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MSK: LQ > lecture 7b: knee join complex emaination , evaluation and interventions > Flashcards

lecture 7b: knee join complex emaination , evaluation and interventions Flashcards

1
Q

• Ligamentous injuries
• ACL, PCL, MCL, LCL
• Instabilities
• Anteromedial, anterolateral,
posteromedial, posterolateral
• Meniscal and articular cartilage
injuries

are these considered acute or chronic problems in the knee

A

acute

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2
Q

• Instabilities
• Degenerative Changes (OA)
• Patellofemoral Pain Syndrome
• Patellar Tendinopathy

are these considered acute or chronic traumas to the knee

A

chronic

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3
Q

what forces come with injury to the MCL , accompanied by injury to medial meniscus , anterior cruiate and posterior medial capsule … “unhappy triad” - ACL , MCL and MM

A

valgus force

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4
Q

what is considered the unhappy triad

A

ACL
MCL
MM

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5
Q

hyperextension will casues injury to what and what is it accompanied by

A

injury to the ACL and accompanied by injury meniscus tears

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6
Q

a macrotrauma with flexion w posterior translation will causes injury to what

A

injury to PCL

classic “dashboard injury”

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7
Q

a macrotrauma with a varus force will cause injury to what and what is it accompanied by

A

injury to LCL
accompanied by injury to posterolateral capsule and PCL

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8
Q

a valgus producing force will causes injury to what ligament ?

a varus producing force will cause injury to what ligament

A

MCL
LCL

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9
Q

what is the MOI for an ACL tear contact vs non contact

A

*Contact: Hyperextension, valgus force
* Non-contact: Deceleration/acceleration
valgus force near extension (cutting , sudden direction change)

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10
Q

if you think a pt tore their ACL they would hear or feel a ___, have ___ , hx of knee ___ ___ and loss of endrange ____

A

pop
swelling
giving away
ext

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11
Q

what special test can u do for ACL tears

A

lachmans ( the best ot do ASAP)
anterior drawer
pivot shift (what they do right before sx)

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12
Q

what functional test can u use fo ACL tear

A

6 m single limb timed hip test

(+) if < 80% of uninvolved side

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13
Q

___ most easily identifies this indirect sign of ACL tear (segnod fx)

A

radiograph

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14
Q

what is a segond fx

A

aculsion of LCL form excessive IR of tibia

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15
Q

> 80% of ACL tears have this and it is most common over lateral femoral condyle

A

concurrent bone bruising

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16
Q

bone bruises heal ___

A

slowly

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17
Q

what is the long term prognosis for ACL tear
• Delayed surgery may be associated with ↑ damage to ____/___ ____
• Resumption of previous activity level following ACL tear may ↑ risk of future ___, (whether the ACL is reconstructed or not)
• Individuals with the highest preinjury activity level seem to have a ____ probability
of not returning to their preinjury activity level

A
  • delayed sx may be associated with increase damage to meniscus/ articular cartilage
  • going back to previous level of activity following ACL tear may increase risk of future OA
  • ndividuals with the highest preinjury activity level seem to have a higher probability
    of not returning to their preinjury activity level
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18
Q

what is the risk of ACL sx

A

time
cost
QOL
complications

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19
Q

how do u know if you should operate or not operate for a ACL tear

A

desicde if they are a copper or non copper

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20
Q

what is the screening process includsion criteria to see if someone is a copper for ACL sx

A
  • Isolated ACL
  • Non repairable meniscal injury
  • No other concomitant
    ligamentous damage
  • Full and pain free ROM
  • No knee joint effusion
  • MVIC of involved quad should
    equal 70% of uninvolved
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21
Q

how do u know if someone is a rehabilitation candidate for a torn ACL

A

• Single, cross over and timed hop
tests score of >80%
• No more than 1 episode of
giving way since time of injury
• KOS ADLs scale and sports
activity scale >80%
• Global rating scale >60%

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22
Q

if a person tore his ACL they are more likely to receive surgery if what 5 things ( non copper)

A
  1. higher activity level
  2. more episodes of giving away
  3. lower KOS ADL score
  4. lower score on the international knee documentation committee subjective knee form 2000
  5. lower limb symmetry index on the 6 meter timed hop test , and a lower quadriceps strength index
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23
Q

what is the MOI for a PCL tear

A

trauma with a posterior tibial shear injury in flexion or hyperextension
- dash board injury
- sudden stopping while wearing cleats
- fall with hyper flexed knees and ankle PF

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24
Q

what are some visual cues that would suspect a PCL tear

A
  • abrasion or bruising anterior proximal tibial if hit
  • Loss of knee extension with ROM testing or gait
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25
Q

what will the pt say with a PCL tear

A

localized posterior knee pain while kneeling or decelerating

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26
Q

if a pt comes in saying their MOI was a sudden stop while wearing cleats and u see that they have loss of knee extension with ROM testing and gait and they say they have localized posteiror knee pain while kneeling or decelerating what do u think is torn

A

PCL

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27
Q

what is the special test for PCL tears

A

(+) posterior drawer

(+) posterio sag sign

(+) valgus stress at 0° ( this test for both cruicate ligaments)

28
Q

what is the MOI and visual presentation for the MCL tear

A

MOI
* Tramatic, valgus force
* Possibly includes rotational trauma

Visual presentation
* Normal knee ROM
* Painful palpation of MCL

29
Q

what may a person with a MCL tear say

A
  • medial knee pain
  • depending on severity , they might report minimal symptoms that sound like a meniscal injury
30
Q

if a pt tells you their MOI is a traumatic valgus force and u see normal knee ROM but they have painful palpation of MCL and they said they have medial knee pain what are u suspecting

A

MCL tear

31
Q

what is the special test for MCL

A

(+) valgus strss test at 20-30° knee flexion

32
Q

what are the different grades for the MCL special test , valgus stress test at 20-30° of knee flexion

A

grade 1: joint space opens within 2 mm of contralateral side

grade 2” Joint space opens 3-5 mm
more than contralateral side

• Grade 3: Joint space opens more
than 5-10 mm more than
contralateral side

33
Q

do u need sx for an MCL tear

A

no it does well w.o sx but they want sc if there is a bony avulsion or combined with ACL tear or if after 3 months there is no progress and pt is still has instability w valgus force

34
Q

what is the MOI and visual presentation for an LCL tear

A

MOI:
* Traumatic, varus force

Visual presentation
* Local effusion over LCL
* Lack of or abnormal LCL with
palpation

35
Q

what might a pt say if they have a LCL tear

A

pain with palpating LCL

36
Q

what is the special test used for an LCL tear

A

varus stress test at 30° knee flexion

37
Q

if a pt tells u their MOI is a traumatic varus force and u see local effusion over LCL and lack of LCL w palpation as well as pain what do u think

A

LCL tear

38
Q

what kind of force is the anterior medial and anterior lateral instability of the knee

A

anterior medial: anterior and ER directed force

anterior lateral: anterior adn IR directed force

39
Q

what kind of force is the posterior medial and posterior lateral instability of the knee

A

posterior medial : posterior and IR directed force

posterior lateral: posterior and ER directed force

40
Q

what are the components involved with a anterior medial stability

A

MCL
POL (posterior oblique lig)
postero medial capsule
ACL

41
Q

what are the components involved with a anterior lateral stability

A

ACL
LCL
posterolateral capsule
Arcuate complex/ popliteus
ITB

42
Q

what are the components involved with a posterior medial stability

A

PCL
POL
MCL
semimem
posteromedial capsule
ACL

43
Q

what are the components involved with a posterior lateral stability

A

PCL
arcute complex/popliteus
LCL
biceps femoris
posterolateral capsule

44
Q

what is the MOI for Anteromedial Rotary Instability and what is it caused by

A

excessive valgus force an tibial ER motion

caused by anterior subluxation of medial tibial plateau

45
Q

what is the special test for Anteromedial Rotary Instability

A

anterior drawer w ER

46
Q

what is the MOI for Anterolateral Rotary Instability and what is almost always associated with it and what is it caused by

A

MOI: excessive valgus force and tibial IR motion

ACL tear

caused by anterior subluxation of lateral tibial plateau

47
Q

what is the special tests for Anterolateral Rotary Instability

A

anterior drawer w IR

half ROM IR test ACL and posterolateral capsule/ligametns
full IR ROM test PCL , ACL and lateral/posterolateal structures

pivot shift

48
Q

what is the MOI with Posteromedial Rotary Instability

A
  • Traumatic force delivered into extension and tibial IR
  • May have valgus movement as well
49
Q

what is the special tests for Posteromedial Rotary Instability

A

hughstons posteromeidal drawer

50
Q

what is the MOI for Posterolateral Rotary Instability

A

tibial posterior and ER force

51
Q

what is the special test for Posterolateral Rotary Instability

A

dial test/PLR test

52
Q

how do u do the dial test/PLR test

A

pt is prone , tibial ER ROM compared side to side
change in 10° or more from side to side is sig
increased ROM at 90° indicated PCL injury
increased ROM at 30° indicted PL corner
increased at both indicated PCL and PL corner

53
Q

what are 2 other special test for Posterolateral Rotary Instability

A

posterolateral drawer test
reserve pivot shift

54
Q

what is the MOI for Posterolateral Corner Injury

A

direct hit on proximal tibia w extended knee adn varus force

posterior force on a flexed knee w the tibia in ER

chronically after a trauma to ACL and/or PCL

55
Q

what is the visual presentation for a Posterolateral Corner Injury

A

varus thrust gait

56
Q

what may the pt report for a Posterolateral Corner Injury

A
  • Posterolateral instability
  • Feeling that the knee may give way
  • 1/24 pts report peroneal nerve irritation
57
Q

ACL injury rates are higher in who

A

young female athletes (most are non contact)

58
Q

according to the ligament sprain CPG update what has raised after post op

A

2nd ACL teat

59
Q

according to the ligament sprain CPG update there is a higher incidence rates ___ and ___ injuries in active individuals

A

ACL and MCL

60
Q

according to the ligament sprain CPG update what sport is the most common for ACL tears

A

soccer

61
Q

what is a risk factors for ACL injury : non contact

A

dry weather
artificial turf

62
Q

what are risk factors for ACL injury

A
  • female
  • narrow femorla notch
  • > A/P tib fem joint laxity
  • prior ACL sx
  • family hx
  • > posterior slope of tib plateau
63
Q

what is the new decision tree model for diagnosis/classification for ligaments

A

(1) Medical Screening
(2) Classification through evaluation
(3) Determining irritability stage
(4) Outcome measures
(5) Intervention strategies

64
Q

what are the clinical findings for knee ligament sprain

A
  • symptoms inset from trauma
  • deceleration , cutting , or valgus motion
  • “pop” heard or felt
  • hemarthrosis within 0-12 hrs after injury
  • knee effusion
  • sense of knee instability
  • excessive tibiofemoral laxity
  • pain/ symptoms w ligament integrity test
  • lower limb strength and coordination deficits
  • impaired SL balance
  • compensation during gait
65
Q

what is considered grade A interventions for ligament sprains

A
  • therapeutic exercise
  • NM electrical stimulation
  • NM re ed
66
Q

what is considered grade B interventions for ligament sprains

A
  • immediate mobilization
  • cryotherapy
  • supervised rehab
67
Q

what is considered grade C interventions for ligament sprains

A
  • CPM
  • knee bracing
  • early WB

MSK: LQ (22 decks)

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