knee conditions Flashcards by alexa rivera

Patellar Fracture - ROM and MMT

MM Knee extension
Knee Ext. ROM
painful end range flexion ROM

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Pittsburg Knee Decision Criterion Rules
3 of them

Blunt trauma or fall
Inability to bear weight x4 steps immediately or in ED
age <12 y/o or >50 y/o

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Indications for Pittsburg Radiograph ( which criteria are needed)

Criterion 1 or Criterion 1 + Criterion 2 or 3

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Ottawa Knee Decision Rule Criterion Rules
5 of them

TTD head of fibula
Isolated TTD patella
Can’t WB x4 steps
age > 55 years old
**5. inability to flex 90*

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Age group for patellar tendon rupture

younger than 40 y/o commonly

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Age group for quad tendon rupture

older than 40 y/o commonly
Males 4-8x > females

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Risk factors for tendon rupture

Local steroid injection
Prolonged corticosteroid use
RA
Lupus
Connective tissue diseases
*Anything that impacts connective tissue

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Quad tendon rupture MOI

regaining balance/ rapid quad contraction
extensor mechanism while flexion

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Patellar tendon rupture MOI

jump landing , high impact land

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Physical Exam Tendon rupture ROM deficits

absent or painful knee extension ROM
painful knee flexion ROM

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Osgood Schlatter Disease patient population ( gender, common age of onset)

Males > Females
Common Age of onset:
Males: 10-15 y/o
Females: 8-13 y/o

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Osgood Schlatter Disease MOI

Repetitive loading of knee into flexion

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Osgood Schlatter Disease ROM findings ( 2)

Pain end-range knee flexion ROM ( AROM & PROM)
Painful knee extension MMT > AROM

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What is Osteochondritis Dissecans? What is affected and where?

= Type of articular cartilage defect
= Separation of articular cartilage from subchondral bone

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What is the most common site in Osteochondritis Dissecans?

= Lateral part of medial condyle

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Osteochondritis Dissecans patient population

Juveniles
Males > females
Greatest 10-20 y/o
Active individuals

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Osteochondritis Dissecans MOI

Traumatic MOI (40-60% juveniles) or insidious onset

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Osteochondritis Dissecans Symptomology ( 3)

Non-specific knee pain
Aggravated with activity, improves with rest
Grinding, locking, catching, popping, clicking

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Osteochondritis Dissecans ROM findings

Limited/ painful knee ROM (flexion, extension)

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How does Microfracture procedure promotes healing ( articular cartilage deficit)?

makes it a subchondral injury
Bone, located in the subchondral area, has healing properties

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Meniscal Leison ROM findings

pain at end range extension
pain/ limited flexion

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Which population will an ACL leison happen more with? 4 reasons why?

population: Females 2-9x > males
1. Jump landing mechanics
2. Q angle
3. Narrower intercondylar notch
4. Hormones & Laxity

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ACL injury MOI ( 4)

= non- contact injury ( more common)
1. Pivoting with planted foot & extended knee
2. Deceleration & direction change / cutting maneuvers
3. Jump landing in full knee extension
4. Hyperextension or hyperflexion of the knee
= can be contact ( varus/ valgus force) but less likely

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ACL ROM and MMT findings

AROM & PROM: painful/ limited all planes (acute)
MMT - weak + painful all planes

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ACL symptomology ( 4)

1. swelling right away 2. severe pain at time of injury 3. audible pop 4. instability

PCL Sprain MOI- where does the force happen

Posterior force at proximal anterior tibia

PCL Sprain exam findings ROM and MMT ( 2)

1. Limited/ painful knee ext & flexion ROM 2. Pain with extension MMT > 90°

How may a PCL injury affect gait?

Gait: limited knee extension in stance phase

MCL sprain MOI

Valgus force (external force at lateral knee) Rotary trauma

MCL Sprain patient population

1. Younger > older individuals 2. Males 2x > females

What may aggravate an MCL sprain?

activity change in direction (ambulation), valgus force at knee

LCL sprain end feel

Guarded/ boggy end-feel with end-range ROM flexion & extension

Those with Patellofemoral Instability are at risk for

osteochondral lesion and further dislocations

Patellofemoral instability 4 presentations on physical exam

1. hypermobility of PF joint 2. ecchmosis/ swelling/ effusion ( acute phase) 3. patellar apprehension sign 4. peri patellar tenderness

Patellofemoral Instability correlated with these 4 things

1. Structural: smaller patella, shallow groove for patella (lateral ridge) Lateral tilt & lateral displacement toward extension (30°) 2. Patella alta/ baja 3. Quad muscle imbalance (VMO/ VL) 4. Generalized ligamentous laxity

Patellofemoral Instability history

History: Subluxation/ Dislocation of patellofemoral joint

Patellofemoral Pain Syndrome ( PPS) patient population

active individuals & adolescents

Clinical Correlations for PPS ( 6)

1. muscle imbalance ( quad and hip ER/ABD) 2. Increased femoral angle of inclination 3. Increased femoral anteversion 4. subtalar pronation (IR of tibia) 5. Increased Q angle 6. lateral retinaculum tightness 7. limited hip extensor endurance

Patellofemoral Pain Syndrome patient population

- Athletes - Female Gender

Onset of PFPS

insidious

PFPS ROM and MMT findings on physical exam

pain with both flexion and extension ROM painful/ weak knee extension MMT

PFPS aggravated with

- prolonged sitting - stairs - squatting - inclined walking

Osteoarthropathy onset

insidious

OA patient population

Age > 50 years Female > Males

Knee OA ROM findings in physical exam

1. pain / limited flexion and extension ROM 2. pain/ weak MMT

OA aggravated with

w/b activities, squatting, stairs, prolonged sitting

Arthrofibrosis is

Dense proliferative intra-articular and extra-articular scar tissue formation with related limitations in knee ROM

Arthrofibrosis limited with this range of motion? How will this affect gait?

knee extension limited knee extension in stance phase ( initial contact to pre swing)

Arthrofibrosis Inhibited/ weak/ painful with what range of motion

knee extension

Stiffness that is worse in the morning is present with which knee condition

arthrofibrosis

end feel with Arthrofibrosis

firm end-feel

Due to tensile loading on posterior LE what is a necessary screen with genu recurvatum?

Neurovascular

Genu Recurvatum places compressive load on what structure

anteriomedial tibiofemoral joint

Genu Recurvatum joint mobility would present with and where

hypermobility posterior glide with posteriolateral bias (with ER of tibia)

ROM and MMT findings ITB friction syndrome

1. end range Hip ADD 2. weak hip ABD MMT + Obers test

What direction is the force to create genu recurvatum

Force to anteriomedial proximal tibia

How will Genu recurvatum present on physical exam?

Tibial ER, genu varum/ valgum, tibial varum, excessive pronation

This type of injury is known as jumpers knee and involves eccentric overload

patellar tendinopathy

For patellar tendinopathy there is pain with what range of motions

+ = end range flexion + = MMT extension> + = AROM extension

This condition commonly occurs in Long distance runners, Downhill skiers, jumping sports, weight lifters, cycling

IT BAND friction syndrome

IT Band Friction Syndrome onset

Insidious / progressive

IT Band Friction Syndrome aggravated with what activities

repeated flexion/ extension stairs

Genu Recurvatum places tensile load on what structure

posterior lateral tibiofemoral joint supporters

local tenderness at these 3 areas ITB friction syndrome

distal ITB, Gerdy’s tubercle, lateral femoral condyle

What is Plica's syndrome?

= synovial fluid pockets don’t dissolve in embryonic development and form the plica = plica gets hypertrophied over time which causes increased inflammation and microtrauma

Patient population plica syndrome

Any age, greatest risk at adolescence

Plica syndrome aggravated with

activity/ prolonged standing & sitting/ squatting

Plica syndrome ROM that hurts the most and less

Painful knee flexion ROM; less pain with active extension Painless extension PROM (likely)

What is baker's fushion?

Intra-articular effusion Swelling at posterior knee

Bakers cyst ROM findings

pain with ROM: flexion and extension

In bakers cyst prominence of cyst increases with what motion

knee flexion MMT

Superficial & deep infrapatellar (nun’s knee) bursitis is the result of

Direct mechanical irritation

Prepatellar bursitis is the result of

Recurrent anterior knee trauma

Superficial Pes Anserine bursitis is the result of

Structures between MCL/ pes anserine *** Swimmers/ distance runners

superficial fibular nerve motor distribution

Fibularis Longus & Brevis

superficial fibular Sensory Distribution

Distal 2/3 lateral leg/ ankle/ dorsal foot