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PHTH 517 > Knee Disorders > Flashcards

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
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2
Q

ACL tear MOI

A

twisting or hyperextension of the knee

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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)
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4
Q

ACL tear diagnostic tests (3)

A
  • anterior drawer
  • lachman’s: most sensitive for acute ACL rupture
  • pivot shift
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5
Q

ACL tear treatment

A
  • closed kinetic chain exercises (CKC)
  • open kinetic chain exercises (OKC)
  • for quad and hamstring strength and knee stability
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6
Q

what is the most important factor with ACL recovery?

A
  • achieving full knee extension and good quad activation
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7
Q

return to sport post ACLR time frame

A
  • minimum of 6 months before returning to competitive sports
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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
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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
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10
Q

types of PCL tears (2)

A
  • stretch injury
  • complete rupture
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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
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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
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13
Q

PCL tear diagnostic tests

A
  • effusion, decreased ROM, tenderness
  • posterior drawer test (most sensitive test)
  • posterior sag sign
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14
Q

PCL treatment

A
  • most require surgical reconstruction similar to the ACL
  • recovery and return to sport 9-12 months
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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
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16
Q

MCL tear objective findings (1)

A
  • tenderness along MCL (best palpated with knee in slight flexion)
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17
Q

MCL function

A
  • resists valgus movement
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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
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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
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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
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21
Q

MCL diagnostic testing

A
  • valgus stress test
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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)
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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
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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
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25
Q

Baker’s cyst objective findings

A
  • 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
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26
Q

Baker’s cyst intervention

A
  • RICE
  • OTC pain reliever or anti-inflammatory to reduce pain
  • aspirate for larger cysts
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27
Q

medial gastrocnemius strain MOI

A
  • acute, forceful push-off with the foot joint
  • increased volumes of running load, acceleration and deceleration
  • fatiguing conditions of play or performance
28
Q

medial gastroc strain - subjective findings (2)

A
  • complaints of pulling or tearing sensation in the calf
  • may hold ankle in PF to avoid placing tension on the injured muscle
29
Q

medial gastroc strain objective findings (5)

A
  • 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
Q

medial gastroc strain intervention (4)

A
  • 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
Q

meniscal tear MOI

A
  • when patient attempts to turn, twist, or change directions when weightbearing
32
Q

meniscal tear subjective findings (4)

A
  • 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
Q

meniscal tear objective findings (3)

A
  • 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
Q

meniscal tear diagnostic tests (3)

A
  • McMurray
  • Apley’s
  • Steinmann I Sign
35
Q

meniscal tear intervention

A

look at PPT

36
Q

Osgood’s Schlatter’s

A
  • osteochondritis of inferior patella
  • osteochondritis of tibial tuberosity
  • OR tibial tubercle traction apophysitis
  • occurs during growth spurts
37
Q

osgood schlatter’s subjective findings (2)

A
  • gradually increasing pain and swelling below the involved knee
  • involvement in sport activities that involve running, jumping, and landing
38
Q

osgood’s shlatter’s objective findings (7)

A
  • 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
Q

patellar tendonitis (jumper’s knee)

A
  • 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
Q

patellar tendonitis subjective findings (5)

A
  • 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
Q

patellar tendonitis objective findings

A
  • 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
Q

patellar tendonitis intervention

A
  • 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
Q

patellofemoral pain syndrome

A

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
Q

patellofemoral pain syndrome subjective findings (4)

A
  • 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
Q

patellofemoral pain syndrome diagnostic tests (2)

A
  • Clarke’s sign/patellar grind/patella tracking with compression
  • Fairbank’s apprehension test for patellar instability
45
Q

patellofemoral pain syndrome objective findings (7)

A
  • 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
Q

plica syndrome

A
  • plica becomes inflamed and thickened from trauma or overuse may interfere with normal joint motion
47
Q

plica syndrome subjective findings (3)

A
  • insidious onset of knee pain
  • activity related aching in the anterior or anteriormedial aspects of the knee
  • may be painful snapping or popping
48
Q

plica syndrome objective findings (3)

A
  • 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
Q

plica syndrome intervention (6)

A
  • conservative:
    • stretching of the quads, HS and gastroc
    • strengthening
    • ice
    • patellar bracing
    • NSAIDs
    • altered sports-training schedule
50
Q

prepatellar bursitis MOI

A
  • inflammation or infection due to trauma to the anterior knee (direct blow or chronic irritation from activities that require extensive kneeling)
51
Q

prepatellar bursitis subjective findings

A
  • complaints of knee swelling
  • knee pain just over the front of the knee
52
Q

prepatellar bursitis objective findings (4)

A
  • 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
Q

prepatellar bursitis intervention (3)

A
  • cyrotherapy to decrease inflammation
  • patient education on activity modification
  • adaptive shortening of quads, HS or ITB, instruction in stretches
54
Q

ITB tendonitis

A
  • excessive friction between ITB and lateral femoral condyle
  • common in runners and cyclists
55
Q

ITB tendonitis subjective findings (3)

A
  • pain at lateral knee
  • initially, sxs only after a certain period of activity
  • progresses to pain immediately with activity
56
Q

ITB tendonitis objective findings (3)

A
  • tender at lateral femoral epicondyle , ~3cm proximal to joint line
  • soft tissue swelling and crepitus
  • no joint effusion
57
Q

ITB tendonitis special tests (2)

A
  • Ober’s
  • Noble’s
58
Q

ITB tendonitis intervention (6)

A
  • relative rest
  • ice
  • NSAIDS
  • stretching
  • cortisone
  • platelet-rich plasma
59
Q

patellar dislocation/instability

A
  • patella may dislocate or sublux laterally
  • young, active patients at highest risk (13-20)
  • common in football and basketball - women more than men
60
Q

patellar dislocation/instability MOI

A
  • indirect trauma most common mechanism
    • strong quad contraction while leg is in valgus and foot planted
61
Q

patellar dislocation/instability subjective findings (4)

A
  • feel a ‘pop’ and immediate pain
  • obvious knee deformity
  • painful, difficult to bend knee
  • may spontaneously relocate, left with feelings of instability
62
Q

patellar dislocation/instability objective findings (3)

A
  • laterally shifted patella
  • patellar apprehension
  • swelling
63
Q

patellar dislocation/instability intervention (4)

A
  • NSAIDs
  • ice
  • patellofemoral knee brace/rigid brace
  • PT
    • ROM quickly (~ 2 weeks)
    • quad strengthening
    • electrical stimulation
64
Q

OA of the knee subjective findings (4)

A
  • insidious onset of pain/stiffness
  • pain with weight bearing
  • may have complaints of buckling, locking, or giving way
  • difficulty climbing or descending stairs
65
Q

OA of knee objective findings (4)

A
  • 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
Q

OA of knee treatment

A
  • quad strengthening
  • ROM exercises
  • low impact activities eg swimming, biking

PHTH 517 (5 decks)

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