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DPT 1 - Fall Semester > MSK Exam 2 > Flashcards

MSK Exam 2 Flashcards

1
Q

How many types of fractures are there for a Salter Harris fracture?

A

5

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2
Q

What type of fracture in kids (ages 10-15) involves the growth plate?

A

Salter Harris fracture

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3
Q

What are common causes of a Salter Harris fracture?

A

trauma, active children, repetitive stress

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4
Q

What type of Salter Harris fracture is considered a compression fracture?

A

type 5

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5
Q

What type of of Salter Harris fracture involves the growth plate plus the epiphysis and metaphysis?

A

type 4

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6
Q

What type of Salter Harris fracture doesn’t involve the growth plate?

A

type 1

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7
Q

What type of Salter Harris fracture extends through the epiphysis?

A

type 3

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8
Q

What type of Salter Harris fracture extends through the metaphysis, producing a chip fracture of the metaphysis?

A

type 2

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9
Q

What type of pediatric condition can affect the growth plate and could possibly lead to growth plate closure?

A

Salter Harris fracture

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10
Q

What type of pediatric conditions involves the tendons around the knee?

A

osgood schlatter and sinding-larsen johansson

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11
Q

How will a patient with Osgood Schlatter disease present?

A

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)

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12
Q

How would a patient with Sinding-Larsen-Johansson Syndrome present?

A

pain at the inferior pole of the patella, weakness of quads, and decreased flexibility of quads (decreased ROM of knee flexion and hip extension)

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13
Q

How would you treat patients that present with Osgood Schlatter’s or Sinding-Larsen-Johansson syndrome?

A

rest from offending activities, decrease inflammation, work on strength of quads and flexibility of quads

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14
Q

What can occur at the tibial tuberosity due to excessive stress where the quads attach?

A

extra bone growth can occur

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15
Q

What is osteochondritis dissecans (OCD)?

A

necrosis of the subchondral bone (especially on the lateral edge of the medial femoral condyle)

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16
Q

How does OCD occur?

A

predisposition to ischemia, overuse, or trauma

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17
Q

What symptoms will patients have with OCD?

A

pain the reproduces with tibial IR & extension, swelling, and a catching/locking in the knee joint

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18
Q

What pediatric condition can involve some of the articular cartilage breaking off within the knee joint?

A

OCD

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19
Q

What is the Wilson’s test?

A

putting pressure on the medial femoral condyle by putting the tibia into internal rotation and extension

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20
Q

How do you treat OCD?

A

Curettage, surgical fixation, regain ROM, strengthening, balance, agility, limit running and jumping for at least 6 weeks

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21
Q

What is curettage treatment for OCD?

A

scraping the area to make it smooth

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22
Q

How many grades of damage to the articular cartilage are there for OCD?

A

4

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23
Q

What grade of OCD involves part of the articular cartilage breaking off within the joint capsule?

A

grade 4

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24
Q

Why is surgery usually the not beneficial for ACL tears in children?

A

the surgical reconstruction crosses the growth plate which can close the growth plate if it is still open

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25
Q

What is the plica?

A

a crease/seam on the medial part of the knee

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26
Q

When does the plica become an issue in kids?

A

can get inflamed with constant knee flexion and extension (biking or running)

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27
Q

What is fat pad syndrome?

A

when the patella tilts from anterior knee pain and compress the fat pad

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28
Q

How many facets does the patella have?

A

5-7

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29
Q

How does the patella track as you flex the knee?

A

goes inferiorly and medially

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30
Q

How does the patella track when you extend the knee?

A

goes superiorly and laterally

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31
Q

what part of the knee controls capsular tension?

A

patella

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32
Q

What is chondromalacia patellae?

A

break down of cartilage on the posterior aspect of the patella and is usually related to tracking issues?

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33
Q

Can PT’s diagnose chondromalacia patellae?

A

no

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34
Q

What is chondromalacia patellae diagnosed as for PT’s

A

patellofemoral pain syndrome

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35
Q

What MOI can cause traumatic anterior knee pain?

A

trauma, dislocation, contusion, fractures, and bipartite

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36
Q

What are the MOI for patella dislocation?

A

blow to medial patella or a twisting valgus force (tibial ER)

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37
Q

What test will be positive if the patient has chronic patella dislocations?

A

positive apprehension test

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38
Q

What type of ligament testing would be contraindicated after a patella dislocation?

A

MCL testing (valgus stress)

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39
Q

What conditions are considered atraumatic anterior knee pain?

A

fat pad syndrome, plica, apophysitis, bursitis, quad & infrapatellar tendonitis

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40
Q

Where is pressure increased on the patella with an increased Q angle?

A

increased pressure on the lateral facets

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41
Q

What can effect the tracking of the patella?

A

weak VMO, drop in arch of foot (pronated feet), weak glut med, anteversion, patella alta, patella baha, and a tight ITB

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42
Q

What symptoms will patients have with patellofemoral pain syndrome?

A

anterior knee pain, increased pain with functional activities, “giving way” due to neurological inhibition of quads

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43
Q

What is the dynamic stabilizer of the ACL?

A

hamstrings

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44
Q

What is the dynamic stabilizer of the PCL?

A

quadriceps

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45
Q

What are provocational OKC tests for patellofemoral pain syndrome?

A

facet compression, facet palpation, resisted extension, McConnell, and Clarke’s sign

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46
Q

What are provocation CKC tests for patellofemoral pain syndrome?

A

eccentric step down, squat, lunge, disco test

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47
Q

What is the best provocational test for patellofemoral pain syndrome?

A

anterior knee pain with squats

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48
Q

What is the best non provocational test for patellofemoral pain syndrome?

A

lateral tilt test

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49
Q

How will a patient with patella tendonitis present?

A

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

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50
Q

How does ROM progress with quadriceps tendon rupture rehab?

A

0-2 weeks = 0-30 degrees
0-4 weeks = 0-60 degrees
4-6 weeks = 0-90 degrees

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51
Q

What contributes to extensor lag?

A

quadriceps weakness

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52
Q

What are some special tests for ITB friction syndrome?

A

Ober’s test, Noble’s compression test, and palpation

53
Q

Where will the pain be located with ITB tendonitis?

A

lateral knee

54
Q

What are some conditions related to lateral knee pain?

A

LCL injury, lateral meniscus injury, peroneal nerve injury, ITB tendonitis

55
Q

What can occur with a peroneal nerve injury?

A

foot drop

56
Q

What percentage of ACL injuries are non-contact?

A

70%

57
Q

What are some MOI’s of ACL injuries when it occurs with no contact?

A

tibial IR, valgus load at/near full extension, deceleration and acceleration motions

58
Q

True or false: females have a narrower notch for their ACL

A

true

59
Q

Why can ACL testing be difficult?

A

hamstrings will activate for protection

60
Q

What ligaments are in the unhappy triad?

A

ACL, MCL, and medial meniscus

61
Q

What are some special tests for the ACL?

A

Lachman, pivot shift, anterior drawer, and lelli’s

62
Q

What degree of the knee will the ITB shift with a pivot shift test?

A

20-30 degrees

63
Q

When would a patient not need a reconstruction for an ACL tear?

A

older population, not planning to return to sports, no instability

64
Q

By what weeks should full ROM be restored after ACL reconstruction?

A

4-6 weeks

65
Q

Why do you want to avoid terminal knee extension early on with rehab after an ACL reconstruction?

A

it could cause anterior translation of the tibia which could affect the graft

66
Q

During the early stages of ACL rehab after reconstruction what degrees of isometric contractions is recommended?

A

up to 60-70 degrees of isometric contraction

67
Q

What are the functional guidelines for ACL reconstruction rehab?

A

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

68
Q

Why would a patient need to stay on crutches during ACL reconstruction rehab?

A

unable to perform a SLR without extensor lag or they have an antalgic gait

69
Q

How much strength should the quadriceps have compared to the uninvolved side to return to sport?

A

90% or greater compared to uninvolved leg

70
Q

How much strength should the hamstrings have compared to the uninvolved leg to return to sport?

A

100% compared to uninvolved leg

71
Q

What are some functional tests for the ACL to return to sport?

A

y-excursion test, straight leg hop, straight leg triple hop

72
Q

What are the guidelines for return to sport after ACL reconstruction?

A

full ROM, quads 90% strength compared to uninvolved leg, hamstrings 100% strength of uninvolved leg, and no more swelling

73
Q

How can you test the strength of the hamstrings or quadriceps?

A

hand held dynamometer or a torque machine

74
Q

What are some problems or complications of ACL reconstruction?

A

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

75
Q

What does quad avoidance gait look like?

A

landing with more knee extension, less knee flexion, less dorsiflexion, and less hip flexion

76
Q

What is the weight bearing status for patients who have the BEAR procedure?

A

50% PWB

77
Q

What is the position of the knee for the first 4 weeks after the BEAR procedure?

A

locked in extension

78
Q

How are PCL injuries usually caused?

A

trauma, contact, posterior force on proximal tibia

79
Q

How will a patient present with a PCL injury?

A

knee effusion & hemarthrosis, posterior knee pain with kneeling

80
Q

What are some special tests for the PCL?

A

posterior sag, posterior drawer, quadriceps active test, degree of opening

81
Q

What are the degrees of opening and the relative grades?

A

1 –> 0-5 mm
2 –> 5-10 mm
3 –> >10mm

82
Q

What is the non-surgical treatment for a grade 1 and 2 isolated sprain of the PCL?

A

quad strengthening, extension brace during early phase, AROM

83
Q

What is the non-surgical treatment for a grade 3 complete rupture of the PCL?

A

more conservative, PROM/AAROM for knee flexion in early phase, less aggressive strengthening

84
Q

What is the return to sport criteria for PCL injuries?

A

no pain, no tenderness, no swelling, function testing > 90% of uninvolved, and hamstrings strength >85-90% of uninvolved

85
Q

What other injury will you commonly see with an MCL injury?

A

medial meniscus injury

86
Q

What types of ligament injuries tend to stay painful for longer period of time?

A

MCL and LCL

87
Q

What part of the knee is typically affected the most with knee osteoarthritis?

A

medial side

88
Q

Why does the medial part of the knee end up more affected with knee OA?

A

knee adduction moment during gait

89
Q

What causes the knee adduction moment?

A

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

90
Q

What modality is not recommended for pain modulation for OA?

A

TENS

91
Q

What are some biomechanical strategies to unload the medial joint space for knee OA?

A

trunk lean, toe out, slower gait, medial knee thrust (dynamic valgus), use of cane to reduce knee adduction moment

92
Q

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)

A

contralateral side and 20% BW support

93
Q

What type of knee valgus brace is best for reducing knee adduction moment?

A

1.5 inch valgus brace

94
Q

What foot position can open up the medial joint space of the knee which can be beneficial for knee OA?

A

pronation of the foot

95
Q

How does foot pronation move the knee joint?

A

moves it into genu valgum

96
Q

How big of a lateral heel wedge is best for reducing the knee adduction moment?

A

5 inch lateral heel wedge

97
Q

What is the most common type of TKR?

A

cemented

98
Q

What is the most common degree of constraint with a TKR?

A

semiconstrained

99
Q

When is a unicompartmental knee replacement surgery performed?

A

only done if there is no advanced OA in other compartments

100
Q

What are some typical post-operative problems/impairments after a TKR?

A

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

101
Q

What is extensor lag?

A

some knee flexion with a SLR and shows that quads can’t control it

102
Q

What should you work on during the first 6 weeks post-op TKR?

A

ROM

103
Q

What should be your primary focus with knee rehab?

A

quads

104
Q

What is the red portion of the meniscus?

A

outer rim of meniscus because it has the most blood flow

105
Q

What is the red on white portion of the meniscus?

A

in between the outer rim and inner rim of the meniscus

106
Q

What is the white on white portion of the meniscus?

A

inner rim of the meniscus because there is very little to no blood flow

107
Q

How does the meniscus control the tibia?

A

controls the extreme translations of the tibia in CKC and OKC

108
Q

How does the meniscus send shock absorption through itself?

A

sends forces in a circular pattern around the meniscus (hoop distribution)

109
Q

What is the purpose of the meniscus?

A

reduces friction, reduces compression and shear forces, improves joint congruency

110
Q

How much weight goes through the medial compartment of the meniscus?

A

50% of load through knee

111
Q

How much of the weight goes through the lateral compartment of the meniscus?

A

70% to 80% of load through knee

112
Q

When does load increase on the lateral compartment of the meniscus?

A

knee flexion increases load through the lateral meniscus

113
Q

What are the 5 types of meniscal tears?

A

vertical longitudinal, oblique, degenerative, transverse, horizontal

114
Q

Which tear goes all the way through the meniscus?

A

horizontal tear

115
Q

What tear of the meniscus points upward?

A

oblique tear

116
Q

What tear is also known as a bucket handle tear?

A

vertical longitudinal tear

117
Q

What tear can block the ROM and cause the knee to lock?

A

vertical longitudinal tear

118
Q

What tear will still allow the most amount of force transmission through the meniscus?

A

vertical longitudinal tear

119
Q

What meniscal tear is the worst for still allowing transmission of forces through the meniscus?

A

horizontal tear

120
Q

When is a meniscal tear less likely to heal?

A

less likely to hear when there is a debridement of the white on white rim (inner rim of meniscus)

121
Q

What ligament tear causes more rotatory translation in the knee?

A

LCL tear

122
Q

What movement of the knee compresses the posterior horn of the meniscus?

A

knee flexion

123
Q

What movement cause the most compression of on the anterior horn of the meniscus?

A

knee extension

124
Q

If there is a peripheral tear of the meniscus, how long until the patient can be FWB?

A

4-8 weeks

125
Q

If there is a central tear of the meniscus, how long will it be until the patient can be FWB?

A

6-8 weeks

126
Q

What are special tests for meniscal injuries?

A

Apley’s, McMurray’s, Thessaly’s, Disco, Joint Line Tenderness

127
Q

What type of activities can promote bone remodeling within the LE?

A

weight bearing activites

128
Q

What type of activities can promote bone remodeling of the upper extremity?

A

muscle contraction

129
Q
A

DPT 1 - Fall Semester (3 decks)

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