Lecture 6 Flashcards
Joints of the knee
-tibiofemoral
-patellofemoral
-superior tibiofibular
Compartments of the lower leg
-lateral
-anterior
-posterior
What is the lateral compartment of leg
-peroneal group
What is the anterior compartment of the leg
-extensor group
What is the posterior compartment of the leg
-flexor group
What muscles are in the anterior compartment of leg
-tibialis anterior
-extensor hallucis longus
-extensor digitorum longus
-fibularis tertius
What muscles are in the lateral compartment of leg
-peroneus longus
-peroneus brevis
What muscles are in the deep posterior compartment of the leg
-Tom, dick and harry
-tibialis posterior
-flexor digitorum longus
-flexor hallucis loongus
What muscles are in the superficial posterior compartment of the leg
-gastrocnemius
-soleus
-achilles tendon
Intracapsular structures of knee (inside capsule)
-ACL
-PCL
-meniscus
-cartilage
-joint surface
Why is it important to know which structures are intracapsular vs extracapsular
-inflammation may be trapped within capsule
What is the special test to determine if there is something intracapsular that is injured
-wipe test
Wipe test
-swipe up on medial side of knee to get inflammation away
-then swipe down on lateral side of knee
-see if fluid shifts onto media l side
What shape is medial meniscus
-c shaped
What shape is lateral meniscus
-o shaped
Components of the quadriceps muscle
-rectus femoris
-vastus lateralis
-vastus intermedius
-vastus medialis
What components of the quadriceps have a lateral pull on patella
-rectus femoris
-vastus lateralis
-vastus intermedius
What components of the quadriceps have a medial pull on patella
-vastus medialis
Divisions of the hamstrings
-medial
-lateral
Medial hamstrings
-semimembranosus
-semitendinosis
Lateral hamstrings
-biceps femoris
Muscles that attach on pes anserine
-semitendinosus
-gracilis
-sartorius
What is the main action of gluteus medius
-hip abduction
-eccentrically controls internal rotation of femur in weight bearing
What extra actions do the anterior fibres of the gluteus medius do
-internally rotate hip
-assists with hip flexion
What extra actions to the posterior fibres of the gluteus medius do
-extend hip
-externally rotate the hip
What action does gluteus medius prevent
-prevents pelvis on stance side from dropping during gait (trendelenburg gait)
What is the quads:ham ratio in how it supports the knee
-ideally 3:2
What is the quads:ham ration post ACL injury
-1:1
What is the full name for shin splints
-medial tibial stress syndrome (MTSS)
What is MTSS
-involves exercise-induces pain over the anterior tibia and is an early injury in the continuum of tibial stress fractures
What is compartment syndrome
-excessive pressure with a muscle/fascial compartment
Acute cause of compartment syndrome
-trauma
-following a long bone fracture
Overuse cause of compartment syndrome
-often overlooked as shin splints
Signs and symptoms of compartment syndrome
-red
-hot
-shiny
-very painful
-numb
-weak
-faint pulse
-distal to site
Acute management of compartment syndrome
-no pressure
-reduce inflammation
-no RTP
-NWB
-refer to sport doc
-sometimes fasciotomy to release pressure
What causes gastroc/soleus strains
-overstretch in dorsiflexion with knee extension
-forceful contraction
Signs and symptoms of gastroc/soleus strains
-pop
-pull
-sharp pain
-swelling
-bruising
Special tests for gastroc/soleus strains
-muscle test for gastroc, soleus, deep flexors
-thompson test to rule out achilles rupture (toe raises)
Acute management of gastroc/soleus strain
-pressure, ice, elevation, rest (PIER)
-pressure pad with wrap
-no weight bearing
-avoid stretch or contraction
Achilles rupture MOI
-sudden forceful contraction
Can an athlete play with gastroc/soleus strain
-no
-once rehabbed can tape with heel lift
What sport is achillles rupture common in
-stop and go sports
-basketball
-tennis
-squash
Signs and symptoms of achilles rupture
-sudden sharp pain
-feel of being hit in back of leg
-unable to go up on toes
-swelling
-delayed onset bruising
Patellofemoral pain (PFPS) syndrome MOI
-poor tracking of patella in femoral condyle
Special tests for achilles rupture
-thompson test
-1 or 2 foot toe raise
Acute management of achilles tendon
-PIER
-NWB
-pressure pad over injured tissue
-educate
-refer to sports doc
Signs and symptoms of patellofemoral pain syndrome
-TOP post aspect of patella
What to check when looking at patellofemoral pain syndrome
-mechanics from bottom up and top down
-stable base?
-quad imbalance (static quad contraction)
-1 leg squat, what happens?
What is patellofemoral pain syndrome most often caused from
-overuse
Patellar dislocation MOI
-valgus force with foot planted, causing internal rotation. of femur
What age is patellar dislocation most common in
-active children ages 10-17 years old
Signs and symptoms of patellar dislocation
-patella positioned on lateral side of knee
-significant pain
-pain with knee flexion
Special tests for dislocated patella
-none
Special tests for subluxed patella
-apprehension test
What do we need to rule out in 1st time patella dislocation
-osteochondral fracture
Acute management of patellar dislocation
-rule out fracture
-PIER
-refer
What is a subluxation
-partial dislocation
-goes out and comes back in
Longer term management of patellar dislocation
-braced in full extension for 3 weeks
-ROM and strengthening
Patellar tendonitis MOI
-excessive traction on patellar tendon
Signs and symptoms of patellar tendonitis
-pain
-swelling and heat over patellar tendon
-pain with jumping, running, quick change of direction or strong quad contraction
-pain with flexion and extension
-can often train through pain
Special tests for patellar tendonitis
-thomas test
-resisted quads
Acute management of patellar tendonitis
-PIER
-roll/soft tissue mobility for quads
-lower extremity mechanics
Tendinopathy rehab of patellar tendon
-eccentrics
-x-training
Return to play taping for patellar tendonitis
-patellar tendonitis tape job
What is a bursa
-fluid-filled sacs
-lay flat between areas of friction
Knee bursitis MOI
-direct trauma
-friction from tight muscles/tendons
Signs and symptoms of knee bursitis
-rebound pain
-often painless
-visible fluid filled sac
Acute management of knee bursitis
-protect with padding to avoid repeat insult
-soft tissue mobility of tight muscles
What does the texture of chronic bursitis feel like
-granular, rice-like texture
Different types of fractures around knee/lower leg
-stress fractures
-patellar fracture
-tibial plateau fracture
What can stress fractures develop from
-medial tibial stress syndrome
-shin splints
Patellar fracture MOI
-direct blow
-patellar dislocation
Tibial plateau fracture (top of tibia) MOI
-varus or valgus load
-direct blow
Function of meniscus
-cushion the joint during loading
Why does meniscus not heal itself well
-poor blood supply
Types of meniscus tears
-vertical
-transverse
-peripheral
-bucket-handle
-parrot beach
-flap
What meniscus tears often cause clicking or catching in the knee
-bucket handle
-flap
Meniscus tear MOI
-plant and twist
-contact
-wear and tear/degeneration
Signs and symptoms of mensicus tears
-sharp pain at specific ROM
-pain with loaded rotation and deep squat
-catching/clicking/locking
-swelling
What are meniscus tears typically presented with
-ACL tears
Special tests for meniscus tears
-mcmurrays
-apleys
-duck walk
Acute management of meniscus tears
-PIER
-NWB
-educate
-conservative treatment often first choice
When would a meniscus tear elicit a trip to emerge
-locking of the knee
Can an athlete return to play with meniscus tear
-no
Ligaments of the knee
-MCL
-LCL
-ACL
-PCL
Where does the ACL run
-ant-med aspect of intercondylar area of tibial plateau
-passes up and back to post-med aspect lateral femoral condyle
What are the 2 bundles of the ACL
-posterolateral
-anteriomedial
Posterolateral bundles of ACL
-taught in extension with less than 30 degrees rotation
Anteromedial bundles of ACL
-taught going into flexion and with rotation
What does the ACL prevent
-prevents anterior translation of the tibia on femur and limits internal rotation of tibia
What is the ACL
-major stabilizer of the knee
-major proprioceptor
ACL tear MOI
-sudden cut or pivot (rotational force)
-sometimes from added external force from a tackle/collision
Signs and symptoms of ACL tear
-swelling
-extreme pain
-difficulty/unable to WB
-delayed onset bruising
Which gender has a higher incidence of ACL tears
-females
-larger quadriceps angle
What are 30% of ACL tears from
-direct contact
What are 70% of ACL tears from
-wrong movement
Special tests for ACL tears
-anterior drawer
-lachmans
-pivot shift
Acute management of ACL tears
-PIER
-NWB
-educate
Types of ACL surgery
-autograft (persons tissues) vs allograft (cadaver)
-bone-tendon-bone graft
-hamstring graft
-BEAR (new technique)
Where does the PCL run
-ant-lat aspect of med femoral condyle within the notch
-inserts along post aspect of tibial plateau
PCL tear MOI
-hyperflexion
-forced post translation of tibia on femur
Signs and symptoms of PCL tear
-swelling
-extreme pain
-difficulty/unable to WB
-delayed onset bruising
Special tests for PCL tear
-posterior drawer
-sag sign
Acute management of PCL tear
-PIER
-NWB
-educate
What are the different types of MCL fibres
-superficial and deep
What are MCL commonly associated with
-ACL injuries
MCL MOI
-valgus stress on the knee (outside of knee)
-plant and twist
Treadmill test for MCL tear
-valgus stress
Acute management of MCL tear
-PIER
-NWB
-pressure pad to approx ends
LCL tear MOI
-varus stress to knee
Signs and symptoms of LCL tear
-lateral knee pain and swelling
-TOP
-stiffness
Special test for LCL tear
-varus stress
Acute management for LCL tear
-PIER
-NWB
-pressure pad to approximate ends
