Knee Unit- Ligamentous Injuries Flashcards
What is the Lachman’s test testing?
ACL
What does the McMurrary’s test for?
Medial meniscus
Pivot shift test?
ACL rotary stability
Posterior drawer test?
PCL
Valgus stress test?
MCL
Anterior drawer test?
ACL
Apley’s test?
Meniscus/ligament
Varus test?
LCL
How will a ligament injury present clinically?
-May be edematous
>Following trauma the joint usually does not swell for several hours
-Painful with palpation to injured ligament
-May not be able to bear full weight with ambulation
-May have hypermobility when testing joint play/ligamentous stability
If the joint is not swollen when tested..
-the patient may feel pain when the injured ligament is stressed
What does it mean when instability is detected during the test?
Complete tear
What happens if the blood vessels are torn?
Immediate swelling
> motion is restricted
Joint assumes position of minimum stress (flexion 25 degrees)
Common functional limitations- Acute
the knee cannot bear weight and person can not ambulate without assistance
Common functional limitations- Complete tear
there is instability and the knee will give away with weight bearing
What’s the MCL’s job?
-connects the medial epicondyle of the femur to the medial tibia and as a result resists medially directed force at the knee
> Primary stabilizer of the medial side of the knee against valgus forces and lateral rotation of the tibia especially during knee flexion
How does a MCL Grade 2 sprain happen?
-Direct blow against the lateral surface of the knee causing valgus stress and subsequent damage to the medial aspect of the knee
What is a grade 2 MCL sprain?
=partial tearing of the ligament’s fibers resulting in joint laxity when ligament is stretched
> Often medial capsular ligament is involved
Contributing factors to MCL sprain:
Contact sports requiring a high level of agility
Twisting the knee
Muscle weakness resulting in poor dynamic stabilization
What might an MCL sprain present like clinically?
- Inability to full extend and flex the knee
- Pain and significant tenderness along the medial aspect of the knee
- Possible decrease in strength
- Potential loss of proprioception
- Discernable laxity with valgus testing
- Instability of the joint
- Slight to moderate swelling around the knee
Dx testing?
MRI, Valgus stress test, check by doing other special tests to rule out ACL and meniscus involvement
How to manage an MCL sprain?
- PRICE
- Meds
- Knee immobilizer/brace
- Crutches with decreased weight bearing
What are ways to increase ROM for MCL
> Heel slides
>Stationary cycling without resistance
What are could be used for light resistance exercise for MCL?
> Isometric quads >Closed kinetic chain exercise
Functional activities for MCL?
> Gait, stairs
Modalities for MCL?
> Estim
Friction massage
-Don’t massage proximal attachment of MCL due to potential bony periosteal disruption
Outcomes for MCL?
- fairly quickly progression if no other structures involved
- should return to previous function within 4-8 weeks following injury
