knee tendinopathies - exam 3

Question 1

ITB syndrome:
-prevalence

Answer 1

5-14% of runner
2nd leading cause of Knee P! in runners
Males compromise 50-81% of cases

Question 2

Tendinopathy of the distal IT band:

Answer 2

Iliotibial Band Syndrome

Question 3

RF of ITB Syndrome:

Answer 3

running
training errors
weak ERs and aBd
Excessive pronation
Increased hip aDd and IR
Trunk lean in unilateral stance
Associated with GTPS and PFPS

Question 4

Etiology of ITB Syndrome:
-consider

Answer 4

Little is known that leads to abnormal mechanical loading
consider lumbar hypermobility/instability w/impaired LE control and excessive recruitment of TFL

Question 5

Structures involved in ITB Syndrome:

Answer 5

TFL/Band
Lateral femoral epicondyle, Gerdys tubercle (lateral tibia) insertion and asscoiated burase and fat pad

Question 6

Symptoms of ITB syndrome:

Answer 6

gradual onset of lateral knee P!
worse with activities involving repetitive knee motion, grades, and dynamic U stance i.e. , running

Question 7

ITB Syndrome: Sign
–observations
–ROM
–Resisted/MMT
–special test

Answer 7

impaired LE control
P! likley with hip add
possible hip ER weakness
possible hip aBd weakness w/P! paricualry in a lengthened position
possibly (+) Obers tests
TTP over lat. femoral condyle and Gerdy’s tubercle

Question 8

PT Rx: ITB Syndrome
–MET parameters
—primary purpose

Answer 8

3x15 heavy loads to fatigue
tendon proliferation and stabilization (hip and lumabr)

Question 9

Tendinosis prescription: ITB Syndrome

Answer 9

isometric loading without compression leneghthing
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

Question 10

Patellar Tendinopathy aka:

Answer 10

jumpers knee or ant. knee P!

Question 11

Incidence & RF of tendinopathy
up to_________ % of athletes
gender?
more common in____________

Answer 11

up to 50% of athletes
males>females
more common in jumping sports

Question 12

Structures involved: Patellar Tendinopathy

Answer 12

patellar tendon
infrapatellar bursae and fat pad

Question 13

Bursae: Patellar Tendinopathy
–superficial infrapatellar between ______ and ____________
–deep infrapatellar between _______ and __________

Answer 13

skin and patellar tendon
patellar tendon and tibia

Question 14

Etiology of Patellar Tendinopathy
Pathomechanics: ________origin

Answer 14

abnormal mechanical loading
tendinopathy

Question 15

S&S of Patellar Tendinopathy?
- onset
- increased with:

Answer 15

overuse of gradual onset of P!
increased w/activity, jumping, lunging, and squatting

Question 16

S&S of Patellar Tendinopathy:
–observation
–ROM

Answer 16

possible thickened tendon
impaired LE control, particularly knee ant. to toes

ROM: possible P! and limitation with end range flexion, especially of hip extended

Question 17

S&S of Patellar Tendinopathy:
Resisted/MMT
AM:
Special Test:
Palpation:

Answer 17

possible P! w/ knee ext, espcially in lengthened position; may be weak
possible impaired patellar motion i.e., limited inf glide
(+) Thomas Test for shortened rectus femoris
TTP: localized ; patella alta adding to tendon tension/compression

Question 18

PT Rx: Patellar Tendinopathy

Answer 18

lack of high-quality evidence
Pt. edu.
–soreness rule
–load management
–movement cues
POLICED
Modalities- no additional benefit when added to MET
Orthotic-tendon strap may help but might cause more P!
JM

Question 19

PT Rx Patellar Tendinopathy Specifics :
–Tendinosis Rx + :
- how?

Answer 19

increased trunk flexion with landing limits tendon stresses

• leaning forward draws the knees back to a better position (think squatting - back straight vs leaning forward)

Question 20

Prognosis: Patellar Tendinopathy

Answer 20

50-70% improvement 3-6 mths

Question 21

prevalence of Tibial Tubercle apophysitis AKA Osgood Schlatter’s disease:

Answer 21

most common causes of anterior knee pain in children
peaks at 12-15 years

Question 22

structures involved with osgood schlatters:

Answer 22

tibial tuberosity apophysis or epiphyseal plate
patellar tendon

Question 23

risk factors of osgood shlatters:

Answer 23

growth spurt
high activity
shortened quads and hamstrings
weak quads
high BMI
reduced core stability

Question 24

cause of osgood shlatters:

Answer 24

overuse

Question 25

how does osgood schlatters happen?
- bone growth exceeds:
- increased:
- weak spot:
- complications:

Answer 25

bone growth exceeds quadriceps lengthening
increased tendon tension
growth plate is the weak spot so also where inflammation begins
complications: avulsion and/or premature closure

Question 26

symptoms of osgood schlatters:

Answer 26

gradual onset of ant knee p! with overuse
a “pop” may indicate an avulsion (dont disregard!)
possible loss of vertical jump

Question 27

osgood schlatters: Signs:
- observation
- ROM
- resisted

Answer 27

• impaired LE control
  possibly enlarged tibial tuberosity
• possible P! with end range flexion esp if hip is extended
• likely P! with ext, esp in lengthened position

Question 28

osgood schlatters: Signs:
accessory motion:
special tests:
palpation:

Answer 28

• patellar hypomobility i.e., limited inf glide
• maybe (+) thomas test for rectus femoris shortening
• TTP over tibial tuberosity, possibly tendon.
  possible patella alta positioning

Question 29

what 3 things should you tell your patient with patient education?

Answer 29

soreness rule
load management (cross training good)
movement cues for LE mechanics

Question 30

Rx for osgood schlatters:

Answer 30

POLICED
JM - PF glides
Stretching - careful stretching quads if P! occurs at growth plate

Question 31

PT Rx for osgood schlatters:
orthotic:

Answer 31

sleeve but may cause compression P!
strap on tendon but may cause traction P!
foot to control LE

Question 32

PT Rx for osgood schlatters:
MET:

Answer 32

possibly for trunk and hip stabilization (quads aren’t the problem here)
caution with muscle/tendon attached to growth plate to avoid greater overuse

Question 33

prognosis for osgood schlatters

Answer 33

PT 90% successful
can become a recurrent/persistent problem