Lab 7 Flashcards
Pt thinks they sprained a ligament, theyre sore for a while but have no instability
possible that they strained their joint capsule, not a ligament
delayed swelling is likely due to
synovitis (swollen capsules)
Immediate swelling/ hemarthrosis is more likely with
ligament tears
whats the most important thing in the history to ask for knee injuries
mechanism
Why is it important to screen if patients are 50+ or under 17 in knee cases
Osteosarcoma in distal femur
atrophy of quad, oddly shaped knee, s/s of cancer
What can we do to help rule out DVTs in the knee?
take vitals
History of blunt trauma or unaccustomed exercise
severe pain
hardness, paresthesia
no pulse in leg
compartment syndrome
URGENT! call the ambulance!
Ottawa knee decision rule:
Age 55+
Tenderness at head of fibula
isolated tenderness at patella
inability to flex knee to 90
inability to WB 4 steps
2+ findings need an xray
pittsburgh knee decision rule
Hx of blunt trauma or fall
inability to WB 4 steps
age under 12 or over 50
2+ gets an xray
Knee decision rule of bauer
inability to WB 4 steps
Presence of knee effusion
presence of ecchymosis
what do the 3 knee decision rules have in common?
Inability to WB 4 steps
what unique things do you need to look at in observation for knee
abrasions
lacerations
contusions
can cause infection!
You must have tibial ________ for full ext and tibial ________ for full flex
External rotation
internal rotation
how much hyperext is normal in the knee
15
what does 3-125 mean when writing knee ROM
Missing 3 ext, 125 degrees of flexion
What direction does the roll/glide happen for knee flexion?
posterior roll posterior glide
What direction does the roll and glide occur for ext of the knee
anterior roll, anterior glide
what are we mobilizing here?
ext
what motion is being mobilized here
ext
.
what movement is being mobilized
technically all of them, but mainly used for flexion
this glide helps with what motion
ext
this glide helps with what motion
flexion
When do we use PA and AP glides for the proximal tibiofibular joint
usually when the patient has chronic problems at the distal tibio-fibular joint
ex= chronic lateral ankle sprains
Where do you palpate to feel meniscus?
Squishy area behind femoral condyles
which collateral ligament is easier to palpate?
Lateral- is easier, shaped like cord
medial-harder to palpate, shaped like band
Subjective -> Observation _> ROM -> MMT -> ____________
Joint play
Where do we palpate the plicae (if present)
medial and superior under patella
When would you do ligamentous testing for the knee vs not
only do ligamentous testing when there’s a MOI
When would you do instability testing on he knee vs not
only do this testing if there’s a current or past MOI
how to do lachmans
bend knee to 30 degrees and provide strong anterior shear with one hand while stabilizing thigh
When do you preform a lachmans vs an anterior drawer
lachmans- immediately after injury b4 it swells
What is the disadvantage of the anterior drawer vs the lachmans
knee is in 60 degrees of flexion and there is more hamstring activation guarding the knee
injury to what structure is the most common cause of Anterio-lateral rotary instability
ACL
what is the pivot shift test for
ACL, ALRI
When we suspect ligamentous instability what tests should we do
test all 4 ligaments of the knee
How do we know if a posterior sag sign is positive
Look for a big divot, compare to other side
A valgus stress test at 0 tests the….
PCL
A valgus stress test at 20 tests what
MCL
A varus stress test at 0 is for…
ACL and PCL
A varus stress test at 20 is for what
LCL
Anteriomedial instability test direction:
Anterior drawer with ER
Anterolateral instability test direction
IR with anterior drawer
Posterio-lateral instability test
posterior drawer with ER
Posterio-medial instability test direction
posterior drawer with IR
how do you preform the mcmurray for the medial meniscus
passively rotate tibia into full ER while passively extending knee
how do you preform mcmurrays for a lateral meniscus
Fully IR the tibia then extend the knee
if you suspect someone has a lateral meniscus tear what part of mcmurray test should you do
BOTH tests
T or F: Apley’s test can identify which side the meniscus is torn
F, it doesn’t discriminate between sides
How to preform the apleys test
compress/ distract knee joint from lower leg and rotate leg into IR and ER
distraction- makes meniscus better compression- makes menicus worse/ligament worse
distraction- makes ligamentous injuries worse
How do you preform Thessaly’s test
Preform at 20 and 5 degrees knee flex
pt twists side to side and positive is pop, click, or pain
positive test = mensicus problem
What does the lateral patellar aprehension test test for?
tests for lateral patellar subluxation
how do you preform clarke’s sign/ patellar grind test and what does it test for
pt is supine w/ knee straight
push the patella inferior and have patient isometricly contract quad
positive- reproduces their pain
means chondromalacia patella or any Pf dysfunction
