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THER EX 2: LQ > lecture 6: continued > Flashcards

lecture 6: continued Flashcards

1
Q

what is altmans criteria for KNEE OA

A

Knee pain and:
 Age >50 yrs
 Knee crepitus
 Palpable bony enlargement
 Bony tenderness to
palpation
 Morning stiffness <30 minutes
 No palpable warmth

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2
Q

what are teh CPG recommendations for KNEE OA that has STRONG evidence

A
  • exercise
    -NSAIDS (when not contraindicated)
  • self management
  • pt education
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3
Q

what are the CPG recommendations for KNEE OA that has MODERATE evidence

A

 Unloading (cane, bracing)
 Neuro Re-ed (balance, coordination, agility)
 Weight loss
 Intra-articular corticosteroid injection (for short term relief)

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4
Q

what are the CPG recommendations for KNEE OA that has LIMITED evidence

A

 Oral dietary supplements (turmeric, glucosamine, etc)
 Manual therapy, massage, laser, acupuncture, TENS
 PRP
 High tibial osteotomy

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5
Q

what are the CPG recommendations for KNEE OA that has NOT RECOMMENDED evidence

A

 Lateral wedge insoles
 Oral narcotics, including tramadol
 Hyaluronic acid injections
 Arthroscopy with lavage and/or debridement

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6
Q

what are 5 indications of a TKA

A
  • 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
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7
Q

where is the pain from patellofemoral pain syndrome (PFPS) and what is it possibly causes by

A

anterior knee pain

possibly causes by direct trauma , over use , faulty patellar tracking or degeneration

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8
Q

what will someone have pain doing with patellofemroal pain syndrome (PFPS)

A
  • squatting
  • getting up from chair
  • kneeling
    -stairs
  • prolonged sitting
  • jumping
  • walking
  • running
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9
Q

how will the foot and hip present with patellofemoral pain syndrome

A

foot ER
hip adduction and IR

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10
Q

what hip motions will be weak w PFPS

A

hip abd/ ER

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11
Q

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

A

Patellofemoral Pain
Syndrome (PFPS)

  • can sound like OA but AGE is a huge factor in this**
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12
Q

what are ACUTE phase treatment from Patellofemoral Pain Syndrome (PFPS)

A

modalities
reset
gentle ROM
isometrics

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13
Q

what are some OKC beginning level exercises fro PFPS

A

 Quad sets
 Quad set + SLR
 Resisted isometrics
 Short arc quads for terminal knee extension (TKE

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14
Q

what are some CKC beginning level exercises fro PFPS

A

 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°

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15
Q

what is the hallmark features of patellar tendinopathy

A
  • pain localized to the inferior pole of the patella
  • load related pain that increases w the demand ont he knee extensors
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16
Q

for patellar tendinopathy

 Rarely have pain at ____
 Sometimes better with ___ ___
 Increased pain day after ___ ___ activities
 May see stiff knee jump landing strategy

A

rest
warming up
energy storage

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17
Q

what is the rehabilitation stages and progression criteria for patellar tendinopathy

A
  1. isometric training
  2. isotonic loading
  3. energy storage loading
  4. return to sport
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18
Q

what are the CPGs for meniscus clinical finding

A
  • 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
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19
Q

what is the clinical finding for the articular cartilage CPG

A
  • 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
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20
Q

when can ppl w articular cartilage damage begin to full weight bear

A

6-8 weeks

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21
Q

if a pt has a valgus force as their MOI what ligament is injured

A

MCL

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22
Q

a valgus force MOI is also accompanied by injury to what other 3 things and what is this called

A

medial meniscus
aCL
and posteromedial capsule

un happy triad (ACL , MCL and medial meniscus)

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23
Q

if a pt has a MOI of hyperextension what is injuried and what is it accompanied by

A

injury to ACL and accompanied by injury to the meniscus

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24
Q

if a pt has a MOI of flexion w posterior tranlastion what is injuried and this is a classic what

A

injury to PCL

classic dashbaord injury

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25
Q

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

A

varus

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26
Q

what special test will be positive for an ACL injury

A

lachman
anterior drawer
pivot shift

27
Q

what will pts be guarding with if they have an ACL injury and what is that guarding preventing

A

guarding by hamstrings to prevent anterior tibial translation

28
Q

if someone has an ACL injury how fast does it swell

A

0-2 hours post injury

29
Q

what is considered the unhappy triad

A

ACL
medial meniscus
sMCL (superficial)

30
Q

what is the MOI of the unhappy triad

A

sudden valgus impact with ER or IR

there is immediate swelling

31
Q

what will the exam look like for someone w a unhappy triad

A

may report a snapping/ click noise
positive lachman test , pivot shift test , anterior drawer test , valgus test , menicual testing

tenderness over sMCL

32
Q

what is the goals for the first 1-4 weeks after a ligament injury (ACL)

A
  • keep the knee calm
  • achieve full ROM (especially EXTENSION)
  • quad activation
  • appropriate single leg strengthening
  • normal gait
33
Q

what is the criteria for the acute/ protective phase from ACL tear

A

 Minimal swelling and pain
 Full ROM
 Straight Leg Raise with no lag
 Normal gait with no AD or brace

34
Q

if someone has cortical inhibiton what are the 4 indicated treatments you can do

A
  1. forced use intervention
  2. cortical drive (biofeedback)
  3. mechanical and metabolic stess
  4. open chain knee extension
35
Q

if someone has arthogenic mm inhibiton what are the 3 indicated treatments you can do

A
  1. disinhibitory interventions
  2. forces used (NMES)
  3. open chain knee extension
36
Q

how many weeks is the strengthening phase for ACL tear

A

4-8 weeks

37
Q

what is the goals for the strengthening phase from ACL

A

 Full ROM
 Normal gait, improve distance
 Progress strengthening
 Start Single Leg strengthening
(usually around week 6

38
Q

what are phase 2 exercise ideas for the quads after an ACL tear

A

• Step Up
• Step Down
• Leg Press
• Single Leg Sit
to Stand
• Front squats
• Lunges
• Split squats

39
Q

what are phase 2 exercise ideas for the glutes after an ACL tear

A

• SL
Bridge/Thruster
• Side-Step with
band
• Side Plank
• Back Squats

40
Q

what are phase 2 exercise ideas for the hammy after an ACL

A

• SL RDL
• Ham Curl
Machine
• Slide Board
Ham Curls
• Physioball
Ham Curls

41
Q

what are phase 2 exercise ideas for the core after an ACL

A

•Planks
•Dead Bugs
•Paloff Press

42
Q

when during ROM is there the most strain on the ACL

A

40°-0°

43
Q

what reduces anterior tibiofemoral shear and thus less strain on the ACL

A

co contraction of quads and hamstrings

44
Q

when are OKC knee extensions exercises safe to do after a ALC injury

A

when performed at low load from 90to 40° of knee flexion ROM

45
Q

how many weeks is the functional phase after a ALC injury

A

8-16 weeks

46
Q

what are the goals during the functional phase (8-16 weeks) for an ACL injury (lig injiry)

A

start running (straight line)
start double leg jumping
improve single leg strength
get back not gym

47
Q

what is the criteria for the functional phase after a ACL sx

A

run normal on treadmill w/o pain
normla double leg landing
normla single leg squat

48
Q

what is the criteria from the return to running after an ACL injury

A
  • 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
49
Q

what are examples of phase 3 exercises (functional phase) after an ACL injury

A
  • pre jogging (jump rob , alter g , single leg squats for speed)
  • strengthening
  • landing mechanics
  • running
50
Q

what is the timeline for return to sport for post ACL

A

16 weeks to 6 months

51
Q

when during ACL recovery can u being light single leg hops ? being cutting/chang of direction ?

A

16 weeks
20 weeks

52
Q

at 24 weeks after an ACL sx what shoudl be at least 90% of contralateral limb , and what else shoudl be normla

A

single leg hopping

change of direction should be normla

53
Q

what is the criteria to return to sport phase for ACL

A
  • 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
54
Q

what is the complex for Anteromedial Rotatory Instability

A

ACL + medial/posterior medial knee ligament
complex

55
Q

what is the complex for posteromedial Rotatory Instability

A

PCL + medial/posterior medial knee ligament
complex

56
Q

what is the instability for the anterolateral rotatory instability

A

ACL alone

ACL and posterolateral corner

57
Q

what is the instability for the posterolateral rotatory instability

A
  • PCL and posterolateral corner
  • posterolateal corner alone
58
Q

what is included int he posterolateral corner

A
  • LCL
    -popliteus tendon
  • poplitofibular ligament ( arcuate lig , fabello-fibular ligament , biceps femoris long head , ITB)
59
Q

what are teh 6 attachments of the IT band

A

-1. ITB tract
2. Lateral intermuscular
septum
3. Kaplan fibers (femoral)
4. Patellar insertion
5. Tibial insertion (Gerdy’s)
6. Lateral femorotibial
ligament

60
Q

what are teh ITB syndrome factors (5)

A

 Excessive foot pronation
 Excessive internal torsion
 Genu varum
 Deep hip rotator/abductor weakness
 Innominate positioning

61
Q

what is a traction injury to the cartilage/bony attachment of tendons
in children and adolescents

A

apophysitis

62
Q

what is the MAIN difference between Osgood- Schlatter syndrome and Sinding- Larsen Johansson syndrome

A

Osgood : pain at the tibial tub
Sinding : pain at the inferior pole of the patella

63
Q

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

A

Osgood-Schlatter syndrome

64
Q

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

A

Osgood-Schlatter syndrome

THER EX 2: LQ (9 decks)

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