Knee- Functional ROM thru Sprains Flashcards
How much flexion do you need for the knee during swing phase of walking?
60˚
How much hyperextension of the knee do we need for heel off during gait?
10˚ or max hyperext
What can it mean if the knee doesn’t reach full ext?
the ankle may become hypermobile
Why will the hip NOT compensate for ext at the knee with less than full hyperext?
hip will NOT compensate bc it needs to IR when knee ER at heel off
How much knee flexion do we need to descend stairs?
90˚ flexion
** may need up to 120˚ flexion
How much flexion of the knee is needed for sit-to-stand from a toilet or low chair?
105˚ flexion - otherwise inefficient
How much flexion of the knee is needed for cycling?
120˚
What is the flexion goal post TKA?
120˚
How much knee flexion do we need for kneeling and deep squatting?
FULL FLEXION
What does the femur do from 90-150˚ of flexion?
ER, posterior glide, <3˚ lateral glide
What is a sprain?
stretch/tear of a ligament that may lead to some degree of joint laxity and dysfunction
What is joint instability?
increased accessory motion and inadequate neuromuscular function
What are functionally instable joints able to do?
offset laxity through neuromuscular function
What are mechanically unstable joints unable to do?
offset laxity and likely requires SURGERY
What describes a grade 1 / 1st degree sprain?
- mild S&S
- activity may continue
- fibers are stretched but NOT torn so minimal to no change during ligamentous special tests
What describes a grade 2 / 2nd degree sprain?
- Moderate S&S
- activity stops
- fibers stretched and torn so increased laxity with softer/later end feels during ligamentous tests
What describes a grade 3 / 3rd degree sprain?
- Severe S&S
- activity stops
- fibers torn completely with possible avulsion
- significant increase in laxity with empty end feel during ligamentous tests
What do we know about ligaments and capsules?
- type 1 collagen to resist tension
- dense connective tissue
- more plastic/less elastic than muscle
for stability - low elastin for better joint stability
- multiple planes of stability, usually limit 1 or more motions
- fibrocytes
What is the mid substance area of a ligament and capsule?
- HYPOvascular
- HYPOneural
What do we know about the insertional ends of ligaments?
- HYPERvascular- high metabolic activity for greater healing capacity
- HYPERneural for proprioception or positional sense
What is an extraarticular sprain?
- blends with capsule
- often heals without sx
What should we know about a intraarticular sprain?
- within joint space
- often sx needed for repair due to dilution from synovial fluid
What is an example of an intraarticular sprain?
ACL, PCL
What are symptoms of a sprain?
- traumatic onset
- swelling
- likely reduced function
What are signs of a sprain in observation?
- antalgic and asymmetrical gait
- swollen joint
What will we find in ROM with a sprain?
likely impaired and painful
What will we find with resisted/MMT with a sprain?
possibly weak and painful
What will we find with combined motions with a sprain?
likely inconsistent block
What will we find with stress tests with sprains?
- likely positive with distraction
What will we find with special tests with sprains?
- positive ligament stability tests
What will we find with palpation with sprains?
TTP
When does initial tensile strength happen?
at 3- 5 weeks
When does dense connective tissue begin filling in?
~ 12 weeks but STILL HEALING
How long until normal strength postoperatively?
10-12 months
- remodeling out to a year, tissue NOT as healed as function is
What are some prescriptions after a sprain?
POLICED
- assistive device and/or external support
- protecting ligament in a shortened position for better long term stability
What is MET primarily for after a sprain?
tissue proliferation and integrity and stabilization
