Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > Knee conditions > Flashcards

Knee conditions Flashcards

1
Q

What aspects are observed during a knee assessment

A

Joints above and below

Anterior view, alignment and level, e.g. varu or valgus
lateral view, flexion or hyperextension,

Gait is observed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are typical ranges of movement for knee movements actively and passively

A

Active ROM
- Knee flexion 135°
- Knee extension 0°
- Internal knee rotation 10°
- External knee rotation 30°-40°

Passive ROM
- Knee flexion 150°
- Knee extension 10° (up to)
- Internal knee rotation 10°
- External knee rotation 30°-40°

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are possible passive ranges of movement that can be conducted at the knee

A
  • Flexion
  • Extension
  • Tibial internal rotation
  • Tibial external rotation
  • Superior patellar glide
  • Inferior patellar glide
  • Medial patellar glide
  • Lateral patellar glide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are possible isometric muscle tests at the knee

A

Extension
Flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what special tests are used to measure test the ACL

A

Lachman’s test
Anterior drawer test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What tests are used to test the PCL

A

Posterior drawer
Sag sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the test for the MCL/LCL

A

Valgus / varus stress test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What test is used for the meniscus?

A

McMurray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What test is used for the patellofemoral ligament

A

Apprehension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what test is used for the ITB

A

Ober’s test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is lachman’s test carried out

A

tests for ACL injury

pt is in supine, with knee flexed to 20-30 degrees, distal femur stabilised with one hand, other hand on proximal tibia with thumb on tibial tuberosity, anterior pressure is then put onto the tibia, whilst some posterior pressure is put on the femur

a positive test is shown by a 2mm difference compared to the unaffected side or 10 mm translation suggested ACL damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is the posterior drawer test carried out?

A

Tests for damage/laxity in the posterior cruciate ligament

Foot rests on plinth, both hands wrap round tibia plateu, try and locate femur tibia step off,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is the anterior drawer test carried out?

A

Tests the ACL for damage, anterior knee laxity

In supine knee is flexed to 60-90 degrees
Both hands put behind tibia and attempt to displace anteriorly, test is repeated in both 30 ext and internal rotation

positive test from increased displacement of the tibia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is the posterior drawer test conducted?

A

The posterior drawer test looks at the integrity of the posterior cruciate ligament (PCL)

Patient in supine with knee flexed 60-90 degree, sitso on toes to stabilize limb, grasps proximal tibia with thimbs on tibial plateu to joint line, try to translate posteriorly

positive if lack of end feel or excessive posterior translation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how is the posterior sag sign carried out

A

helps identify PCL tears

pt in supine, hips to 45 and knee in 90, in this position the tibia may be dropped, if positive bring hip to 100 degree, the pt extends knee and tibia should move back to its correct position

positive, tibia creates a concave bellow the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How are the MCL and LCL stress tests conducted

A

Valgus stress test
tests integrity of the MCL

2 versions, both pt in supine lying, palpate medial joint line, move knee into valgus , then in neutral apply valgus force

positive if excessive gapping or pain, may also be extra laxity

Varus stress test
Tests LCL ligament integrity

Same as valgus but in varus direction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how is the mcmurray test conducted

A

determines presence of a meniscal tear

Pt lies supine with knee flexed
Proximal hand is on the knee joint line with thumb one side and fingers the other
distal hand holds sole of foot and acts to support limb
from max flexion knee is extended with internal rotation and a varus stress, its returns to max flexion and is then extended with external rotation and valgus stress

internal rotation with varus tests lateral meniscus

external rotation with valgus stress stests medial meniscus

positive finding with pain, snapping, clicking and locking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how is the apprehension test conducted

A

tests integrity of the patellofemoral ligament

pt in supine
press on medial patellar with knee in 30 degree flexion, quads shouldbe relax
thumbs should put lateral pressure

positive if pt attempts to straighten knee or resists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how is clarke’s sign conducted

A

identifies patellofemoral disorders

supine with leg relaxed and in extension, clasp patella with thumb and finger on superior, pt contracts quads,

positive if pain on contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how is the ober’s test conducted

A

tests the iliotibial band / contractors in tensor fascia latae

pt in side lying, flexion in hip and knee
extend hip slightly and abduction,
slowly lower leg down to the table,

positive if leg stays in air and does not fall to table

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the epidemiology of ACL injuries

A

one of most frequently injured structures
20,000 injuries annually in the UK
most common in directional change sports
so football, basketball, skiing
women 2-4 times more likely to obtain this injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the mechanism of injury for ACL injuries

A

80% of injuries are non-contact
often occur when:
quickly changing direction, landing from jump and have sudden deceleration before changing direction

dynamic lower extremity valgus = most common cause of injury
= hip adduction with medial rotation, knee valgus lateral rotation and partial flexion with ankle eversion

can also be due to varus internal rotation
hyperextension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the grades of acl rupture and how frequent are they

A

15% of acl injuries are partial ruptures
85% are complete ruptures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the prevalence of associated injuries for ACL injuries

A

ACL occurs as an isolated injury in 25% of cases

60% with meniscal injury
30% with articular cartilage damage
30% with other collateral ligaments
>50% with anterolateral ligament
? 10% with posterolateral corner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the symptoms of an ACL injury?

A

In the early stages
pain and swelling

later stage
main concern of ACL injury is functional instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is functional instability in terms of ACL injuries

A

Giving way or apprehension of giving way, during activities involving rotation

Experienced mainly by participants of jumping, pivoting and directional change sports

Pivot shift phenomenon
relocates and clunks back and forward
subluxation and relocation of femur and tibia
normally done by surgeons under aneasthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How are ACL injuries diagnosed

A

History
60% of patients report audible pop
immediate pain in many cases
Significant swelling within first 2 hours
85% of cases have acute haemarthrosis due to the tear

Manual testing
Anterior drawer test
lachman test

Imaging
MRI
X-rays rule out bony injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are medical treatment options for ACL injuries

A

Conservative management
3+ months rehab
many dont cope
as they dont cope are worse by the time they have surgery so have worse outcomes post surgery
some elite athletes can cope without an ACL

Surgical
ACL reconstruction surgery
6 months+ rehab

28
Q

which acl injured patients are more likely to need surgery

A

pts at high risk of giving way
○ Ppts of pivoting and cutting (change direction) sports
○ Very physically-demanding jobs
§ E.g. firefighters
○ Combined ligament injuries

Pts with repairable meniscal tears
○ Improved meniscus healing when combined with ACLR

29
Q

what are the stages of surgical ACL reconstruction

A

Graft harvest
2 common choices
Bone-patellar tendon-bone (BPTB) graft
8-11 mm wide graft taken from central third of patella tendon
Quadrupled hamstring graft
Semitendinosus and gracilis tendons folded in half and combined
More flexibility with hamstrings
So often preferred to have BPTB
Sutures passed through bone plugs
Tibial and femoral tunnel drilling
Passage of graft through holes
Graft fixated with screws

30
Q

what is the process of ligamentisation

A

Over several months/ years tendon loses tendon properties becoming a ligament

animal studies have shown the process is necrosis, revascularisation, cellular proliferation, remodelling

31
Q

what occurs in the early stages of ACL rehabilitation

A

1-2 weeks
aim to control pain and swelling
maintain patella mobility
protect graft
(brace and crutches)
Gait re-education
Begin regaining ROM
- hyperextension
(early, full hyperextension reduces incidence of anterior knee pain and other post-op)
Lifted ankle on supine
ankles off bed in prone
early balance exs, early quads and hamstring strengthening

32
Q

what occurs in the intermediate stage of ACL rehab

A

3-12 weeks
quad strengthening exercies
recommend open chain with closed chain quad exercises

balance training
aerobic fitness
Controlling dlev
- Single leg squat, theraband pull to valgus, resist valgus
toe taps, flex knee bring opposite leg back or lateral
dynamic step up

hamstring strengthening
protect ACL
e.g. hamstring curls with exs ball, -> single leg

33
Q

what are the componenets of late stage ACL rehab

A

jogging - running
running sideways and backwards
changing directions
plyo + sport specific drills

activities with impact
should be introduced slowly and built gradually as majority of ACL injuries have articular cartilage trauma

34
Q

what is the epidemiology of meniscal injuries

A

often seen in athletes
15% of cases are sport injuries
most common in men (men are more likely to get bucket handle lesions)
women more likely to have peripheral datachment as more of an elderly injury from minor trauma

mean age of injury is 28-40

35
Q

what are risk factors for meniscal injuries

A

playing sports
osteoarthritis (can lead to spontaneous meniscal tear)
torn or completley ruptured
sport
older age
overweight
intensive training
reduced muscle strength
varus or valgus deformities

36
Q

what are the types of meniscal tears

A

traumatic meniscal tear
degenerative meniscal tear
meniscal rupture

37
Q

what is the mechanims of injury for meniscal tears

A

most common mechanism of injury is twisting injury on a semi-flexed limb through weight bearing knee

can be associated with other ligament injuries at the knee

38
Q

what are the symptoms of a traumatic meniscal lesion

A

○ Produced by instability of torn fragment
○ Locking of knee (in bucket handle tears)
○ Responsible for knee clicking and popping
§ Torn part moves under femoral condyle
○ Medial or lateral knee pain (depends on compartment affected)
§ Caused by abnormal increase in tension in capsule

39
Q

what are the symptoms for a degenerative meniscus

A

○ Same as in traumatic
○ May also be problems with patella or cartilage
○ Symptoms frequently worsened by flexing and loading at knee
§ e.g. squatting and kneeling
□ These are poorly tolerated

40
Q

what are the different types of ruptures

A

Radial rupture
Oblique rupture
Longitudinal rupture
Bucket handle
Horizontal rupture
Complex rupture

41
Q

how are meniscal tears classified

A

tear length
tear depth
tear pattern

42
Q

what diagnostic procedures are used for diagnosing ACL tears

A

MRI
athroscopy
CT scan

43
Q

what is the main medical treatment used for meniscal injuries

A

conservative treatment is often used however is normally unsuccessful for young adults

probability of healing is also low in degenerative tears

operative treatments include:
arthroscopy
repair and partial reconstruction
meniscal allograft transplantation can also be used

44
Q

what are the focusses of physiotherapy in meniscal tear conservative management

A

focusses on quad strengthening
will use strengthening exercises for quads and hamstrings

flexibility exercises can also be important
joint mobilizations also key

45
Q

what is the acute management for meniscal tear

A

RICE
cryotherapy

46
Q

what is the epidemiology of MCL injuries

A

athletes
ligament injuries account for 40% of all knee injuries and MCL are the most common

47
Q

what is the mechanims of injury for MCL injuries

A

turning, cutting or twisting
direct blows to the knee

48
Q

what is the key anatomy for MCL injuries

A

one 4 ligaments which stabilizes the knee
spans entire medial side of knee from medial aspects of extensor mechanism to posterior aspect of the knee
controls for excessive movements at the joint

49
Q

what is the pathophysiology for MCL injuries

A

Impact on outside of knee, lower thigh or upper legs when foot is unable to move
MCL goes under stress due to impact and combined flexion/valgus/ external rotation leads to fibre tears

50
Q

what conditions will have similar symptoms to MCL tears

A

Medial meniscal tear or injury
ACL tear
Tib plateau #
patellar subluxation/ dislocation
medial knee contusion
paediatric femoral fracture
damage to posteromedial corner structures

51
Q

what are the overall principles for treating MCL injuries

A

controlling oedema
initiating medial quads
working to restore ROM as early as possible

52
Q

how is rehab conducted for MCL injuries in the first 2 weeks

A

ice as needed and tolerated
crutches for pain whilst early weight bearing is encouraged
maintenance of flex/ ext 0-90
static bike use encouraged

53
Q

what rehab is used MCL injures in the second phase

A

ROM exs are key
pt should progress to 20 mins biking
hamstring curls, leg press, step ups

54
Q

what kind pf rehab is from week 5 for MCL injuries

A

FWB on injured knee
discontinued brace when mobilising / weaning
Full ROM
continue cold therapy for swelling

55
Q

what is the rehab for the final therapy stage of MCL recovery

A

discontinue brace
cold therapy
exs are sport specific
increased exs intensity

56
Q

what is typical medical treatment for MCL injuries

A

grade I and II treatment is normally conservative

Grade III is usually unsuccessful conservatively

57
Q

what is the epidemiology for patella tendinopathy

A

young athletes 15-30 yrs
more likely in men
sports with repetitive loading such as basketball, volleyball, athletic jumping events
over 40% prevalence in volleyball and basketball players
only 0.1% in general population

58
Q

what are risk factors for patella tendinopathy

A

gender, weight and BMI
more risk at age 30 onwards
tight quads and poor core stability

59
Q

what is the key anatomy for mcl injuries

A

quads inferior to pole of patella through quad tendon
patellar ligament connects bottom of patella to tibial tuberosity
does not have own nerve supply but adjacent tendon nerve ending are present

60
Q

what is the process of patella tendinopathy

A

3 stages:
* Reactive tendinopathy
○ Non-inflammatory proliferative response to acute tensile or compressive overload
○ Increased protein production

* Tendon disrepair
	○ Tendon healing is continually attempted following previous stage
	○ Greater matrix breakdown
	○ Increased no. of cells in matrix
	○ Increased vascularity and neuronal ingrowth may occur

* Degenerative tendinopathy
	○ Areas of cell death occur due to apoptosis, tenocyte exhaustion
	○ Large areas of disordered matrix
	○ Changes hard to reverse at this stage
	○ Mainly seen in elder populations
61
Q

what are the main symptoms of patella tendinopathy

A

localized pain to the inferior pole of the patella
pain rarely present when resting
may have pain from long periods of sitting, squatting or stairs
loading activities load pain
some have warm up phenomenon (increased pain day after activities)

62
Q

what are conditions for differential diagnosis with patella tendinopathy

A

infrapatellar bursitis
fat pad impingement
patellofemoral pain
plica injuries
osgood-schlatter syndrome

63
Q

what advice should be provided and what is the focus for patella tendinopathy rehab

A

advice on selective rest

focus on early return to activities

64
Q

what are the stages of patella tendinopathy managemetn

A

Stage 1: isometric loading
Stage 2: Isotonic Loading
Stage 3: Energy-Storage Loading
Stage 4: Return to sport
(as always based on pain level before move to next stage)

65
Q

what advice can be given for pain management of patella tendinopathy

A

patellar strap and tape can be used
nsaids have a risk of impeding healing
corticosteroid injections can decrease pain

66
Q

what are some knee muscle length tests

A

rectus femoris can be measured with Ely’s test

hamstrings can be measured with 90-90 stright leg raise

Back saver sit and reach test

67
Q

what are some knee functional tests

A

one leg stand with hands on hips

one leg STS
one leg hop along line

MSK (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions