Knee Extensor Pathology Flashcards
how do you treat chondromalasia patella conservatively? what about surgically
conservative = relieve stress and restore kinematics
surgical = chondral shaving, realignment
what are some causes of patellofemoral pain syndrome?
- repetitive motion
- anatomical issues (patellar alta/baja)
- activity related
- post-op
tightness in what structures can cause a lateral patellar tilt
- lateral retinaculum
- IT band
what is the patellar critical zone
- it is situated around the central ridge of the patella with a certain extension to the lateral facet
- lesions here can lead to abnormal tracking of the patella
what is the difference between kinesio-taping and McConnell taping
K-tape is not strong enough to change movements… it just gives sensory feedback. McConnell tape is strong enough to actually help control movement
T or F: taping is beneficial long-term
F: it can help short term though
chondromalasia patella may be caused by
excessive lateral pressure
chondromalasia patella normally occurs where
in the critical zone
T or F: chondromalasia patella is commonly misdiagnosed
T: if they aren’t getting better send them back to PCP
T or F: the fat pad is highly innervated
T
How can you injure the fat pad of the knee
- direct trauma
- surgery
- malalignment
s/s of fat pad syndrome
- swollen, painful
- pain at end ranges of motion
- loss of both flex/ext
is it more common to dislocate the patella medially or laterally
laterally
T or F: patellar dislocations are traumatic
T: contact sports
patella ______ (alta/baja) sets you up for patellar instability. why
alta b/c the patella does not make contact with trochlea until deeper knee flexion so you rely more on ligaments/muscles
typical MOI for lateral patellar dislocation
- valgus with ER of lower leg
- medial blow to the patella
what is an essential structure in preventing a lateral patellar dislocation
medial patellofemoral lig
terminal J sign
lateral shift of patella when extending the knee
A _________ (larger/smaller) sulcus angle can create more instability
larger - b/c you have a more shallow trochlea
if the patella congruence angle is lateral what does that mean
the patella is lateral to the trochlea… you want it to either be in line with the trochlea or slightly medial
sinding-larsen johansson disease
- apophysitis of inferior pole of patella
- seen in adolescents
what is the typical MOI for SLJ disease, osgood schlatters, and patellar tendinopathy
traction type injury
how do you differentiate between SLJ and osgood schlatters
with SLJ they are tender at the infrapatellar pole while with osgood schlatters they are tender at the tibial tubercle
osgood schlatters disease
apophysitis of the tibial tubercle
Your pt is a 12 y.o. male basketball player who c/o anterior knee pain especially with jumping. He has a positive Ely’s test, decreased quad strength, and is TTP over the tibial tubercle. What does your pt most likely have?
osgood schlatters
T or F: patellar tendinopathy (jumpers knee) can occur anywhere along the tendon
T
what kind of training may be helpful for patellar tendinopathy
eccentric training
is the area of degeneration in patellar tendinopathy on the anterior or posterior surface of the patellar tendon
posterior
T or F: surgery shows better outcomes than eccentric training for patellat tendinopathy
F
what actions exacerbate patellar tendinopathy symptoms
jumping, squatting
what is typically the MOI for patellar tendon ruptures? where does it usually rupture
- eccentric contraction
- mid-substance or patellar/tibia insertion
T or F: patellar tendon ruptures need surgery
T
is patellar tendinopathy or quadriceps tendinopathy more common? what about ruptures
patellar for both
T or F: quad tendon tears have a high rate of RTP
F: even with surgery RTP rate is low
Your pt is a 30 y.o. female who presents with lateral hip pain. She has pain with passive hip adduction and resisted hip abduction. Her hip ER is decreased. She has a positive Ober’s test and a slight leg length difference. What does she most likely have?
IT band syndrome
how to treat IT band syndrome
- increase abduction and ER strength, glute strength
- manual therapy
- rest
- possible orthotic
synovial plica syndrome
- the plicaes become hard and fibrotic resulting in decreased amount of flexibility in the “seam” of the synovial membrane
- something to keep in mind for pts who aren’t improving
T or F: synovial plicae syndrome can cause damage to the underlying articular cartilage
T
complex regional pain syndrome (CRPS)
- intense or prolonged pain
- vasomotor disturbance
- delayed functional recovery
- trophic changes in soft tissue
what are some options for CRPS
- PT
- oral meds
- pharmacologic sympathetic blocks
- surgical or chemical sympathectomy
T or F: too much exercise can make CRPS worse
T: be cautious with pts who have CRPS
T or F: there is good evidence for sympathetic blocks in the low back for CRPS
T
what is the common precipitating event for reflex sympathetic dystrophy (A form of CRPS)
arthroscopic procedures
what are some things you may see during gait in someone with quad avoidance
- hyperextension
- shortened stride
- decreased knee extension in midstance
for PFP or any anterior knee pain it is important to work on strengthening to control what motions
hip adduction
hip IR
tibial IR
pronation
*the hips are important, do both hip and quad strengthening
why can lack of pronation cause patellofemoral pain
you aren’t absorbing force when you walk
in the beginning, for PFP what arcs of motion do you want to work in for closed and open chain to help avoid pain
Closed = 45-0 (shallow squat)
Open = 90-45 (flexed LAQ)
during knee ext, the patella glides ______- and during flexion it glides ________
superiorly
inferiorly
the patella does not make contact with the trochlea from ______- to ____ degrees
20 to 0
when doing a quad set, you pt has a j-sign. should they keep doing a quad set
no, because you are facilitating a bad habit
does muscle have a stronger influence on the patellafemoral joint near full extension or near flexion
extension because the patella is not in contact with the trochlea… you are relying on the quads
T or F: there is strong evidence for isolated quad strengthening in PFP syndrome
T
is open chain or closed chain quad strengthening more effective for PFP syndrome
trick question… no type was more effective
is closed chain or isokinetic joint isolated exercise more effective for PFP syndrom
closed chain
do neural mechanisms of strengthening or hypertrophy transfer better across tasks
hypertrophy
*but neural does improve activation
T or F: studies show a clear benefit to early operative intervention for PFP
F
2 distal surgeries for PFP
marquet - elevation of tibial tubercle
fulkerson - tibial tubercle anteromedialization
T or F: most patients post-surgery for PFP are NWB or PWB early on
T: based on radiographic evidence of healing
*some surgeons will start with quad sets right away
after surgery. for PFP syndrome the brace is typically locked in _____
extension
2 proximal surgeries for PFP
- medial advance
- lateral release
*these have long recoveries
whar are 3 negative factors for PFP outcomes
1 - bilateral symptoms
2 - taller pts
3 - older pts
There is ______ evidence for taping and strong evidence for exercise and ________ in treating PFP
moderate
orthotics (for pronators)
what are some interventions there is evidence against in PFP
bracing
biofeedback
needling
manual therapy
