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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
what will the pt say with a **PCL tear**
localized posterior knee pain while kneeling or decelerating
26
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
PCL
27
what is the **special test** for **PCL tears**
(+) posterior drawer (+) posterio sag sign (+) valgus stress at 0° ( this test for both cruicate ligaments)
28
what is the **MOI** and **visual presentation** for the **MCL** tear
MOI * Tramatic, valgus force * Possibly includes rotational trauma Visual presentation * Normal knee ROM * Painful palpation of MCL
29
what may a person with a **MCL tear** say
- medial knee pain - depending on severity , they might report minimal symptoms that sound like a meniscal injury
30
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
MCL tear
31
what is the **special test** for **MCL**
(+) valgus strss test at 20-30° knee flexion
32
what are the different grades for the MCL special test , valgus stress test at 20-30° of knee flexion
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
do u need sx for an MCL tear
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
what is the **MOI** and **visual presentation** for an **LCL** tear
MOI: * Traumatic, varus force Visual presentation * Local effusion over LCL * Lack of or abnormal LCL with palpation
35
what might a pt say if they have a **LCL tear**
pain with palpating LCL
36
what is the **special test** used for an **LCL tear**
varus stress test at 30° knee flexion
37
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
LCL tear
38
what kind of force is the **anterior medial** and **anterior lateral** instability of the knee
anterior medial: anterior and ER directed force anterior lateral: anterior adn IR directed force
39
what kind of force is the **posterior medial** and **posterior lateral** instability of the knee
posterior medial : posterior and IR directed force posterior lateral: posterior and ER directed force
40
what are the components involved with a **anterior medial stability**
MCL POL (posterior oblique lig) postero medial capsule ACL
41
what are the components involved with a **anterior lateral stability**
ACL LCL posterolateral capsule Arcuate complex/ popliteus ITB
42
what are the components involved with a **posterior medial stability**
PCL POL MCL semimem posteromedial capsule ACL
43
what are the components involved with a **posterior lateral stability**
PCL arcute complex/popliteus LCL biceps femoris posterolateral capsule
44
what is the **MOI** for **Anteromedial Rotary Instability** and what is it caused by
excessive valgus force an tibial ER motion caused by anterior subluxation of medial tibial plateau
45
what is the **special test** for **Anteromedial Rotary Instability**
anterior drawer w ER
46
what is the MOI for **Anterolateral Rotary Instability** and what is almost always associated with it and what is it caused by
MOI: excessive valgus force and tibial IR motion ACL tear caused by anterior subluxation of lateral tibial plateau
47
what is the special tests for Anterolateral Rotary Instability
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
what is the **MOI** with **Posteromedial Rotary Instability**
* Traumatic force delivered into extension and tibial IR * May have valgus movement as well
49
what is the **special tests** for **Posteromedial Rotary Instability**
hughstons posteromeidal drawer
50
what is the **MOI** for **Posterolateral Rotary Instability**
tibial posterior and ER force
51
what is the **special test** for **Posterolateral Rotary Instability**
dial test/PLR test
52
how do u do the dial test/PLR test
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
what are 2 other special test for Posterolateral Rotary Instability
posterolateral drawer test reserve pivot shift
54
what is the MOI for Posterolateral Corner Injury
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
what is the visual presentation for a **Posterolateral Corner Injury**
varus thrust gait
56
what may the pt report for a **Posterolateral Corner Injury**
* Posterolateral instability * Feeling that the knee may give way * 1/24 pts report peroneal nerve irritation
57
ACL injury rates are higher in who
young female athletes (most are non contact)
58
according to the ligament sprain CPG update what has raised after post op
2nd ACL teat
59
according to the ligament sprain CPG update there is a higher incidence rates ___ and ___ injuries in active individuals
ACL and MCL
60
according to the ligament sprain CPG update what sport is the most common for ACL tears
soccer
61
what is a risk factors for ACL injury : non contact
dry weather artificial turf
62
what are risk factors for ACL injury
- female - narrow femorla notch - > A/P tib fem joint laxity - prior ACL sx - family hx - > posterior slope of tib plateau
63
what is the new decision tree model for diagnosis/classification for ligaments
(1) Medical Screening (2) Classification through evaluation (3) Determining irritability stage (4) Outcome measures (5) Intervention strategies
64
what are the clinical findings for knee ligament sprain
- 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
what is considered **grade A** interventions for **ligament sprains**
- therapeutic exercise - NM electrical stimulation - NM re ed
66
what is considered **grade B** interventions for **ligament sprains**
- immediate mobilization - cryotherapy - supervised rehab
67
what is considered **grade C interventions** for **ligament sprains**
- CPM - knee bracing - early WB

MSK: LQ (22 decks)

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