Lecture 17 - Knee MSK conditions Flashcards
What contributes to poor patellar tracking
patellar position soft tissues - laxity neuromuscular control of muscles - VMO tightness of lateral complex - ITB/TFL lower limb alignment
What is the Q angle, and what is a normal angle for men and women, what is it increased by
ASIS to central patella to tibial tubercle
14 for men
17 for women
increased by valgum, femoral IR, external tibial torsion, tight lateral retinaculum
Describe and Meniscal Injury
damage to the medial or lateral aspects of the meniscus, which is a piece of cartilage that sits between the tibia and femur in the knee joint
Acute, twisting +WB, delayed onset of swelling "click/lock" and giving way jt line tenderness pain on F, ER - medial, IR - lateral pain on squat, flexion overpressure \+brush test \+mcmurrays
RICE, minimize pain, increase ROM, functional strenght - co contraction of quads/hams
What are some types of meniscal tears
longitudinal –> bucket handle
radial split –> parrots beak
horizontal –> horizontal flap
Describe and MCL/LCL
acute partial or full tear of the medial/lateral ligamaent of the knee
acute pop/snap - instability swelling on medial/lateral pain lack of fulls ext \+Valgus/Varus stress test
ROM, balance, hip strengh, VMO/hams, calf stretch, functional
What are the 3 grades to ligament injury
1) mild - tenderness, no swelling, no laxity
2) moderate - tenderness, mild swelling, some laxity,
3) severe - tenderness, variable pain, swelling, significant
What are the 4 stages of the healing process for Ligament injuries
hemorrhage, inflammation, repair, remodelling
When can athletes return to sport after a grade 1,2,3 ligament injury
1 - 2 weeks
2 - 4 weeks
3 - 6 weeks
What are some risk factors for an ACL injury
family hx previous acl injry AP laxity altered neuromuscular patterns environment
What are the 4 theories behind an ACL injury
Ligament dominance theory - dynamic knee valgus, hip ADD, IR
Quad dominance theory - deceleration w/ knee in 30 degree flexion or hyperextension
trunk dominance theory - deficits in trunk control - valgus force at knee
leg dominance theory - leg to leg asymmetries
Describe an ACL injury
acute, twisting, deceleration, hyperextension
pop/snap
instability
excessive swelling
diffuse knee pain
+brush swipe, + lachmans, + anterior drawer
ROM, balance, Quad and hamstring strength,
functional training
What are the phases of rehab for an ACL tear
pre-rehab - swelling, pain, range, strength
phase 1) 0-2 weeks - RICE, ROM 0-100, CKC Quads/Hams
Phase 2) 2-12w - full ROM 100-130, functional, balance
Phase 3) 3-6 m - jogging/sport specific
Phase 4) 6-12 m - return to sport
Describe a PCL injury
direct trauma - dashboard hyperflexion "giving way" pop/snap instability \+post drawer test +post sag test bruising in calf
Manage: CKC-OKC quads/hams, balance, hip strength, functional
Describe Patellofemoral dislocation
lateral most common twisting/jumping F +ER of the tibia direct trauma with knee flexed "knee going out" \+effusion \+patella apprehension test
Immobilize in cast 3-4 w
VMO activation, strength, coordination
McConnel Taping
What are some predisposing factors to Patella dislocation
genu valgum lig laxity muscle weakness shallow femoral grooves increased q angle subtalar pronation
