Knee: non-acute Flashcards
Knee OA definition
Deterioration of the articular cartilage and remodelling of the periarticular bone
Knee OA SE
• I/M deep knee pain/ache 1st with activity & stiffness after rest
• Onset: gradual, insidious
•Mechanism: nil or post trauma
• Progresses to constant & night pain (particularly if they have a flare up) &
AM stiffness (< 30 min)
• Agg: WB, squatting, twisting
• Ease: heat, rest
Knee OA OE
• Antalgic gait eg. limp
• Valgus/ varus deformity (often developed from walking with antalgic gait
and muscle imbalance)
• Swelling (usually small, cold swelling but with flare up progressed to hot
swelling) + TOP jt line
• ROM: F/E restricted, pain and stiffness during ROM (normal flexion =
about 160, OA = 90-110; normal extension = 0 -5 deg hyp, lack hyp)
• +/- crepitus (knee grates)
• +/- stiff patella accessory movements (because not moving leg through full
ROM)
Knee OA Management
• Active exercise -range of movement -F/E -strengthening eg quadriceps -stretching/imbalance-?hamstrings tight from prolonged flexion -proprioception -gait re-education ?gait aid to reduce pain on WB • Wt ↓ and self management education • Gait aids • Aquatic therapy (NWB exercises) • NSAIDs (oral paracetomol or topical) • Cold pack • Tai Chi
Common sources of anterior knee pain
o Patellofemoral Joint Syndrome
o Patellar tendinopathy
o Patellofemoral instability & dislocation
Less common sources of anterior knee pain
o Fat pad impingement-fat pad behind patellar tendon
o Quadriceps tendinopathy
o Bursitis (pre-patellar, infra patellar are the most common in
anterior knee problem)
o Stress fracture patella
o Osgood Schlatters –inflamed patellar ligament at
insertion on tibial tuberosity (traction apophysitis)
o Johansson Larsen-osteochondritis (degeneration of cartilage)
inferior pole patellar
o Synovial plica (fold in synovium)-medial pain
PFPS SE
- Onset: Gradual overuse or after injury (i.e. blow to knee) • Area: Vague ant/lat or ant/med pain
- Often bilateral Nature:
- i/m, deepish ache, +/- crepitus
- Often irritable Behaviour:
- Agg: ↑ PFJ forces (i.e. Squat, stairs, sitting)
- Ease: ↓ PFJ force (i.e. rest, tape to realign)
- Aetiology: young women, , patella malt racking, VMO vs V lat imbalance, hip abd weakness, abnormal foot mechanics, ITB tight
PFPS OE
• +/- slight swelling ( pick up with patella tap/palpation) • Knee HE • Foot pronation • Femoral IR/ add • ↑ Q angle • Wasted VMO • Tilted patella Functional: • pain & poor control on squat & going ↓ stairs
ROM: usually FROM +/- pain @ EOR Flexion (when compress patella) PFJ: pain/creps on comp/ glides
RSC: E may cause P (positive result - RSQ compress patella, can be negative result)
MLT: tight ITB
Palpation: Patella usually lateral +/- tilt, Tender under surface of patella; crepitus
PFPS: Management
• ↓ pain and inflammation EPAs • Stretch tight lateral structures (eg. ITB) DTF, Myofascial release, stretches • Strengthen VMO Exercise program EMG biofeedback • Patella mobilisation techniques • Correct contributing factors • Orthotics • Training programme • Strengthen hip ER/ abductors • Patellar taping – tape medially • Strengthen hips (glut med and min so don’t go into IR)
Patellar Tendinopathy SE
- Onset: Gradual overuse, common in jumping sports
- Area: Inferior pole of the patella; Superficial
- Behaviour: Agg: Jumping, hopping, bounding; Ease: Rest, ice
Patellar Tendinopathy OE
•Knee ROM: Usually normal
•RSC: Q/S weakness in severe cases; may cause pain reproduction
•Palpation:
TOP attachment to inferior pole of patella. Thickening also common.
•PFJ: Normal, taping has less effect
•Functional: Decline squats ↑pain
Patellar Tendinopathy Management
• Local treatment i.e. ice/ EPA’s, TF
- Address contributing factors: Quads/ HS tightness, LL biomechanics (e.g. foot position), PFJ (may not glide enough superiorly, stretch tendon), Core stability
- ‘strengthening’ of PT then progressive eccentric exs
- Eccentric treatment program: decline board, some level of discomfort, work up to 3 sets of 15 reps daily, modify sports activities
Patellar dislocation SE
- Onset: Sudden, severe pain
* Mechanism: Jumping/twisting – knee gives way, +/- audible pop, Often reduces spontaneously, Immediate, gross effusion
Patellar dislocation OE
• Haemarthrosis (blood around patella)
• RSC: Q/S ↑pain
• Lateral apprehension test +ve (if you push in direction they dislocated
in, will spasm)
Patellar dislocation Management
Conservative – 4 weeks extension splint and quads rehab +++
Surgical:
• Lateral release (release structures on lateral side to stop patella being pulled laterally)
• VMO advancement or transfer of patellar tendon [limited evidence for efficacy]
Knee bursitis: causes, presentation and management
• Inflammation of the bursa
• Due to repetitive friction (from surrounding structures)
• Soft fluctuant swelling (extra-capsular)
• Locally painful-eg over knee cap or behind quadriceps tendon
(suprapatellar bursa) or behind patellar tendon (infrapatellar bursa)
• Inflammatory presentation i.e. constant pain, night pain, hot/ red/ swollen/
tender
• Rx: rest form aggravating activity, ice, elevation, medication, prevention
ITB friction syndrome SE
• Ache over lateral knee
• Agg: running (worse with longer distances, ↓ hill or cambered/slope
surface)
• Ease: rest
ITB friction syndrome OE
- Weak kneeF&E
- ↓ braking forces
- Weak hip abductors (worse eccentrically) & hip F
- TOP lateral femoral epicondyle (2-3cm ↑ jt line)
- +/- tight & TrP in ITB, TFL, glutes
- Biomechanical & foot posture contributors
ITB friction syndrome Management
- Activity modification
- Symptom relief – EPAS, analgesics
- Soft tissue release
- ITB stretch
- Correct biomechanical contributing factors
