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MSK II - EXAM 3 KNEEEEEEE > Knee- Patellar Dislocation thru Functional Testing > Flashcards

Knee- Patellar Dislocation thru Functional Testing Flashcards

1
Q

What is the worse case of PFPS?

A

Patellar dislocation

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2
Q

What is the incidence of patellar dislocation?

A

rare

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3
Q

What are risk factors for patellar dislocation?

A
  • pre-existing patellar hypermobility
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4
Q

What makes patellar dislocation more common?

A
  • shallow sulcus angle
  • congruence angle lateral to zero line or laterally located patella
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5
Q

What is the etiology of patellar dislocation?

A
  • trauma with lateral patella displacement
  • may be more likely with pre-existing patellar hypermobility
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6
Q

What are the structures involved with patellar dislocation?

A
  • patella
  • med retinaculum and other medial tissues
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7
Q

What are S&S of patellar dislocation?

A
  • worse case of PFPS hypermobility
  • patellar apprehension likely to be positive
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8
Q

What is the PT rx for patellar dislocation?

A
  • non- WB to PWB up to 3 weeks
  • immobilizer
  • POLICED
  • MET
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9
Q

What do we need the immobilizer for with patellar dislocations? (DONT MEMORIZE RN, REFERENCE)

A
  • possibly allowing up to 60 degrees flexion for 3 weeks
  • flexion progressed to 90 degrees until 6 weeks
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10
Q

When should we have full ROM with patellar dislocation?

A
  • full ROM after 6 weeks
  • < 6 weeks leads to higher dislocation rates
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11
Q

What can taping do for patellar dislocation?

A
  • protection
  • allowed 30-40 degrees flexion for 5-6 weeks
  • apply after 1 week immobilization
  • better outcomes than complete immobilization
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12
Q

When should muscular control be used with patellar dislocation?

A

at least up to 6 weeks

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13
Q

What can we use a brace for with patellar dislocation?

A

patellar control

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14
Q

What kind of exercises should we start with for MET?

A

CKC exercises prior to OCK

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15
Q

What should we do for the quads with MET for patellar dislocation?

A
  • isometrics and isotonics
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16
Q

What structures should we work on extensibility and elasticity with?

A
  • postlat structures
  • hams
  • IT band
  • Gastroc
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17
Q

What is the prognosis with patellar dislocation?

A
  • up to a 44% re-dislocation rate
  • higher without sx
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18
Q

What is IT band syndrome?

A
  • basically a tendinopathy of the distal IT band
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19
Q

What is the prevalence of IT band syndrome?

A
  • 5-14% of runners
  • 2nd leading cause of knee pain in runner
  • biological males are 50-81% of cases
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20
Q

What are risk factors for IT band syndrome?

A
  • running
  • training errors
  • weak hip ERs and Abd
  • excessive pronation
  • increased hip add and IR
  • trunk lean in U stance
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21
Q

What is IT band syndrome associated with? (other conditions)

A
  • GTPS
  • PFPS
  • recognize common contribution
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22
Q

What is the etiology of IT band syndrome?

A
  • little is known that leads to abnormal mechanical loading
  • consider lumber hypermobiity/instability with impaired LE control and excessive recruitment of TFL as a hip flexor
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23
Q

What are the structures involved with IT band syndrome?

A

-TFL/IT band
- Lateral femoral epicondyle, Gerdy’s tubercle (insertion) and associated bursae and fat pad

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24
Q

What are the pathomechanics of IT band syndrome?

A
  • tendinopathy origins
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25
Q

What are the symtoms of IT band syndrome?

A
  • gradual onset of lateral knee pain
  • worse with activities involving repetitive knee motion, hills, and dynamic U stance such as running
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26
Q

What will we observe with IT band syndrome?

A
  • impaired LE control
  • possibly thickened tendon
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27
Q

What will we find with ROM with IT band syndrome?

A

pain likely with hip adduction and knee fleixon

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28
Q

What will we find with resisted testing/MMT withIT band syndrome?

A
  • possible hip ER weakness
  • possible hip abd weakness with pain, particularly in a lengthened position
  • possible pain and weakness with knee ext
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29
Q

What will we find with special tests with IT band syndrome?

A
  • possible positive Ober’s
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30
Q

What will we find with palpation with IT band syndrome?

A
  • TTP over lateral femoral condyle and Gerdy’s tubercle
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31
Q

What can we educate the patient on with IT band syndrome?

A
  • soreness rule (MILD pain okay 24-48 hours out)
  • load management (active rest, rest days)
  • movement cues for LE mechanics
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32
Q

What are some PT rx for IT band syndrome?

A
  • POLICED
  • Pt. ed
  • address impairments
  • MET
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33
Q

What is the primary purpose of MET for IT band syndrome?

A
  • tendon proliferation and stabilization (hip and lumbar)
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34
Q

What kind of MET should we be doing with IT band syndrome?

A
  • Tendonosis prescription (2-3 sets of 10-15 with heavy load)
  • isometric loading without compression from lengthening
  • Isotonic loading without compression from lengthening
  • isotonic loading WITH compression from lengthening
  • Isometric loading in weight bearing (CC hip abd, er, and ext)
  • plyometric loading
35
Q

What is patellar tendinopathy?

A
  • aka jumper’s knee or ant knee pain
36
Q

What is the incidence and risk factors for patellar tendinopathy?

A
  • up to 50% of athletes
  • biological males > females
  • more common in jumping sports
37
Q

What are the structures involved with patellar tendinopathy?

A
  • patellar tendon
  • infra patellar bursae and fat pad
38
Q

What bursae are involved with patellar tendinopathy? where?

A
  • superficial infrapatellar: between skin and patellar tendon
  • deep infrapatellar: between patellar tendon and tibia
39
Q

What is the etiology of patellar tendinopathy?

A
  • abnormal mechanical loading
40
Q

What are the pathomechanics of patellar tendinopathy?

A

tendinopathy origins

41
Q

What are the symptoms of patellar tendinopathy?

A
  • overuse or gradual onset of pain
  • increased with activity, jumping, lunging and squatting
42
Q

What will we observe with patellar tendinopathy?

A
  • possible thickened tendon (due to scar tissue?)
  • impaired LE control, particularly knee anterior to toes
43
Q

What will we find with ROM with patellar tendinopathy?

A
  • possible pain and limitation with end range flexion, especially if hip extended
44
Q

What will we find with resisted/MMT with patellar tendinopathy?

A
  • possible pain with knee ext, esp in a lengthened position; may be weak
45
Q

What will we find with accessory motion testing with patellar tendinopathy?

A
  • possible impaired patellar motion (such as limited inferior glide)
46
Q

What special tests can we do for patellar tendinopathy?

A
  • possible positive Thomas Test for shortened rectus femoris
47
Q

What will we find with palpation with patellar tendinopathy?

A
  • localized TTP
  • possible patella alta positioning
48
Q

What is the PT rx for patellar tendinopathy?

A
  • pt ed
  • POLICED
  • Modalities
  • Orthotics
49
Q

What should we know about PT rx for patellar tendinopathy?

A
  • lack of high quality evidence
50
Q

What can we educate the patient on with patellar tendinopathy?

A
  • soreness rule
  • load management
  • movement cues for LE mechanics, increased trunk flexion with landing limits tendon stresses
  • Address previously mentioned impairements
  • MET
51
Q

How does increased trunk flexion upon landing decrease tendon stresses?

A

Decreases stress by preventing “knees over toes” position which would lengthen the patellar tendon. With trunk flexion, knees are less likely to go over the toes.

52
Q

What modalities can we use with patellar tendinopathy?

A
  • extracorporeal shockwave therapy
53
Q

What should we know about extracorporeal shockwave therapy for patellar tendinopathy?

A
  • no additional benefit when added to MET
54
Q

What orthotics are helpful with patellar tendinopathy?

A
  • tendon strap may help; why might it cause more pain
55
Q

What are the primary purposes of MET for patellar tendinopathy?

A
  • tendon proliferation and stabilization (hip and lumbar)
56
Q

What is the prescription for MET for patellar tendinopathy?

A
  • Tendinosis prescription
  • Isometric loading without compression from lengthening- e.g., ?
  • Isotonic loading without compression from lengthening- e.g.?
  • Isotonic loading with compression from lengthening- e.g., ?
  • (Isometric loading in weight bearing)- CC hip abd, ER, and ext
  • Plyometric loading
57
Q

What is the MD rx for patellar tendinopathy?

A
  • platelet rich plasma injections: minimal benefit
  • cortisone (should NOT be used)
58
Q

What is the prognosis of patellar tendinopathy?

A
  • 50-70% improvement at 3-6 months with MET.
59
Q

What is another name for tibial tubercle apophysitis?

A

Osgood Shalatter’s disease

60
Q

What is the prevalence of tibial tubercle apophysitis?

A
  • MOST common cause of anterior knee pain in children
61
Q

When does tibial tubercle apophysitis peak? (age)

A

at 12-15 years of age

62
Q

What are the structures involved with tibial tubercle apophysitis?

A
  • tibial tuberosity apophysis or epiphyseal plate
63
Q

What are risk factors for tibial tubercle apophysitis?

A
  • growth spurt
  • high activity
  • shortened quads and hamstrings
  • weak quads
  • high BMI
  • reduced core stability
64
Q

What is the etiology of tibial tubercle apophysitis?

65
Q

What are the pathomechanics of tibial tubercle apophysitis?

A
  • bone growth exceeds quadriceps lengthening
  • increased tendon tension
  • most often inflammation
66
Q

What is the weak spot in children? Adults?

A
  • growth plate is the weak spot in children as opposed to tendons in adults
67
Q

What are complications with tibial tubercle apophysitis?

A
  • avulsion and/or premature closure
68
Q

What are symptoms of tibial tubercle apophysitis?

A
  • gradual onset of anterior knee pain with overuse
  • a “pop” may indicate an avulsion
  • possible loss of vertical jump
69
Q

What are some signs we could observe with tibial tubercle apophysitis?

A
  • impaired LE control
  • possibly enlarged tibial tuberosity
70
Q

What will we find with ROM with tibial tubercle apophysitis?

A
  • possible pain with end-range flexion, esp if hip is extended
71
Q

What will we find with resisted/MMT with tibial tubercle apophysitis?

A
  • likely pain with extension, especially in lengthened position; possible weakness
72
Q

What will we find with accessory motion with tibial tubercle apophysitis?

A
  • possible patellar hypo mobility (ie limited inferior glide)
73
Q

What will we find in special tests with tibial tubercle apophysitis?

A
  • maybe positive Thomas test for rectus femoris shortening
74
Q

What will we find with palpation with tibial tubercle apophysitis?

A
  • TTP over tibial tuberosity, and possibly tendon
  • possible patella alta positioning
75
Q

What is the PT rx for tibial tubercle apophysitis?

A
  • pt ed
  • POLICED
  • JMs
  • orthotics
  • MET
76
Q

What can we educate the patient on with tibial tubercle apophysitis?

A
  • soreness rule
  • load management
  • movement cues for LE mechanics
77
Q

What can we do JMs on with tibial tubercle apophysitis?

A
  • PF glides, likely to increase inferior glide
78
Q

Why should we be careful with stretching with tibial tubercle apophysitis?

A
  • be careful with stretching quads if pain occurs at epiphyseal plate
79
Q

What kind of orthotics can be useful with tibial tubercle apophysitis?

A
  • sleeve but may cause compression pain
  • strap on tendon but may cause traction pain
  • arch support to control LE
80
Q

What is MET for with tibial tubercle apophysitis?

A
  • possibly for trunk and hip stabilization
81
Q

When should we use caution with MET for tibial tubercle apophysitis?

A
  • caution with muscle/tendon attached to growth plate to avoid greater overuse
82
Q

What is the prognosis with tibial tubercle apophysitis?

A
  • PT 90% successful
  • can become a recurrent/persistent problem
83
Q

What are Ottawa Knee rules?

A

x ray if any are present after trauma for fx
- ≥ 55 years of age
- fibular head tenderness
- isolated patellar tenderness
- inability to flex knee > 90 degrees
- inability to bear weight immediately and take 4 steps in ER
- Do NOT use if > 7 days from injury

84
Q

What is PT rx for fracture?

A
  • primarily treating consequences of immobilization with other tissues

MSK II - EXAM 3 KNEEEEEEE (6 decks)

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