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KIN 440 > Knee & Ankle > Flashcards

Knee & Ankle Flashcards

1
Q

Explain what it means when we say the knee is part of a kinetic chain.

A
  • affected by actions and/or transmits forces
  • occurring at the foot, ankle, and lower leg
  • from the hip, pelvis and spine
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2
Q

Why is the knee one of the most traumatized joints in sports?

A
  • due to the stresses that are regularly applied
  • in ADL, activity, mobility
  • due to forces = vulnerable
  • exposed joint in sport, lack of medial and lateral stability
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3
Q

Identify structures of stability and support in the knee:

A
  • ligamentous, joint capsule, meniscus, bursa (structural, inert)
  • muscles surrounding the knee (functional)
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4
Q

Explain what it means when we say the ankle is part of a kinetic chain.

A
  • relationships joint to joint
  • functions to transmit ground reaction and rotational forces
  • movement at the ankle joint may be dictated by the foot
  • contact with the ground may impact lower leg mechanics
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5
Q

Identify structures of stability and support in the ankle:

A
  • muscles (contractile) structures from lower leg to toes

- ligaments, bones (inert) structures with respect to alignment and positioning

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6
Q

Knee joint = _____ joint

A

tibiofemoral

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7
Q

What type of joint is the knee? What structures are involved?

A
  • hinge joint

- articulation of femur and tibia

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8
Q

Movements at the knee:

A
  • flexion-extension

- tibial rotation (with a modified pivotal joint, int. /ext. rotation)

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9
Q

Screw home rotation:

A
  • tibial internal rotation with flexion

- tibial external rotation with extension

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10
Q

Discuss kinetic chain and rotation at the knee.

A
  • functionally (gait, squat, motor skills & sports skills)
  • affect of rotation to joints above and below (consider quadriceps distal attachment)
  • MMT - hamstrings
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11
Q

Position based observations of ROM:

A
  • sitting knee flexion
  • prone knee flexion
  • standing knee flexion
  • kneeling knee flexion
  • knee rotation (medial, lateral with foot)
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12
Q

Patella: _____ bone in tendon, ____ aspect of joint.

A
  • sesamoid

- anterior

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13
Q

Functions of the patella:

A
  • covers and protects anterior surface of joint
  • distributes compressive forces on the femur by increasing contact area
  • aids in knee flexikon/extension
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14
Q

How does the patella aid in flexion and extension?

A
  • translates during flex/extension
  • increases leverage tendon can exert on femur
  • lengthens lever arm of quadriceps muscle
  • protects the patellar tendon against friction
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15
Q

Observe patellar movement _____ and _____.

A
  • actively

- passively

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16
Q

Direction of movements in patella:

A
  • superiorly/inferiorly

- medially/laterally

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17
Q

Patellar movement is influenced by ____ ____:

A
  • extensor mechanism
  • muscles, retinaculum, bones shape & design
  • alignment with angles of pull or forces
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18
Q

2 types of injury to patella:

A
  • acute (fracture, tendonitis, infection etc.)

- chronic - more common (PFPS)

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19
Q

PFPS =

A

patellofemoral pain syndrome

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20
Q

Knee joint capsule provides ____ ____ and is supported by ______.

A
  • joint stability

- ligaments

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21
Q

Capsular injury results in _____ _____:

A
  • capsular swelling
  • intra-capsular swelling
  • extra-capsular swelling
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22
Q

Capsular injury is referred to as a _____.

A

sprain

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23
Q

Capsular injury creates a _____ of ….

A
  • pattern of restriction of ROM

- flexion more restricted than extension

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24
Q

Medial & lateral menisci of knee joint: 2 ____ ____ held to ____ _____ by _____ _____.

A
  • articular disks
  • tibial condyles
  • coronary ligaments
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25
Q

Medial and lateral menisci have limited _____ ____.

A

healing capacity

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26
Q

Function of medial and lateral menisci:

A
  • improve joint stability
  • increase shock absorption
  • distribute weight over larger surface area to deal with contact forces
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27
Q

How do bursa at the knee joint function to increase ROM?

A

works with muscles & tendons to decrease tissue stress on bone, on tendons

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28
Q

Anterior bursa at knee joint:

A
  • suprapatellar
  • prepatellar (subcutaneous)
  • infrapatellar (superficial & deep)
  • pretibial
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29
Q

Lateral bursa at knee joint:

A
  • lateral gastrocnemius
  • fibular
  • fibulopopliteal
  • subpopliteal
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30
Q

Medial bursa at knee joint:

A
  • medial gastrocnemius
  • pes anserine
  • semimembranosa
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31
Q

IOS =

A

indications for assessment

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32
Q

IOS for bursa at knee joint:

A
  • pain presents with movement (ROM)

- pain with compression

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33
Q

Attachments and orientation of fibres for MCL and LCL:

A
  • both cross joint line, bone to bone

- extracapsular (except MCL blends with the medial meniscus)

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34
Q

How do MCL and LCL add to joint stability?

A
  • fibres are tight throughout ROM

- taut in position of extension

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35
Q

MCL function:

A
  • protects against an abducting force that puts the knee into a valgus position
  • supports medial knee joint
  • functions to protect against rotational forces to the knee
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36
Q

LCL function:

A
  • protect against an adducting force that puts the knee into a varus position
  • supports lateral knee joint
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37
Q

Attachments and orientation of fibres for ACL and PCL:

A
  • bone to bone

- intra-capsular

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38
Q

MCL =

A

medial collateral ligament

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39
Q

LCL =

A

lateral collateral ligament

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40
Q

ACL =

A

anterior cruciate ligament

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41
Q

PCL =

A

posterior cruciate ligament

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42
Q

ACL function:

A

protect against anterior translation of tibia relative to the femur

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43
Q

PCL function:

A

protect against posterior translation of the tibia relative to the femur

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44
Q

Ligaments are _____ restraints to _____ and _____ forces at the knee.

A
  • secondary
  • valgus
  • varus
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45
Q

Ligaments stabilize joint in _____ ____.

A

excessive ROM

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46
Q

ACL works with the _____.

A

hamstrings m.

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47
Q

PCL works with the _____.

A

quadriceps m.

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48
Q

Ankle joint consists of _____ and _____.

A
  • talocrural

- talocalcaneal

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49
Q

Talocrural joint articulation:

A
  • tibia
  • fibular
  • talus
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50
Q

Talocrural joint motion:

A

hinge joint with plantarflexion & dorsiflexion ROM

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51
Q

Subtalar joint (talocalcaneal joint) articulation:

A
  • talus

- calcaneus

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52
Q

Subtalar joint (talocalcaneal joint) motion:

A

gliding joint with eversion and inversion ROM

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53
Q

Ankle joint stability = _____ and _____.

A
  • structural

- functional

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54
Q

How does the bony shape of the ankle affect stability of the joint?

A

malleoli & talus = joint mortise

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55
Q

Ligamentous support of ankle joint:

A
  • medial: deltoid is strong band
  • lateral: 3 key ligaments
  • superior: syndesmotic, distal tib-fib ligament assists as joint stabilizer
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56
Q

3 key ligaments on lateral ankle:

A
  • ATFL
  • PTFL
  • CFL
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57
Q

ATFL =

A

anterior talofibular ligament

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58
Q

PTFL =

A

posterior talofibular ligament

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59
Q

CFL =

A

calcaneofibular ligament

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60
Q

4 parts that add to ankle joint stability:

A
  • bony shape
  • ligamentous support
  • joint capsule support
  • muscular support
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61
Q

ROM of ankle joint:

A
  • plantar flexion, dorsiflexion

- inversion, eversion

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62
Q

Toes (MTP joints) ROM:

A
  • flexion
  • extension
  • adduction
  • abduction
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63
Q

4 evertors:

A
  • peroneus brevis
  • peroneus longus
  • peroneus tertius
  • extensor digitorum longus
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64
Q

3 invertors:

A
  • Tom Dick & Harry
  • post tibial
  • flex digit longus
  • flex hall longus
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65
Q

Capsular injury of the ankle joint results in _____ swelling that _____ ____.

A
  • capsular

- decreases ROM

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66
Q

Medial ligaments of the ankle:

A

deltoid ligament

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67
Q

2 syndesmotic ligaments of ankle:

A
  • distal ant. tibio-fibular lig

- distal post. tibio-fibular lig

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68
Q

Key to IOS at ankle:

A
  • MOI

- position of injury with the orientation of ligaments

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69
Q

Injury to a bursa in the ankle can result in _____. We should consider _____.

A
  • bursitis

- MOI

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70
Q

Foot and toe bursae:

A
  • metatarsal bursa
  • metatarsophalangeal bursa
  • calcaneal bursa
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71
Q

Ankle bursae:

A
  • retrocalcaneal bursa
  • subcutaneous calcaneal bursa
  • subcutaneous bursa of medial malleolus
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72
Q

When asking additional questions for knee and ankle, questions determining ____ is critical.

A

MOI

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73
Q

Acute or chronic injury depends on:

A
  • MOI and DOI
  • forces delivered
  • angles of stress
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74
Q

“Give way” sensation is associated with…

A

ligaments

75
Q

Locking or clicking is associated with…

A

meniscus

76
Q

Pops, snaps, cracks are associated with..

A

ligament

77
Q

Clicking and grating are associated with…

A

patellar

78
Q

What to look for with bruising and swelling:

A
  • occur rapidly or immediately?
  • location
  • any changes since DOI
  • what kind of swelling (intra/extra capsule)
79
Q

An important additional question to ask is regarding their ability to ____ ____ after injury. This includes…

A
  • weight-bear
  • walk? continue activity?
  • ADL
  • consider functional limitations
80
Q

What components of past medical history are important for the knee and ankle?

A
  • PMHx of joints above and/or below

- frequent joint instability episodes

81
Q

In activity history, it is important to find…

A
  • history of instability in activity
  • relevant findings to activity (changes to …)
  • linking to MOI (forces or stress to structures)
82
Q

With personal history, we should consider the affect of ____ on the ankle and knee, including…

A
  • age
  • growth spurts (young)
  • load with time (age)
83
Q

Why is it important to consider anthropometrics in personal history for ankle and knee injuries?

A

changes to weight = loads to structures

84
Q

Why is male/female important?

A
  • Q-angles

- pelvic posture

85
Q

Personal history: know _____ limb relationship to CC.

A

dominant

86
Q

Personal history: know _____ and _____ relationship to CC.

A
  • occupation

- ADL

87
Q

Flag type questions for differential diagnosis of CC;

A
  • progressive or severe neurological deficits in the LE

- young patients with swelling

88
Q

Local observations for knee and ankle:

A
  • swelling, red, bruising (inflammation)

- asymmetries or malalignment (bony landmarks, muscle girth, deformity)

89
Q

Global observations for knee and ankle:

A
  • overall LE alignment and position

- function of LE, signs of altered function

90
Q

How to assess overall LE alignment and position:

A

trunk & pelvis to the arches of foot

91
Q

How to assess function of LE:

A
  • gait: unremarkable or remarkable

- able to walk on toes, walk on heels, sit/squat

92
Q

Components of gait:

A
  • equal weight
  • stride length
  • heel-toe walking
  • limp
  • toe in/out
  • abnormal gait
93
Q

Patella baja:

A

low patella

94
Q

Patella alta:

A

high patella

95
Q

Notable observation at the knee: observe ____ positioning.

A

patella

96
Q

Patella can be displaced how?

A
  • high or low

- medial or lateral

97
Q

What can we do for patellar positioning?

A

taping

98
Q

Patella moves with the _____, and the angle of pull can be affected by the position of the _____.

A
  • quadriceps

- foot

99
Q

PFS =

A

patellofemoral syndrome

100
Q

PFS is commonly described as:

A

pain to patellar area

101
Q

Cause of PFS:

A

TBD

102
Q

MOI and IOS of PFS:

A
  • subluxation
  • dislocation
  • chondromalacia
  • tendonitis/tendonopathy
  • sprain to retinaculum, to medial patellar ligament
  • contusion
  • fracture (avulsion)
103
Q

Intra-capsular knee joint swelling:

A

inside of knee joint effusion –> structures

104
Q

Extra-capsular knee joint swelling:

A

outside of knee joint –> structures

105
Q

Additional global observations of LE relative to the knee and ankle:

A
  • hyper-extension
  • genu varum
  • genu valgum
106
Q

Genu varum:

A

bow leggedness

107
Q

Genu valgum:

A

knock knee

108
Q

Global observations of ankle:

A
  • over pronation (eversion)
  • pronation
  • neutral
  • supination
  • over supination (inversion)
109
Q

Normal arch means what kind of foot alignment?

A

normal alignment

110
Q

High arched print means what kind of foot alignment?

A
  • supinator

- rolls to outside/lateral

111
Q

Flatfoot print means what kind of foot alignment?

A
  • pronator

- rolls to inside/medial

112
Q

MMT for bicep femoris:

A
  • prone, knee flexed
  • externally rotate foot
  • pull down on ankle as they try and flex knee
113
Q

MMT for semimembranosus/semitendinosis:

A
  • prone, knee flexed
  • internally rotate foot
  • pull down on ankle as they try and flex knee
114
Q

MMT for gastrocnemius:

A
  • prone, knee extended
  • stabilize distal leg
  • resist movement at bottom of foot as they plantar flex
115
Q

MMT for soleus:

A
  • prone, knee flexed 90 degrees

- resist movement at bottom of foot as they plantar flex

116
Q

MMT for tib posterior:

A
  • sit over the table legs over
  • plantar flex, invert
  • pushed out and up
117
Q

MMT for tib. anterior:

A
  • dorsi flex, inversion

- pressure on medial part down and out

118
Q

MMT for ext. digitorum from ext. dig. hallicus:

A

big toes vs other toes pulling up

119
Q

Special tests at the knee:

A

patellar apprehension

120
Q

Special tests at the ankle:

A
  • kleiger test

- anterior drawer

121
Q

When doing the patellar apprehension test, apply _____ pressure to _____.

A
  • lateral

- patella

122
Q

Positive test (remarkable) for patellar apprehension test:

A
  • painful/apprehensive (guarding)
  • patellar instability/laxity
  • patellar dislocation or subluxation
123
Q

What structures are assessed with the patellar apprehension test?

A
  • patellar ligament
  • patellar retinaculum
  • quads
  • quad tendon
124
Q

Knee joint positioning for patellar apprehension test:

A
  • 0 degrees

- no muscle tension

125
Q

How is the patellar apprehension test a observation test?

A
  • end lateral glide feel and description

- observe quad muscle response

126
Q

Anterior drawer test assesses which structures?

A
  • inert
  • ligaments: ATFL, CFL, deltoid
  • capsule, bone
127
Q

Anterior drawer test is assessing for…

A
  • laxity
  • pain
  • crack, clunk
128
Q

Ankle joint positioning for anterior drawer test:

A
  • in degrees of PF

- glide talus - calcaneus anteriorly

129
Q

How is anterior drawer test a passive movement?

A
  • note joint movement bilaterally

- end feel description

130
Q

With the anterior drawer test, the degree of injury is associated with…

A

amount of laxity

131
Q

IOS of anterior drawer:

A

test is looking for ligament

132
Q

Kleiger test is assessing which structures?

A
  • inert ankle
  • ligaments
  • anterior and/or posterior tib fib ligaments
  • interosseous membrane
133
Q

Kleiger test is assessing for…

A
  • pain (location, description)

- laxity

134
Q

Describe Kleiger’s test:

A
  • knee at 90 degrees
  • stabilize lower leg
  • dorsiflex and externally rotate at ankle joint
135
Q

IOS of Kleiger test:

A

test is looking for a ligament injury and the degree of injury

136
Q

Functional movements for knee and ankle: tests for joint position of stress:

A
  • gait: on heels, toes
  • squat- duck walk
  • stairs
  • activity related movement
137
Q

Functional movement at the ankle joint includes _____ and _____.

A
  • stability

- mobility

138
Q

Influences at the ankle joint of static or inert structures:

A
  • joint (bony)
  • ligaments
  • joints
  • capsule
  • plantar fascia
  • retinaculum
139
Q

Muscular groupings in ankle:

A
  • anterior: dorsiflexors & extensors
  • posterior: plantarflexors & flexors
  • lateral: everters with dorsifelxors
140
Q

Affect/effect of ankle structures on stability and mobility:

A

position of stability vs positions of mobility and function

141
Q

Compartment syndrome related to functional movement:

A
  • movement or repetitive activity of muscles within a compartment
  • pressure within builds; decrease blood flow
142
Q

The pressure that builds and decreases blood flow with compartment syndrome affects…

A
  • muscles

- neurovasculature

143
Q

2 types of compartment syndrome:

A
  • acute compartment syndrome

- chronic (exertional) compartment syndrome

144
Q

Signs and symptoms of compartment syndrome:

A
  • pain that is functionally related to movements of respective compartment
  • cramping during exercise subsides when activity stops
  • may affect sensation or colour of foot, visible muscle bulging
145
Q

Main compartments of the lower leg:

A
  • anterior compartment
  • lateral compartment
  • deep posterior compartment
  • superficial posterior compartment
146
Q

There can be ____ on structures of foot and toes based on _____ position.

A
  • stress

- functional

147
Q

The feet and toes absorbs ____ from activity, acts as ____ ____ ____.

A
  • forces

- weight-bearing stress

148
Q

Lisfranc injury:

A
  • common in basketball players

- metatarsals displace from tarsals = stress fracture

149
Q

Stable position of foot:

A
  • heel
  • 1st toe
  • 5th toe
150
Q

Knee is a joint that features ______ over _____.

A
  • movement

- stability

151
Q

Stability at the knee joint is affected and influenced by:

A
  • position of LE (ie. plant position of foot, lower leg rotation, posture of the knee joint)
  • contractile or dynamic structure for stability
  • positions of joint laxity
152
Q

Discuss how the position of LE affects the stability of the knee joint:

A
  • forces directed to knee joint (angle of stress) in position found
  • ligaments and meniscus provides some stability when motion tries to exceed the limits of the envelope of passive motion
153
Q

Discuss how the contractile or dynamic structure affects the stability of the knee joint:

A
  • joint is dependent upon muscles to provide dynamic stability
  • retains stability with static structures: bony joint, ligaments, meniscus, capsule
  • reinforced with muscular mechanism to support joint stability (importance of strength and neuromuscular re-training goals in a rehab plan)
154
Q

Discuss how the positions of joint laxity affects the stability of the knee joint:

A
  • are often positions of function

- may be hip and ankle dependent

155
Q

Stability and mobility at the patellar-femoral articulation is influenced by:

A
  • patellar retinaculum
  • shape of patella; depth of femoral trochlear groove
  • Q-angle
  • position of patella (at rest, in flexion)
  • strength (VMO & quads, patellar tendon)
  • IT tract flexibility
156
Q

Objective evaluation =

A

palpation

157
Q

Why evaluate by palpating?

A
  • specific structures relative to IOS

- to confirm or dispute your IOS

158
Q

How to palpate:

A
  • palpate with client in position that is effective
  • palpate bilaterally for comparisons
  • palpate to assess for pain
  • palpate to assess status of structure
159
Q

Why palpate the joint line (medially and laterally)?

A
  • tibial condyles
  • femoral condyles, epicondyles
  • meniscus deep
160
Q

Why palpate the patella for movement or joint play?

A
  • move medially, laterally, superiorly, inferiorly

- note pain, apprehension, mobility

161
Q

Why palpate the muscles?

A
  • deformity
  • pain
  • spasm
  • swelling
  • soft tissue
162
Q

What to palpate for bone (fracture)?

A
  • palpate tibia and fibula
  • malleoli
  • palpate and compression of tibia and fibula (compression of bones above or below site of concern)
  • palpate the ankle and foot
163
Q

When palpating for bone (fracture), we are assessing for…

A
  • pain
  • tenderness
  • instability
  • crepitus
  • deformity
  • localized
164
Q

When palpating the ankle and foot, consider ____ ___ ____ as a guideline for referral to physician (____).

A
  • Ottawa Ankle Rules

- x-ray

165
Q

Ottawa Ankle Rules: ankle x ray:

A
  • bone tenderness at posterior tip of lateral malleolus
  • bone tenderness at posterior tip of medial malleolus
  • inability to weight bear
166
Q

Ottawa Ankle Rules: foot x ray:

A
  • bone tenderness at base of 5th metatarsal
  • bone tenderness at navicular
  • inability to weight bear
167
Q

What 3 ankle ligaments should we palpate?

A
  • anterior tibiofibular ligament
  • anterior talofibular ligament
  • calcaneofibular ligament
168
Q

What structures to assess:

A
  • bone
  • joint
  • ligament
  • muscular
  • nerve
  • meniscus
  • bursa
  • capsule
169
Q

Types of possible injuries:

A
  • sprain
  • strain, tendonitis
  • bursitis
  • fracture, bone stress fracture
  • compartment syndrome
  • plantar fascitis
170
Q

Grade 1 achilles tendon strain:

A
  • stretching

- minor tear

171
Q

Grade 2 achilles tendon strain:

A

partial tear

172
Q

Grade 3 achilles tendon strain:

A

ruptured

173
Q

What needs to be monitored throughout treatment sessions?

A

alignment of foot, knee and hip

174
Q

During rehab, we should prevent _____ and ensure ____ ____.

A
  • re-injury
  • optimal recovery
  • reducing chance of injury producing loads being applied (protective equipment, bracing, taping)
175
Q

Why do we have to monitor strength during rehabilitation?

A
  • prevent muscle atrophy
  • decrease quadriceps inhibition and increase ability
  • strength in all ROMs for the ankle joint
176
Q

In rehab, we have to move from ____ _____ and emphasize _____ slowly move to ____ and _____ movements. Ex. …

A
  • static postures
  • alignments
  • motion
  • ballistic
  • squat, lunge, forward motion, lateral motion, change of direction, ballistic activity (plyometrics)
177
Q

Rehab: ROM is generally ____ due to injury. Early mobilization can…

A
  • lost

- reduce the histological changes that ligamentous tissue encounter (ie decrease collagen-cross linkage)

178
Q

When looking at ROM in rehab, ____ motion to patient _____ is critical.

A
  • controlled

- tolerance

179
Q

Pitfalls in ROM acquisition during rehab:

A
  • joint capsule or ligament contractures (structures shortening)
  • muscular resistance due to pain
180
Q

With ROM in rehabilitation, we must determine ____ of limitations and manage accordingly.

A

cauase

181
Q

Joint mobilization techniques at the knee:

A

must re-establish accessory motions of tibiofemoral, tibiofibular and patellofemoral joints to ensure appropriate physiological motion

182
Q

Joint mobilization techniques at the ankle:

A

must re-establish accessory motions of joints in ankle and in foot and toes.

183
Q

When strengthening in rehab, consider using ….

A

open vs closed kinetic chain exercises

184
Q

Open vs closed kinetic chain exercises:

A
  • positions of stability
  • re-education to movement and technique
  • must be aware of potential joint stresses at varying degrees of motion during strengthening
  • seen as progressions in movement (start with CKC, progress with OKC)

KIN 440 (10 decks)

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