Knee Unit- Ligamentous Injuries

Question 1

What is the Lachman’s test testing?

Answer 1

ACL

Question 2

What does the McMurrary’s test for?

Answer 2

Medial meniscus

Question 3

Pivot shift test?

Answer 3

ACL rotary stability

Question 4

Posterior drawer test?

Answer 4

PCL

Question 5

Valgus stress test?

Answer 5

MCL

Question 6

Anterior drawer test?

Answer 6

ACL

Question 7

Apley’s test?

Answer 7

Meniscus/ligament

Question 8

Varus test?

Answer 8

LCL

Question 9

How will a ligament injury present clinically?

Answer 9

-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

Question 10

If the joint is not swollen when tested..

Answer 10

-the patient may feel pain when the injured ligament is stressed

Question 11

What does it mean when instability is detected during the test?

Answer 11

Complete tear

Question 12

What happens if the blood vessels are torn?

Answer 12

Immediate swelling

> motion is restricted
Joint assumes position of minimum stress (flexion 25 degrees)

Question 13

Common functional limitations- Acute

Answer 13

the knee cannot bear weight and person can not ambulate without assistance

Question 14

Common functional limitations- Complete tear

Answer 14

there is instability and the knee will give away with weight bearing

Question 15

What’s the MCL’s job?

Answer 15

-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

Question 16

How does a MCL Grade 2 sprain happen?

Answer 16

-Direct blow against the lateral surface of the knee causing valgus stress and subsequent damage to the medial aspect of the knee

Question 17

What is a grade 2 MCL sprain?

Answer 17

=partial tearing of the ligament’s fibers resulting in joint laxity when ligament is stretched

> Often medial capsular ligament is involved

Question 18

Contributing factors to MCL sprain:

Answer 18

Contact sports requiring a high level of agility
Twisting the knee
Muscle weakness resulting in poor dynamic stabilization

Question 19

What might an MCL sprain present like clinically?

Answer 19

• 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

Question 20

Dx testing?

Answer 20

MRI, Valgus stress test, check by doing other special tests to rule out ACL and meniscus involvement

Question 21

How to manage an MCL sprain?

Answer 21

• PRICE
• Meds
• Knee immobilizer/brace
• Crutches with decreased weight bearing

Question 22

What are ways to increase ROM for MCL

Answer 22

> Heel slides

>Stationary cycling without resistance

Question 23

What are could be used for light resistance exercise for MCL?

Answer 23

> Isometric quads >Closed kinetic chain exercise

Question 24

Functional activities for MCL?

Answer 24

> Gait, stairs

Question 25

Modalities for MCL?

Answer 25

> Estim
Friction massage
-Don’t massage proximal attachment of MCL due to potential bony periosteal disruption

Question 26

Outcomes for MCL?

Answer 26

• fairly quickly progression if no other structures involved

- should return to previous function within 4-8 weeks following injury