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OCS prep > Lateral and anterior knee pain > Flashcards

Lateral and anterior knee pain Flashcards

1
Q

What is the standard structural explanation for lateral knee pain?

A
  • caused by inflammation at the distal ITB as it crosses over the lateral condyle
  • ITB friction syndrome
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2
Q

What structures does the ITB connect to?

A
  • TFL and glute max/med proximally

- proximal anterior tibia and patella distally

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3
Q

T or F;

You can see movement of the ITB with contraction of the TFL and glutes at the same time.

A
  • F

- ITB is really just a passive stabilizer, it doesn’t move with muscular contraction

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4
Q

When the knee is flexed, the ITB is _________ to the lateral femoral condyle

A
  • posterior
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5
Q

When the knee is extended, the ITB is ________ to the lateral femoral condyle

A
  • anterior
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6
Q

The ITB is a relative passive ______ when the knee is in flexion, and a relative passive ______ when the knee is in extension.

A
  • knee flexor when in flexion

- knee extensor when in extension

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7
Q

Would you characterize the attachment of the ITB to the patella as minor or major?

A
  • minor
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8
Q

Lateral knee pain is common with which athletic activities?

A
  • running and cycling.

- Also likely quick walking

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9
Q

T or F;

Lateral knee pain is the most common running injury with an incidence up to 12%

A
  • T
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10
Q

The ITB alternates between extensor and flexor of the knee at ~____* flexion

A
  • ~20*
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11
Q

T or F;

Friction is the cause for ITB distal irritation.

A
  • debatable. Some say friction, others say just repetitive loading.
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12
Q

What are some primary structural sources of lateral knee pain? (5)

A

 ITBFS, lateral meniscal injury, LCL injury, popliteal tendinopathy, proximal dib fib joint dysfunction

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13
Q

What are some primary structural sources of medial knee pain? (3)

A

 Pes anserine bursitis, MCL injury, medial meniscal injury

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14
Q

What are some primary structural sources of posterior knee pain? (2)

A

 Baker’s cyst, popliteal tendinopathy

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15
Q

What standard test can be done to assess for ITB involvement in lateral knee pain?

A
  • Ober’s. Not the greatest, and won’t tell you that much in the way of specificity, but can give some useful information if there is a marked asymmetry
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16
Q

What provocative test can be done to test for ITB involvement in lateral knee pain?

A
  • compress the distal ITB and flex/extend the knee repeatedly ~20* of flx; in side lying
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17
Q

What knee position should Ober’s be done in?

A
  • ~90* flexion and in extension to assess loading as both a passive extensor and a passive flexor
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18
Q

When is imaging appropriate for atraumatic lateral knee pain?

A
  • really not until conservative management fails
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19
Q

In general what is a guideline for when knee imaging is appropriate or not? (ACR recommendation not Ottawa)
(5)

A
  • no fall
  • no twisting injury
  • no focal tenderness
  • no effusion
  • can walk
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20
Q

T or F;

There is strong evidence to support guidelines for conservative management of lateral knee pain

A
  • F

- nope

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21
Q

In general, what are the recommendations for treating lateral knee pain, conservatively? (6)

A
  • manage inflammation in acute phase
  • stretch ITB and related structures
  • strengthen hip abductors
  • promote strength/control of hip abductors
  • STM to appropriate soft tissue (deep tissue massage to ITB)
  • rest and activity modification
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22
Q

What regions are appropriate for joint mobilization for lateral knee pain? (2)

A
  • PF joint (lateral retinaculum)

- proximal tib-fib joint

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23
Q

What are thought to be the three primary mechanicsms/contributors to anterior knee pain?

A
  • malalignment/tracking of the patella
  • chondromalacia patella (softening of the patellar cartilage)
  • poor motor control of quads and hip abductors
24
Q

The patella is least stable in which position?

A
  • full extension
25
Q

In full flexion, the patella contacts the femur with which facets?

A
  • lateral and odd facets only
26
Q

T or F;

The PF joint is the most incongruent in the body.

27
Q

T or F;

The patella has some of the thickest hyaline cartilage in the body.

28
Q

The patella has what other accessory motions?

A
  • tilt, rotation, translation
29
Q

Compressive forces on the patella during walking are ~___% to ___% of body weight

A
  • 25-50% during walking
30
Q

Compressive forces on the patella during walking are ~___ to ____x body weight

A
  • 5-6x body weight during running
31
Q

Peak knee flexion during walking is ~___*

32
Q

Compressive force increases in the PFJ with increased _________ (flx/ext)

33
Q

The ____ facet of the patella bears the highest compressive forces

34
Q

The greatest torque is generated at ____ to ____* of knee flexion

35
Q

Greatest compression through the medial facet is occurring at ____ to ____*

A

30-70…makes sense

36
Q

Patella is more susceptible to dislocation biomechanically at _______

A

full extension

37
Q

Patella is more susceptible to what kind of injury with full flexion?

A
  • increased degenerative changes due to increased compressive forces
38
Q

Two primary structures associated with anterior knee pain.

A
  • patella

- patellar tendon (tibial tubercle)

39
Q

Sports requiring sprinting and jumping are more closely associated with PFPS, or patellar tendinopathy?

A
  • patellar tendinopathy
40
Q

Studies have found as many as ____% of volleyball, soccer, and basketball players have had __________.

A
  • patellar tendinopathy
41
Q

PFPS is most common in what demographic?

A
  • adolescents and young adults
42
Q

PFPS effects _____ of active sports participants?

A
  • 9-25%

- includes people who run regularly, not just organized sports

43
Q

T or F;

Chronic tendinopathy (tendinosis) will typically respond well to anti-inflammatories

A
  • F; not really. Acute tendinopathy (tendinitis) usually will though
44
Q

What are some examples of functional tests for anterior knee pain? (5)

A 
o	Hop testing (B and unilateral)
o	Deep lunge
o	Deep squat
o	Stair ascent/descent
o	Step up/down
45
Q

T or F;

Most guidelines do not recommend routine imaging for suspected anterior knee pain pathology

46
Q

T or F;

MRI is appropriate to order before radiographs for suspected meniscal lesions.

A
  • F

- MRIs are considered advanced imaging, and should never be the first choice of imaging

47
Q

T or F;

Patellar mobs are appropriate for anterior knee pain.

A
  • they can be. No evidence provided to support
48
Q

What are some proposed causes for anterior knee pain? (4)

A

o Overtraining
o Improper exercise
o Motor control impairment
o Muscle length impairment

49
Q

What muscle is considered primary to focus on with anterior knee pain?

50
Q

Is open- or closed-chain quad exercise more appropriate for strengthening?

A
  • debatable. Conflicting evidence.
51
Q

What seems to be more important in conjunction with quad strengthening; proximal or distal strength?

52
Q

What hip musculature is appropriate to strengthen for anterior knee pain?

A
  • probably all of it, but medbridge specifically references abduction, ER, and extension
53
Q

What are 3 main components of patellar tendinopathy management?

A
  • eccentric knee extensor loading
  • pain/inflammation management
  • activity modification
54
Q

How long before someone has considered as failing patellar tendinopathy conservative management with eccentric strengthening?

55
Q

What is a way to enhance eccentric quad loading during a squat?

A

heel elevation; decline board

OCS prep (25 decks)

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