lecture 6: continued Flashcards
what is altmans criteria for KNEE OA
Knee pain and:
Age >50 yrs
Knee crepitus
Palpable bony enlargement
Bony tenderness to
palpation
Morning stiffness <30 minutes
No palpable warmth
what are teh CPG recommendations for KNEE OA that has STRONG evidence
- exercise
-NSAIDS (when not contraindicated) - self management
- pt education
what are the CPG recommendations for KNEE OA that has MODERATE evidence
Unloading (cane, bracing)
Neuro Re-ed (balance, coordination, agility)
Weight loss
Intra-articular corticosteroid injection (for short term relief)
what are the CPG recommendations for KNEE OA that has LIMITED evidence
Oral dietary supplements (turmeric, glucosamine, etc)
Manual therapy, massage, laser, acupuncture, TENS
PRP
High tibial osteotomy
what are the CPG recommendations for KNEE OA that has NOT RECOMMENDED evidence
Lateral wedge insoles
Oral narcotics, including tramadol
Hyaluronic acid injections
Arthroscopy with lavage and/or debridement
what are 5 indications of a TKA
- severe joint pain w WB that compromises function
- desdstruction of articular cartilage of the knee secondary to arthritis
- deformity of the knee (genu varum or valgum)
- gross instability or limitation of motion
- failure of non operative things
where is the pain from patellofemoral pain syndrome (PFPS) and what is it possibly causes by
anterior knee pain
possibly causes by direct trauma , over use , faulty patellar tracking or degeneration
what will someone have pain doing with patellofemroal pain syndrome (PFPS)
- squatting
- getting up from chair
- kneeling
-stairs - prolonged sitting
- jumping
- walking
- running
how will the foot and hip present with patellofemoral pain syndrome
foot ER
hip adduction and IR
what hip motions will be weak w PFPS
hip abd/ ER
if a pateint is 23 active female that complains of anterior knee pain and she explains she is a runner and has been ever since she was little and she has pain w squatting , kneeling , stairs and running what u see her foot is ER and her hip is add and IR what syndrome can we suspect
Patellofemoral Pain
Syndrome (PFPS)
- can sound like OA but AGE is a huge factor in this**
what are ACUTE phase treatment from Patellofemoral Pain Syndrome (PFPS)
modalities
reset
gentle ROM
isometrics
what are some OKC beginning level exercises fro PFPS
Quad sets
Quad set + SLR
Resisted isometrics
Short arc quads for terminal knee extension (TKE
what are some CKC beginning level exercises fro PFPS
Begin with partial WB if full WB is painful
Retrain mechanics and knee control
Standing TKE
Mini squats
Leg press, total gym
Use caution when squatting past 60°
what is the hallmark features of patellar tendinopathy
- pain localized to the inferior pole of the patella
- load related pain that increases w the demand ont he knee extensors
for patellar tendinopathy
Rarely have pain at ____
Sometimes better with ___ ___
Increased pain day after ___ ___ activities
May see stiff knee jump landing strategy
rest
warming up
energy storage
what is the rehabilitation stages and progression criteria for patellar tendinopathy
- isometric training
- isotonic loading
- energy storage loading
- return to sport
what are the CPGs for meniscus clinical finding
- twisting injury
- tearing sensation at time of injury
- delayed effusion (6-24hrs)
- history of “catching” or “locking”
- pain with forced hyperextension
- pain w maximum passive knee flexion
- pain or audible click w McMurray maneuver
- joint line tenderness
- positive thessaly test
what is the clinical finding for the articular cartilage CPG
- acute trauma w hemarthrosis (0-2 hrs)
- insidious onset aggravated by repetitive impact
- intermittent pan and swelling
- history of “catching” or “locking”
- joint line tenderness
when can ppl w articular cartilage damage begin to full weight bear
6-8 weeks
if a pt has a valgus force as their MOI what ligament is injured
MCL
a valgus force MOI is also accompanied by injury to what other 3 things and what is this called
medial meniscus
aCL
and posteromedial capsule
un happy triad (ACL , MCL and medial meniscus)
if a pt has a MOI of hyperextension what is injuried and what is it accompanied by
injury to ACL and accompanied by injury to the meniscus
if a pt has a MOI of flexion w posterior tranlastion what is injuried and this is a classic what
injury to PCL
classic dashbaord injury
if a pt has a injury to the LCL and it is accompanied by injury to the posterolateral capsule and PCL what kind of MOI/force is it
varus
what special test will be positive for an ACL injury
lachman
anterior drawer
pivot shift
what will pts be guarding with if they have an ACL injury and what is that guarding preventing
guarding by hamstrings to prevent anterior tibial translation
if someone has an ACL injury how fast does it swell
0-2 hours post injury
what is considered the unhappy triad
ACL
medial meniscus
sMCL (superficial)
what is the MOI of the unhappy triad
sudden valgus impact with ER or IR
there is immediate swelling
what will the exam look like for someone w a unhappy triad
may report a snapping/ click noise
positive lachman test , pivot shift test , anterior drawer test , valgus test , menicual testing
tenderness over sMCL
what is the goals for the first 1-4 weeks after a ligament injury (ACL)
- keep the knee calm
- achieve full ROM (especially EXTENSION)
- quad activation
- appropriate single leg strengthening
- normal gait
what is the criteria for the acute/ protective phase from ACL tear
Minimal swelling and pain
Full ROM
Straight Leg Raise with no lag
Normal gait with no AD or brace
if someone has cortical inhibiton what are the 4 indicated treatments you can do
- forced use intervention
- cortical drive (biofeedback)
- mechanical and metabolic stess
- open chain knee extension
if someone has arthogenic mm inhibiton what are the 3 indicated treatments you can do
- disinhibitory interventions
- forces used (NMES)
- open chain knee extension
how many weeks is the strengthening phase for ACL tear
4-8 weeks
what is the goals for the strengthening phase from ACL
Full ROM
Normal gait, improve distance
Progress strengthening
Start Single Leg strengthening
(usually around week 6
what are phase 2 exercise ideas for the quads after an ACL tear
• Step Up
• Step Down
• Leg Press
• Single Leg Sit
to Stand
• Front squats
• Lunges
• Split squats
what are phase 2 exercise ideas for the glutes after an ACL tear
• SL
Bridge/Thruster
• Side-Step with
band
• Side Plank
• Back Squats
what are phase 2 exercise ideas for the hammy after an ACL
• SL RDL
• Ham Curl
Machine
• Slide Board
Ham Curls
• Physioball
Ham Curls
what are phase 2 exercise ideas for the core after an ACL
•Planks
•Dead Bugs
•Paloff Press
when during ROM is there the most strain on the ACL
40°-0°
what reduces anterior tibiofemoral shear and thus less strain on the ACL
co contraction of quads and hamstrings
when are OKC knee extensions exercises safe to do after a ALC injury
when performed at low load from 90to 40° of knee flexion ROM
how many weeks is the functional phase after a ALC injury
8-16 weeks
what are the goals during the functional phase (8-16 weeks) for an ACL injury (lig injiry)
start running (straight line)
start double leg jumping
improve single leg strength
get back not gym
what is the criteria for the functional phase after a ACL sx
run normal on treadmill w/o pain
normla double leg landing
normla single leg squat
what is the criteria from the return to running after an ACL injury
- 95% of knee flexion
- full extension ROM
- no swelling
- limb symmetry index >80% from quad strength
- limb symmetry index > 80& eccentric impulse during counter movement lump
- pain free jogging and alter G running
- pain free repeated single leg hopping
what are examples of phase 3 exercises (functional phase) after an ACL injury
- pre jogging (jump rob , alter g , single leg squats for speed)
- strengthening
- landing mechanics
- running
what is the timeline for return to sport for post ACL
16 weeks to 6 months
when during ACL recovery can u being light single leg hops ? being cutting/chang of direction ?
16 weeks
20 weeks
at 24 weeks after an ACL sx what shoudl be at least 90% of contralateral limb , and what else shoudl be normla
single leg hopping
change of direction should be normla
what is the criteria to return to sport phase for ACL
- Y balance within 4cm of contra
- single leg hop test 90% of contra
- LESS is good
- 5-10-5 is normla
- strength testing of quads/hammy writhing 90% of contra
what is the complex for Anteromedial Rotatory Instability
ACL + medial/posterior medial knee ligament
complex
what is the complex for posteromedial Rotatory Instability
PCL + medial/posterior medial knee ligament
complex
what is the instability for the anterolateral rotatory instability
ACL alone
ACL and posterolateral corner
what is the instability for the posterolateral rotatory instability
- PCL and posterolateral corner
- posterolateal corner alone
what is included int he posterolateral corner
- LCL
-popliteus tendon - poplitofibular ligament ( arcuate lig , fabello-fibular ligament , biceps femoris long head , ITB)
what are teh 6 attachments of the IT band
-1. ITB tract
2. Lateral intermuscular
septum
3. Kaplan fibers (femoral)
4. Patellar insertion
5. Tibial insertion (Gerdy’s)
6. Lateral femorotibial
ligament
what are teh ITB syndrome factors (5)
Excessive foot pronation
Excessive internal torsion
Genu varum
Deep hip rotator/abductor weakness
Innominate positioning
what is a traction injury to the cartilage/bony attachment of tendons
in children and adolescents
apophysitis
what is the MAIN difference between Osgood- Schlatter syndrome and Sinding- Larsen Johansson syndrome
Osgood : pain at the tibial tub
Sinding : pain at the inferior pole of the patella
if a pt is 12 y/o boy and has pain at the anterior tibial tibuerle w kneeling and activity what do we think it is
Osgood-Schlatter syndrome
if a pt is 12 y/o boy and has pain at the anterior tibial tibuerle w kneeling and activity what do we think it is
Osgood-Schlatter syndrome
