knee tendinopathies - exam 3 Flashcards
ITB syndrome:
-prevalence
5-14% of runner
2nd leading cause of Knee P! in runners
Males compromise 50-81% of cases
Tendinopathy of the distal IT band:
Iliotibial Band Syndrome
RF of ITB Syndrome:
running
training errors
weak ERs and aBd
Excessive pronation
Increased hip aDd and IR
Trunk lean in unilateral stance
Associated with GTPS and PFPS
Etiology of ITB Syndrome:
-consider
Little is known that leads to abnormal mechanical loading
consider lumbar hypermobility/instability w/impaired LE control and excessive recruitment of TFL
Structures involved in ITB Syndrome:
TFL/Band
Lateral femoral epicondyle, Gerdys tubercle (lateral tibia) insertion and asscoiated burase and fat pad
Symptoms of ITB syndrome:
gradual onset of lateral knee P!
worse with activities involving repetitive knee motion, grades, and dynamic U stance i.e. , running
ITB Syndrome: Sign
–observations
–ROM
–Resisted/MMT
–special test
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
PT Rx: ITB Syndrome
–MET parameters
—primary purpose
3x15 heavy loads to fatigue
tendon proliferation and stabilization (hip and lumabr)
Tendinosis prescription: ITB Syndrome
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
Patellar Tendinopathy aka:
jumpers knee or ant. knee P!
Incidence & RF of tendinopathy
up to_________ % of athletes
gender?
more common in____________
up to 50% of athletes
males>females
more common in jumping sports
Structures involved: Patellar Tendinopathy
patellar tendon
infrapatellar bursae and fat pad
Bursae: Patellar Tendinopathy
–superficial infrapatellar between ______ and ____________
–deep infrapatellar between _______ and __________
skin and patellar tendon
patellar tendon and tibia
Etiology of Patellar Tendinopathy
Pathomechanics: ________origin
abnormal mechanical loading
tendinopathy
S&S of Patellar Tendinopathy?
- onset
- increased with:
overuse of gradual onset of P!
increased w/activity, jumping, lunging, and squatting
S&S of Patellar Tendinopathy:
–observation
–ROM
possible thickened tendon
impaired LE control, particularly knee ant. to toes
ROM: possible P! and limitation with end range flexion, especially of hip extended
S&S of Patellar Tendinopathy:
Resisted/MMT
AM:
Special Test:
Palpation:
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
PT Rx: Patellar Tendinopathy
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
PT Rx Patellar Tendinopathy Specifics :
–Tendinosis Rx + :
- how?
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)
Prognosis: Patellar Tendinopathy
50-70% improvement 3-6 mths
prevalence of Tibial Tubercle apophysitis AKA Osgood Schlatter’s disease:
most common causes of anterior knee pain in children
peaks at 12-15 years
structures involved with osgood schlatters:
tibial tuberosity apophysis or epiphyseal plate
patellar tendon
risk factors of osgood shlatters:
growth spurt
high activity
shortened quads and hamstrings
weak quads
high BMI
reduced core stability
cause of osgood shlatters:
overuse
how does osgood schlatters happen?
- bone growth exceeds:
- increased:
- weak spot:
- complications:
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
symptoms of osgood schlatters:
gradual onset of ant knee p! with overuse
a “pop” may indicate an avulsion (dont disregard!)
possible loss of vertical jump
osgood schlatters: Signs:
- observation
- ROM
- resisted
- 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
osgood schlatters: Signs:
accessory motion:
special tests:
palpation:
- patellar hypomobility i.e., limited inf glide
- maybe (+) thomas test for rectus femoris shortening
- TTP over tibial tuberosity, possibly tendon.
possible patella alta positioning
what 3 things should you tell your patient with patient education?
soreness rule
load management (cross training good)
movement cues for LE mechanics
Rx for osgood schlatters:
POLICED
JM - PF glides
Stretching - careful stretching quads if P! occurs at growth plate
PT Rx for osgood schlatters:
orthotic:
sleeve but may cause compression P!
strap on tendon but may cause traction P!
foot to control LE
PT Rx for osgood schlatters:
MET:
possibly for trunk and hip stabilization (quads aren’t the problem here)
caution with muscle/tendon attached to growth plate to avoid greater overuse
prognosis for osgood schlatters
PT 90% successful
can become a recurrent/persistent problem
