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CATA 337 - fall 2022 > Lecture 5 - Knee Ax > Flashcards

Lecture 5 - Knee Ax Flashcards

1
Q

Largest joint in the body

A

Tibiofemoral joint

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2
Q

Allows for end range/rotation at knee
Does not move much

A

Superior tibiofibular joint

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3
Q

Resting position of tibiofemoral joint
Closed packed position
Capsular pattern

A

25° flexion (open pack)
Full extension, lateral rotation of tibia
Flexion, extension

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4
Q

Which joint improves efficiency of ext. and guides quads, is often overlooked and needs to move well to avoid injuries (friction)?

A

Patello-femoral joint

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5
Q

Type of joint for tibiofemoral?

A

Hinge joint (modified)

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6
Q

Cruciate ligaments are ____ capsular

A

extra

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7
Q

Meniscus movement - Medial is __ and ___ mobile

A

Larger and less mobile

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8
Q

Meniscus movement - lateral is ___ mobile

A

More

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9
Q

Which meniscus has a higher tendency to get injured?

A

Medial

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10
Q

Functions of the menisci for the knee (4)

A
  • Aid in lubrication and nutrition of the joint
  • Act as shock absorbers
  • Make the joint surfaces more congruent
  • Improve weight distribution
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11
Q

Menisci is primarily ___ (vascular or avascular) with __ (high or low) regeneration potential

A

Avascular / low

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12
Q

T or F: the medial meniscus may heal on its own from the blood supply of the MCL (proximity of attachments)

A

TRUE

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13
Q

C-shaped part of knee
O-shaped part of knee

A

Medial
Lateral meniscus

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14
Q

Both menisci are ___ along periphery and ___ along inner margin

A

Thicker / thinner

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15
Q

What is the consequence of an odd relationship between the patella and the femur?

A

Patellofemoral syndrome (PFS)

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16
Q

Type of joint of patellofemoral?

A

Plane joint (modified)

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17
Q

Thickest layer of cartilage in body

A

Patella

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18
Q

Patellar loading with activity - Walking

A

0.3 times BW

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19
Q

Patellar loading with activity - climbing stairs

A

2.5 times BW

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20
Q

Patellar loading with activity - descending stairs

A

3.5 times BW

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21
Q

Patellar loading with activity - squatting

A

7 times BW

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22
Q

Type of joint superior tibiofibular joint

A

Plane synovial joint

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23
Q

Consequence of hypomobility at superior tibiofibular joint?

A

Pain in knee area on activity, because the fibular can bear up to 1/6 of BW

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24
Q

Look at table 12.1 in OPA

A

p.873

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25
Q

MOI for Hx of knee injury (8 examples)

A
  • Valgus force
  • Varus force
  • Hyperextension
  • Flexion with posterior translation
  • Instability/giving away/locking
  • Functional impairments
  • Deceleration/acceleration
  • Contact/Non-contact
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26
Q

Observation (4 things)

A
  • Malalignments (genu varum/valgum + patella)
  • SHARP
  • Cyst’s? Osgood-Schlater? Bursitis?
  • Gait
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27
Q

Observation - anterior view (standing) what to look for?

A

Any malalignment including genu varum of valgum
Patella position (tilt and rotation + quad atrophy)

28
Q

Observation - lateral view (standing) what to look for?

A
  • Genu recurvatum
  • Patella alta vs patella baja or patella infera
  • Note if inferior pole of the patella is tilted in (inferior tilt)
29
Q

High patella

A

Patella alta

30
Q

Low patella

A

Patella baja or infera

31
Q

Observation - posterior view (standing) what to look for?

A

Look for abnormal swellings, such as a popliteal (Baker) cyst.

32
Q

What is a quad lag?

A

Inability to fully extend because the quadriceps muscle are not strong enough

33
Q

Explain the path of the patella as the knee moves from extension to flexion

A

Curved pattern
Moving medially in early flexion and then laterally

34
Q

To complete the last 15° of knee extension, a ___ increase in force of the __ muscles is required

A

60% / quadriceps

35
Q

What do you do for passive?

A

ROM
Overpressure
Patellar movement

36
Q

About ___ of flexion is necessary for activities such as squatting to tie a shoelace of to pull on a sock

A

117°

37
Q

Sitting on a chair requires approximately ___ of flexion

A

90°

38
Q

Climbing stairs (average height) requires approximately ___ of flexion

A

80°

39
Q

Resisted at knee

A

Flexion/extension
Ankle DF/PF
Clear capsular pattern of the joint

40
Q

When is it okay to move on to functional tests?

A

If passive/active/resisted isometric movements is performed with little difficulty

41
Q

Sequence of functional testing (10 steps)

A
  1. Walking
  2. Ascending and descending stairs (walking -> running)
  3. Squatting
  4. Squatting + bouncing at the end (pulse)
  5. Running straight ahead
  6. Running straight ahead and stopping on command
  7. Vertical jump
  8. Running and twisting (carioca, figure 8)
  9. Jumping and going into a full squat
  10. Hard cuts, twists, pivots
42
Q

3 things related to ligament instability

A
  • Primary vs secondary restraint (table 12.8)
  • One plane instability
  • Rotational instability
43
Q

When testing for ligament instability of the knee, keep in mind (5)

A
  1. Test normal knee first to establish baseline
  2. When comparing normal/injured limbs, perform the same test for both limbs
  3. Muscles must be relaxed
  4. Gently apply appropriate stress
  5. Repeat stress several times and increase it to point of pain to demonstrate maximum laxity without causing muscle spasm
44
Q

Common ligament tests (7)

A
  • Varus/valgus
  • Lachman’s
  • Ant. & post. drawer
  • Pivot shift
  • Reverse pivot shift
  • Slocum
  • Sag
45
Q

Varus stress test

A

Lateral stress

46
Q

Valgus stress test

A

Medial stress

47
Q

Lachman test

A

Anterior instability

48
Q

Anterior drawer vs posterior drawer test

A

Anterior and posterior instability

49
Q

Slocum test

A

Ant/med & ant/lat

50
Q

Pivot shift test

A

3rd degree ACL CAUTION

51
Q

Reverse pivot shift

A

posterior/lateral instability

52
Q

PCL testing - name test + explain

A

Godfrey test - examiner watches for posterior shift of tibia when in 90° flexion

53
Q

Sag sign

A

Posterior shift of tibia - will have +ive ant. drawer but not coming from ACL, more from the PCL laxity

54
Q

Common meniscus tests (4)

A
  • McMurray’s
  • Apley’s (compression and distraction)
  • Bounce home
  • Thessaly test
55
Q

Signs and symptoms of meniscus injury (6)

A

Joint line pain
Loss of flexion (more than 10°)
Loss of extension (more than 5°)
Swelling (synovial)
Crepitus
Positive special test

56
Q

McMurray test (what’s a +ive)

A

Medial meniscus or lateral meniscus
++ test -> snap or click could possibly mean a torn medial meniscus

57
Q

Tests for swelling (3)

A
  • Brush/stroke or bulge test
  • Patellar tap test
  • Girth measurements
58
Q

Tests for patellofemoral dysfunction (5)

A
  • Clarke’s sign
  • Eccentric step test
  • McConnell test for chondromalacia patellae
  • Step up test
  • Vastus medialis coordination test
59
Q

Vastus medialis coordination test - 2 things to look at & +ve meaning

A
  1. ability to do it
  2. ability of VMO to contract (palpate)
    +ve indicates quad lag
60
Q

Test for plica

A

Mediopatellar plica test

61
Q

ITB test

A

Noble’s compression

62
Q

Joint play for knee (5)

A

A-P tibio-femoral
M-L tibio-femoral
M-L displacement of patella
Patellar depression
A-P Tib-Fib

63
Q

Neurological considerations (3)

A

Myotomes
Dermatomes
Reflexes

64
Q

What are the two reflexes and cutaneous distribution?

A

Patellar (L3-L4) and medial hamstring (L5-S1) reflexes

65
Q

Diagnostic imaging (5)

A
  • Plain film radiography
  • Arthroscopy
  • Computed tomography
  • Magnetic resonance imaging
  • Xeroradiography
66
Q

Knee muscles and referral pain - see p.79 ppt

A

READ AND LEARN

67
Q

Peripheral nerve injuries about the knee - see p.81 ppt

A

READ and LEARN

CATA 337 - fall 2022 (16 decks)

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