What are the 4 general treatments of OA treatment?
- Pain relief
- Correcting biomechanical faults
- Strengthening the lower quarter
- Endurance
- Activity modification
96
What is typically used to reduce pain in OA of the knee?
Lower quarter joint mobilizations
97
How are biomechanical faults of the knee typically corrected?
- Orthotics or braces
- Stretching/ flexibility/ ROM
- Weight reduction
98
How do you know if you have too aggressively exercised a patient knee OA for strengthening?
- Joint pain lasting more than 2 hours after exercise.
99
What are 3 endurance activities for a patient with OA of the knee?
- Walking
- Water aerobics
- Bike
100
What are 6 basic exercises for the knee?
- 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
What exercises are particularly good following surgery?
`- Quad/ ham/ glute sets
102
What can be used to make short arc quads easier?
- Quad board
103
What are some variations for squats, wall slides, and leg presses?
- Uni/bilateral
- 1/2 way, 1/4 way
- Use of an exercise ball
104
How can a lunge with advanced?
- Matrix
- With reach
- Catch a ball
105
What is knee extensor lag?
- Inability to perform SLR while maintaining terminal knee extension
106
What are 3 causes of extensor lag?
- Quad weakness
- Hamstring tightness
- Joint ROM loss
107
What are 3 possible causes of joint ROM loss causing extensor lag?
- Capsular restriction
- Meniscal blocking
- Joint swelling
