Knee Disorders Flashcards
1
Q
ACL tear subjective findings (6)
A
- most are non contact
- sensation of their knee “popping” or “giving out” as the tibia subluxes anteriorly
- pain and immediate dysfunction
- instability of the involved knee
- inability to walk without assistance
- immediate swelling
2
Q
ACL tear MOI
A
twisting or hyperextension of the knee
3
Q
ACL tear objective findings (4)
A
- large hemarthrosis (bleeding into the joint cavity)
- pain
- positive special tests for anterior stability
- involvement of other knee structures (med. meniscus, MCL)
4
Q
ACL tear diagnostic tests (3)
A
- anterior drawer
- lachman’s: most sensitive for acute ACL rupture
- pivot shift
5
Q
ACL tear treatment
A
- closed kinetic chain exercises (CKC)
- open kinetic chain exercises (OKC)
- for quad and hamstring strength and knee stability
6
Q
what is the most important factor with ACL recovery?
A
- achieving full knee extension and good quad activation
7
Q
return to sport post ACLR time frame
A
- minimum of 6 months before returning to competitive sports
8
Q
ACL function
A
- primary restrain to the anterior translation of the tibia relative to the femur
- secondary restraint to both internal and external rotation in the NWB knee
9
Q
PCL function and characteristics
A
- strongest and largest intraarticular ligament in human knee
- primary posterior stabilizer of the knee
- primary restraint to posterior translation of the tibia relative to the femur
10
Q
types of PCL tears (2)
A
- stretch injury
- complete rupture
11
Q
PCL tear MOI (3)
A
- “dashboard injury” - posteriorly directed force on the anterior aspect of the proximal tibia with the knee flexed
- direct blow to the anterior tibia
- fall onto the knee with the foot in a plantar flexed position
12
Q
PCL tear signs and symptoms
A
- effusion within first 24 hours
- limited ROM
- pain and instability with weight bearing
- acute PCL injuries present with joint swelling and about 10-20 degrees of restriction in further flexion due to pain
13
Q
PCL tear diagnostic tests
A
- effusion, decreased ROM, tenderness
- posterior drawer test (most sensitive test)
- posterior sag sign
14
Q
PCL treatment
A
- most require surgical reconstruction similar to the ACL
- recovery and return to sport 9-12 months
15
Q
MCL tear subjective findings (6)
A
- localized swelling or stiffness
- immediate medial pain and tenderness
- worse with flexion/extension of knee
- pain may be constant or present with movement only
- knee feels unstable
soft tissue swelling, bruising - most patients are able to ambulate after an acute collateral ligament injury
16
Q
MCL tear objective findings (1)
A
- tenderness along MCL (best palpated with knee in slight flexion)
17
Q
MCL function
A
- resists valgus movement
18
Q
MCL tear Grade I objective exam (3)
A
- local tenderness on the medial femoral condyle or medial tibial plateau, with minimal swelling
- pain
- no laxity on valgus stress test at 30 degrees knee flexion
19
Q
MCL tear grade II objective exam (3)
A
- marked tenderness over the MCL
- mild to moderate swelling and pain
- laxity on valgus stress testing
- stable at full extension with laxity only present at 30 degrees flexion
20
Q
MCL tear grade III objective exam (5)
A
- tenderness over the MCL
- severe laxity on valgus stress test without a distinct end-feel
- usually laxity at full extension, indicating damage to the deeper, capsular fibers of the MCL
- may be minimal pain on testing, due to rupture of nociceptive fibers
- rarely an associated medial meniscus injury: compressing and shearing the lateral compartment while opening the medial compartment
21
Q
MCL diagnostic testing
A
- valgus stress test
22
Q
MCL tear treatment
A
- initially focuses on controlling knee edema
- slowly progress to improving knee ROM and quad function
- start stationary bike early
- quad sets
- SLR
- hip ext
- hamstring curls
- LE stretches (calf, HS, quad, adductors)
23
Q
Baker’s (popliteal) cyst
A
- abnormal collection of synovial fluid in the fatty layers of the popliteal fossa
- most common synovial cyst in the knee
24
Q
Baker’s (popliteal) cyst subjective findings (3)
A
- complaints of tightness/swelling behind the knee
- pain down the back of the leg (largest cyst)
- no history of trauma
25
Baker's cyst objective findings
- patient is prone and leg fully extended
- oblong mass is palpable and visible in the medial popliteal fossa
- active knee flexion may be limited by 10 to 15 degrees with a large cyst
26
Baker's cyst intervention
- RICE
- OTC pain reliever or anti-inflammatory to reduce pain
- aspirate for larger cysts
27
medial gastrocnemius strain MOI
- acute, forceful push-off with the foot joint
- increased volumes of running load, acceleration and deceleration
- fatiguing conditions of play or performance
28
medial gastroc strain - subjective findings (2)
- complaints of pulling or tearing sensation in the calf
- may hold ankle in PF to avoid placing tension on the injured muscle
29
medial gastroc strain objective findings (5)
- tenderness and swelling over medial gastroc
- pain aggravated with passive DF
- unable to perform a single-leg toe raise
- negative Thompson test
- peripheral pulses intact
30
medial gastroc strain intervention (4)
- acute: control pain and inflammation (RICE)
- gentle active and passive ROM exercises before progressing to strengthening exercises for the plantar flexors
- stationary bike, leg presses, heel raises
- once painfree, with full and symmetrical ROM and full strength regained, sport specific activities can be resumed
- stretching and strengthening should continue for several months to overcome the increased risk for re-injury
31
meniscal tear MOI
- when patient attempts to turn, twist, or change directions when weightbearing
32
meniscal tear subjective findings (4)
- reports significant twisting injury to the knee
- older patients with degenerative tears may have a Hx of minimal or no trauma
- Hx of popping, swelling, or clicking
- pain along the joint line, particularly twisting or squatting activities
33
meniscal tear objective findings (3)
- tenderness over the medial or lateral joint lines
- some degree of effusion
- forced flexion and (internal and external rotation of the foot) frequently elicit pain on the side of the knee with meniscal tear
34
meniscal tear diagnostic tests (3)
- McMurray
- Apley's
- Steinmann I Sign
35
meniscal tear intervention
look at PPT
36
Osgood's Schlatter's
- osteochondritis of inferior patella
- osteochondritis of tibial tuberosity
- OR tibial tubercle traction apophysitis
- occurs during growth spurts
37
osgood schlatter's subjective findings (2)
- gradually increasing pain and swelling below the involved knee
- involvement in sport activities that involve running, jumping, and landing
38
osgood's shlatter's objective findings (7)
- prominence over the tibial tubercle
- mild swelling may be evident
- pinpoint tenderness over the tibial tuberosity
- PROM reveals limitation of knee flexion
- AROM is painful at end-ranges
- resisted knee extension typically reproduces the pain
- flexibility tests reveal adaptive shortening of the HS, quads, and calf muscles
39
patellar tendonitis (jumper's knee)
- overuse condition frequently associated with eccentric overloading during deceleration activities (repeated jumping and landing, downhill running)
- occurs at the inferior pole of the patella or at its insertion at the tibial tubercle
40
patellar tendonitis subjective findings (5)
- Hx of jumping or kicking sports
- anterior knee pain
- pain noted immediately at the end of exercise or following sitting that has been preceded by exercise
- pain with sitting, squatting, or kneeling
- pain with climbing or descending stairs, jumping, or running
41
patellar tendonitis objective findings
- localized tenderness at either the inferior pole of the patella, at tibial tubercle or both
- AROM knee typically normal
- pain with passive hyperflexion of the knee
- pain with resisted knee extension
42
patellar tendonitis intervention
- 3 stages
1) relative rest from aggravating activities
2) regaining pain-free active motion, flexibility of quads and HS, and exercises focusing on pain-free quad strengthening
3) gradual resumption of the activities that causes the symptoms
43
patellofemoral pain syndrome
diagnosed in the presence of anterior or retropatellar knee pain associated with prolonged sitting or with wt-bearing activities that load the PF joint
- squatting, kneeling, running, and ascending/descending stairs
44
patellofemoral pain syndrome subjective findings (4)
- anterior knee pain with going up or down stairs or hills; instability of patella with activities
- no Hx of trauma and swelling
- more common in females than male patients
- they will say it feels swollen
45
patellofemoral pain syndrome diagnostic tests (2)
- Clarke's sign/patellar grind/patella tracking with compression
- Fairbank's apprehension test for patellar instability
45
patellofemoral pain syndrome objective findings (7)
- valgus alignment of knees
- femoral anteversion
- abnormal tracking
- quad weakness
- generalized laxity of the patellofemoral ligaments
- hip weakness
- poor eccentric quad control in weight bearing
46
plica syndrome
- plica becomes inflamed and thickened from trauma or overuse may interfere with normal joint motion
47
plica syndrome subjective findings (3)
- insidious onset of knee pain
- activity related aching in the anterior or anteriormedial aspects of the knee
- may be painful snapping or popping
48
plica syndrome objective findings (3)
- tenderness according to the location of the symptomatic plica (medial)
- reproduce the snapping or popping at ~60 degrees of knee flexion with passive extension
- you can feel the thickening
49
plica syndrome intervention (6)
- conservative:
- stretching of the quads, HS and gastroc
- strengthening
- ice
- patellar bracing
- NSAIDs
- altered sports-training schedule
50
prepatellar bursitis MOI
- inflammation or infection due to trauma to the anterior knee (direct blow or chronic irritation from activities that require extensive kneeling)
51
prepatellar bursitis subjective findings
- complaints of knee swelling
- knee pain just over the front of the knee
52
prepatellar bursitis objective findings (4)
- swelling directly over the inferior portion of the patella
- palpation reveals bursal sac tenderness (acute) or bursal sac thickening (chronic)
- normal AROM of the knee
- no specific special test
53
prepatellar bursitis intervention (3)
- cyrotherapy to decrease inflammation
- patient education on activity modification
- adaptive shortening of quads, HS or ITB, instruction in stretches
54
ITB tendonitis
- excessive friction between ITB and lateral femoral condyle
- common in runners and cyclists
55
ITB tendonitis subjective findings (3)
- pain at lateral knee
- initially, sxs only after a certain period of activity
- progresses to pain immediately with activity
56
ITB tendonitis objective findings (3)
- tender at lateral femoral epicondyle , ~3cm proximal to joint line
- soft tissue swelling and crepitus
- no joint effusion
57
ITB tendonitis special tests (2)
- Ober's
- Noble's
58
ITB tendonitis intervention (6)
- relative rest
- ice
- NSAIDS
- stretching
- cortisone
- platelet-rich plasma
59
patellar dislocation/instability
- patella may dislocate or sublux laterally
- young, active patients at highest risk (13-20)
- common in football and basketball - women more than men
60
patellar dislocation/instability MOI
- indirect trauma most common mechanism
- strong quad contraction while leg is in valgus and foot planted
61
patellar dislocation/instability subjective findings (4)
- feel a 'pop' and immediate pain
- obvious knee deformity
- painful, difficult to bend knee
- may spontaneously relocate, left with feelings of instability
62
patellar dislocation/instability objective findings (3)
- laterally shifted patella
- patellar apprehension
- swelling
63
patellar dislocation/instability intervention (4)
- NSAIDs
- ice
- patellofemoral knee brace/rigid brace
- PT
- ROM quickly (~ 2 weeks)
- quad strengthening
- electrical stimulation
64
OA of the knee subjective findings (4)
- insidious onset of pain/stiffness
- pain with weight bearing
- may have complaints of buckling, locking, or giving way
- difficulty climbing or descending stairs
65
OA of knee objective findings (4)
- angular deformity through the knee (varus or valgus)
- effusion (mild or severe)
- diffuse tenderness along the joint lines
- loss of AROM in a capsular pattern
66
OA of knee treatment
- quad strengthening
- ROM exercises
- low impact activities eg swimming, biking
