MSK Exam 2 Flashcards
How many types of fractures are there for a Salter Harris fracture?
5
What type of fracture in kids (ages 10-15) involves the growth plate?
Salter Harris fracture
What are common causes of a Salter Harris fracture?
trauma, active children, repetitive stress
What type of Salter Harris fracture is considered a compression fracture?
type 5
What type of of Salter Harris fracture involves the growth plate plus the epiphysis and metaphysis?
type 4
What type of Salter Harris fracture doesn’t involve the growth plate?
type 1
What type of Salter Harris fracture extends through the epiphysis?
type 3
What type of Salter Harris fracture extends through the metaphysis, producing a chip fracture of the metaphysis?
type 2
What type of pediatric condition can affect the growth plate and could possibly lead to growth plate closure?
Salter Harris fracture
What type of pediatric conditions involves the tendons around the knee?
osgood schlatter and sinding-larsen johansson
How will a patient with Osgood Schlatter disease present?
pain with resisted knee extension and squats, swelling around the tibial tuberosity, and decrease flexibility of the quads (decreased ROM of knee flexion and hip extension)
How would a patient with Sinding-Larsen-Johansson Syndrome present?
pain at the inferior pole of the patella, weakness of quads, and decreased flexibility of quads (decreased ROM of knee flexion and hip extension)
How would you treat patients that present with Osgood Schlatter’s or Sinding-Larsen-Johansson syndrome?
rest from offending activities, decrease inflammation, work on strength of quads and flexibility of quads
What can occur at the tibial tuberosity due to excessive stress where the quads attach?
extra bone growth can occur
What is osteochondritis dissecans (OCD)?
necrosis of the subchondral bone (especially on the lateral edge of the medial femoral condyle)
How does OCD occur?
predisposition to ischemia, overuse, or trauma
What symptoms will patients have with OCD?
pain the reproduces with tibial IR & extension, swelling, and a catching/locking in the knee joint
What pediatric condition can involve some of the articular cartilage breaking off within the knee joint?
OCD
What is the Wilson’s test?
putting pressure on the medial femoral condyle by putting the tibia into internal rotation and extension
How do you treat OCD?
Curettage, surgical fixation, regain ROM, strengthening, balance, agility, limit running and jumping for at least 6 weeks
What is curettage treatment for OCD?
scraping the area to make it smooth
How many grades of damage to the articular cartilage are there for OCD?
4
What grade of OCD involves part of the articular cartilage breaking off within the joint capsule?
grade 4
Why is surgery usually the not beneficial for ACL tears in children?
the surgical reconstruction crosses the growth plate which can close the growth plate if it is still open
What is the plica?
a crease/seam on the medial part of the knee
When does the plica become an issue in kids?
can get inflamed with constant knee flexion and extension (biking or running)
What is fat pad syndrome?
when the patella tilts from anterior knee pain and compress the fat pad
How many facets does the patella have?
5-7
How does the patella track as you flex the knee?
goes inferiorly and medially
How does the patella track when you extend the knee?
goes superiorly and laterally
what part of the knee controls capsular tension?
patella
What is chondromalacia patellae?
break down of cartilage on the posterior aspect of the patella and is usually related to tracking issues?
Can PT’s diagnose chondromalacia patellae?
no
What is chondromalacia patellae diagnosed as for PT’s
patellofemoral pain syndrome
What MOI can cause traumatic anterior knee pain?
trauma, dislocation, contusion, fractures, and bipartite
What are the MOI for patella dislocation?
blow to medial patella or a twisting valgus force (tibial ER)
What test will be positive if the patient has chronic patella dislocations?
positive apprehension test
What type of ligament testing would be contraindicated after a patella dislocation?
MCL testing (valgus stress)
What conditions are considered atraumatic anterior knee pain?
fat pad syndrome, plica, apophysitis, bursitis, quad & infrapatellar tendonitis
Where is pressure increased on the patella with an increased Q angle?
increased pressure on the lateral facets
What can effect the tracking of the patella?
weak VMO, drop in arch of foot (pronated feet), weak glut med, anteversion, patella alta, patella baha, and a tight ITB
What symptoms will patients have with patellofemoral pain syndrome?
anterior knee pain, increased pain with functional activities, “giving way” due to neurological inhibition of quads
What is the dynamic stabilizer of the ACL?
hamstrings
What is the dynamic stabilizer of the PCL?
quadriceps
What are provocational OKC tests for patellofemoral pain syndrome?
facet compression, facet palpation, resisted extension, McConnell, and Clarke’s sign
What are provocation CKC tests for patellofemoral pain syndrome?
eccentric step down, squat, lunge, disco test
What is the best provocational test for patellofemoral pain syndrome?
anterior knee pain with squats
What is the best non provocational test for patellofemoral pain syndrome?
lateral tilt test
How will a patient with patella tendonitis present?
anterior knee pain with running, jumping, squats, kneeling, and stairs, pain decreases with a warm up, increased pain with knee extension and prone knee flexion stretch
How does ROM progress with quadriceps tendon rupture rehab?
0-2 weeks = 0-30 degrees
0-4 weeks = 0-60 degrees
4-6 weeks = 0-90 degrees
What contributes to extensor lag?
quadriceps weakness
What are some special tests for ITB friction syndrome?
Ober’s test, Noble’s compression test, and palpation
Where will the pain be located with ITB tendonitis?
lateral knee
What are some conditions related to lateral knee pain?
LCL injury, lateral meniscus injury, peroneal nerve injury, ITB tendonitis
What can occur with a peroneal nerve injury?
foot drop
What percentage of ACL injuries are non-contact?
70%
What are some MOI’s of ACL injuries when it occurs with no contact?
tibial IR, valgus load at/near full extension, deceleration and acceleration motions
True or false: females have a narrower notch for their ACL
true
Why can ACL testing be difficult?
hamstrings will activate for protection
What ligaments are in the unhappy triad?
ACL, MCL, and medial meniscus
What are some special tests for the ACL?
Lachman, pivot shift, anterior drawer, and lelli’s
What degree of the knee will the ITB shift with a pivot shift test?
20-30 degrees
When would a patient not need a reconstruction for an ACL tear?
older population, not planning to return to sports, no instability
By what weeks should full ROM be restored after ACL reconstruction?
4-6 weeks
Why do you want to avoid terminal knee extension early on with rehab after an ACL reconstruction?
it could cause anterior translation of the tibia which could affect the graft
During the early stages of ACL rehab after reconstruction what degrees of isometric contractions is recommended?
up to 60-70 degrees of isometric contraction
What are the functional guidelines for ACL reconstruction rehab?
After 2 weeks –> rid of crutches if showing no lag with SLR
12 weeks –> begin running progression
4-5 months –> initiate sport specific drills
6-9 months –> return to competition
Why would a patient need to stay on crutches during ACL reconstruction rehab?
unable to perform a SLR without extensor lag or they have an antalgic gait
How much strength should the quadriceps have compared to the uninvolved side to return to sport?
90% or greater compared to uninvolved leg
How much strength should the hamstrings have compared to the uninvolved leg to return to sport?
100% compared to uninvolved leg
What are some functional tests for the ACL to return to sport?
y-excursion test, straight leg hop, straight leg triple hop
What are the guidelines for return to sport after ACL reconstruction?
full ROM, quads 90% strength compared to uninvolved leg, hamstrings 100% strength of uninvolved leg, and no more swelling
How can you test the strength of the hamstrings or quadriceps?
hand held dynamometer or a torque machine
What are some problems or complications of ACL reconstruction?
loss of motion (due to arthrofibrosis), anterior knee pain, quad deficits, quad avoidance gait, patellar fracture, tendon rupture, infection, DVT, pulmonary embolism, and fear of reinjury
What does quad avoidance gait look like?
landing with more knee extension, less knee flexion, less dorsiflexion, and less hip flexion
What is the weight bearing status for patients who have the BEAR procedure?
50% PWB
What is the position of the knee for the first 4 weeks after the BEAR procedure?
locked in extension
How are PCL injuries usually caused?
trauma, contact, posterior force on proximal tibia
How will a patient present with a PCL injury?
knee effusion & hemarthrosis, posterior knee pain with kneeling
What are some special tests for the PCL?
posterior sag, posterior drawer, quadriceps active test, degree of opening
What are the degrees of opening and the relative grades?
1 –> 0-5 mm
2 –> 5-10 mm
3 –> >10mm
What is the non-surgical treatment for a grade 1 and 2 isolated sprain of the PCL?
quad strengthening, extension brace during early phase, AROM
What is the non-surgical treatment for a grade 3 complete rupture of the PCL?
more conservative, PROM/AAROM for knee flexion in early phase, less aggressive strengthening
What is the return to sport criteria for PCL injuries?
no pain, no tenderness, no swelling, function testing > 90% of uninvolved, and hamstrings strength >85-90% of uninvolved
What other injury will you commonly see with an MCL injury?
medial meniscus injury
What types of ligament injuries tend to stay painful for longer period of time?
MCL and LCL
What part of the knee is typically affected the most with knee osteoarthritis?
medial side
Why does the medial part of the knee end up more affected with knee OA?
knee adduction moment during gait
What causes the knee adduction moment?
torque vector passes medial to the knee joint center of rotation from the ground reaction force causing the tibia to move more into a varus position
What modality is not recommended for pain modulation for OA?
TENS
What are some biomechanical strategies to unload the medial joint space for knee OA?
trunk lean, toe out, slower gait, medial knee thrust (dynamic valgus), use of cane to reduce knee adduction moment
What is the best way to use a cane for knee OA? (think which hand to hold it in and how much BW to put through the cane)
contralateral side and 20% BW support
What type of knee valgus brace is best for reducing knee adduction moment?
1.5 inch valgus brace
What foot position can open up the medial joint space of the knee which can be beneficial for knee OA?
pronation of the foot
How does foot pronation move the knee joint?
moves it into genu valgum
How big of a lateral heel wedge is best for reducing the knee adduction moment?
5 inch lateral heel wedge
What is the most common type of TKR?
cemented
What is the most common degree of constraint with a TKR?
semiconstrained
When is a unicompartmental knee replacement surgery performed?
only done if there is no advanced OA in other compartments
What are some typical post-operative problems/impairments after a TKR?
Acute pain, swelling, quad activation deficits (leading to extensor lag), PROM, AAROM, AROM, gait with assistive device, DVT, nerve damage (gonalgia paresthetica), loosening, limited knee flexion, patella instability, infection
What is extensor lag?
some knee flexion with a SLR and shows that quads can’t control it
What should you work on during the first 6 weeks post-op TKR?
ROM
What should be your primary focus with knee rehab?
quads
What is the red portion of the meniscus?
outer rim of meniscus because it has the most blood flow
What is the red on white portion of the meniscus?
in between the outer rim and inner rim of the meniscus
What is the white on white portion of the meniscus?
inner rim of the meniscus because there is very little to no blood flow
How does the meniscus control the tibia?
controls the extreme translations of the tibia in CKC and OKC
How does the meniscus send shock absorption through itself?
sends forces in a circular pattern around the meniscus (hoop distribution)
What is the purpose of the meniscus?
reduces friction, reduces compression and shear forces, improves joint congruency
How much weight goes through the medial compartment of the meniscus?
50% of load through knee
How much of the weight goes through the lateral compartment of the meniscus?
70% to 80% of load through knee
When does load increase on the lateral compartment of the meniscus?
knee flexion increases load through the lateral meniscus
What are the 5 types of meniscal tears?
vertical longitudinal, oblique, degenerative, transverse, horizontal
Which tear goes all the way through the meniscus?
horizontal tear
What tear of the meniscus points upward?
oblique tear
What tear is also known as a bucket handle tear?
vertical longitudinal tear
What tear can block the ROM and cause the knee to lock?
vertical longitudinal tear
What tear will still allow the most amount of force transmission through the meniscus?
vertical longitudinal tear
What meniscal tear is the worst for still allowing transmission of forces through the meniscus?
horizontal tear
When is a meniscal tear less likely to heal?
less likely to hear when there is a debridement of the white on white rim (inner rim of meniscus)
What ligament tear causes more rotatory translation in the knee?
LCL tear
What movement of the knee compresses the posterior horn of the meniscus?
knee flexion
What movement cause the most compression of on the anterior horn of the meniscus?
knee extension
If there is a peripheral tear of the meniscus, how long until the patient can be FWB?
4-8 weeks
If there is a central tear of the meniscus, how long will it be until the patient can be FWB?
6-8 weeks
What are special tests for meniscal injuries?
Apley’s, McMurray’s, Thessaly’s, Disco, Joint Line Tenderness
What type of activities can promote bone remodeling within the LE?
weight bearing activites
What type of activities can promote bone remodeling of the upper extremity?
muscle contraction
