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NMS 1-3 > NMS 3: Knee > Flashcards

NMS 3: Knee Flashcards

1
Q

Knee: General Characteristics

A

-Largest and most complex joint in the body
-All in one capsule
-Tibiofibular: More associated with the ankle and in it’s own capsules

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2
Q

Joints of the Knee

A

Medial tibiofemoral, lateral tibiofemoral, patellofemoral

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3
Q

What joint is more associated with the ankle and it’s own capsules

A

Tibiofibular Joint

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4
Q

Functions of the knee

A

Weight bearing and Locomotion

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5
Q

Knee: Vulnearability to Dysfunction

A

-Superficial anatomical exposure: No muscles to protect from direct blows
-Large functional demands

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6
Q

Stabilizing Structures of the Knee

A

-Shape of the articular surfaces
-Interposed medial and lateral meniscus: Support a majority of the weight
-Fibroelastic properties of the capsule
-Protective action of the bursa
-Restrictive effects of the joint ligaments
-Strength of the surroundings muscles: Quads-around the patellar tendon
-Lubricating and cushioning of the fat pads

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7
Q

Knee Flexion

A

-Tibia slides forward/Femur slides back
-Tibial condyles roll A-P under femoral condyles
-Tibial condyles also glide A-P

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8
Q

Knee Extension

A

-Tibia is stationary, femur slides back
-Tibial condyles roll P-A under femoral condyles
-Tibial condyles also glide P-A

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9
Q

What happens in the last 10-20 degrees of knee extension

A

Tibia externally rotates (screw-home mechanism)

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10
Q

Knee-Full Extension

A

-Tibia externally rotated (screw home)
-Cruciate “uncrossed”
-More resilience on collaterals (taking on most of the force )
-Muscular stabilization by: Pes anserine tendons, ITB, hamstring

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11
Q

Patella: Strucure/Functions

A

-Medial and lateral facets articulate with the patellar groove of the femur
-Patellar groove and facets cover with articular coverage and lie inside the capsular fibers of the knee joint
-Patella protects from anterior blows
-The more you flex, the more force that is placed into the patella

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12
Q

Patellofemoral Joint Reaction Forces

A

-Walking: 100 lbs
-Bike: 100lbs
-Deep Squatting: 4000lbs
-Squatting: 1400lbs
-Jogging: 1400lbs
-Stairs descent: 1000lbs
-Stair ascend: 660lbs

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13
Q

Coupled Motions of the Knee

A

-Flexion and internal rotation
-Extension and external rotation

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14
Q

-Most injuries happen are a result of rotation to the ________side of flexion and extension

A

Opposite; Plant foot bent knee and turn inward sports and even going down stairs

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15
Q

The knee is very susceptible to injury in the ______ packed position

A

Open; more impact on the cruciate ligaments, which don’t hold load as well

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16
Q

Suprapatellar Bursa

A

-Can be continuous with the joint capsule
-Superior aspect of patella upward beneath the quadriceps
-Decreases friction between the quadriceps tendon and femur
-Extension of the synovial membrane (contains fluid)
-Intrasynovial

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17
Q

Prepatellar Bursa

A

-Subcutaneous anterior to patella
-Protects from blow to patella and from kneeling on the kee
-“Housemaid knee”
-Extracapsular

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18
Q

Superficial Infrapatellar Bursa

A

-Subcutaneous anterior to patellar tendon below patella
-Inflammation…

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19
Q

Deep Infrapatellar Bursa

A

-Deep to infrapatellar tendon
-Sometimes continuous with the synovial space
-Increase in the superficial or deep infrapatellar bursa called “Parson’s Knees”

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20
Q

Pes Anserine Bursa

A

-Lies between MCL/tibia and pes anserine muscles
-Related to runners

21
Q

Chondromalacia Patella

A

-Degenerative process that involves softening and fissuring of the patellar articular cartilage
-Very common (Affect 1/3)
-3 categories: Primary Idiopathic, secondary adolescent, adult

22
Q

Primary Idiopathic

A

-No trauma, disease, or deformity
-Adolescents and young adults
-Begins on the medial of the patella

23
Q

Signs/Symptoms of Idiopathic Chondromalacia patella

A

-Diffuse ache
-pain increased with quadriceps stress
-creptis/catching in the knee
-effusion
-movie sign (prolonged sitting)

24
Q

Diagnosis of Primary idiopathic

A

Pain over the margin of the patella
-pain when the patella is “scrambled” across the femur (Perkins sign)
-Pain with direct pressure of the patella on the femur (Fourchet’s sign)

25
X-Ray Findings: Primary Idiopathic Chondromalacia
-MRI (image of choice) -Prognosis: Continue for years and may become better or worse -Most improve spontaneously and do not progress to DJD
26
Treatment of Primary Idiopathic
-Exercise* :Lateralis stretched/medialis strengthened -conservative care -improve the tracking of the patella, align lower leg, adjust the hip, knee, foot and ankle and low back -Inflammation control -Nutritional supplements for inflammation and cartilage support -Align lower leg (pes planus)
27
Secondary Adolescent Chondromalacia
-Softening of cartilage secondary to trauma -Adolescents and young adults -Etiology: Direct or indirect trauma, increased Q angle, elongation of patella tendon, microtrauma -Signs/symptoms: Lesion is more lateral over lateral aspect of patella, buckling is common -Treatment: Same as idiopathic
28
Adult DJD-Patellofemoral Syndrome
-Middle aged and beyond -Softening of the entire patella, onset usually insidious -Signs/symptoms: Limitation of motion, effusion, crepitation, pain w/ activity -Treatment: Same as adolescent (adjust to restore normal tracking)
29
Osgood Schlatter’s Disease
-One of most common causes of knee pain in active adolescents -Jumping/cutting sports -Bilateral in about 20% of cases -Exact cause is unknown -enlarged tibial tubercle (where pain is) -Usually remits on skeletal maturity -Permenent bump
30
Grades of OS
1. Pain after activity 2. Pain during/after activity 3. Constant pain
31
Sinding-Larsen-Johansson Disease
-Located at inferior pull of the patella -Treatment: Same as OS
32
Osteoarthritis of the Knee
-The risk of disability from OA Knee is as great as that of CV disease -One of the most common sites of osteoarthritis
33
Etiology of Osteoarthritis
-Heredity: genetic mutations -Weight: increases pressure on joints -Age -Gender -Trauma -Repetitive Stress Injuries: -High Impact Sports: Soccer, long-distance running, tennis -Other Illnesses
34
Symptoms of OA
-Early: Painful cracking or grinding -Late: Attacks of synovitis and muscle atrophy of the quadriceps
35
Treatment of OA
-Mobilize joint -normalize abnormal stress -Treat the effusion -Exercise: Weight loss, strengthen quads, increase circulation -Anti-inflammatory drugs -Intra-articular treatments -Surgery -Brace
36
Infrapatellar Bursitis
-Deep and superficial infrapatellar bursitis -dumbbell shaped -Parson’s Knees -The prepatellar bursae is most common (Housemaid’s knee)
37
IT Band Syndrome
-Most common cause of lateral knee pain in runners -Friction on distal IT band -Seen in: long distance runners, weight lifters, cyclists, skiers, x-country runners
38
Predisposing factors of IT Band Syndrome
-Genu varum, foot problems, leg length discrepancy
39
Signs/Symptoms of IT Band Syndrome
-Tenderness over the lateral epicondyle -Usually occurs between miles 1-5
40
Jumper’s Knee (Patellar Tendinitis)
-Tendititis occuring at the bone tendon junction -Occurs in athletes requiring explosive quad movements -Rapid increase in training frequency/intensity -Improper mechanics -Training on ridged surface
41
Signs/Symptoms of Jumpers Knee
-Squeaky Knee
42
Baker’s Cyst (Popliteal Cyst)
-Synovial herniation in the posterior of the knee -Causes: Semimembranous/gastroc bursa
43
Torn Meniscus
-Mostly avascular -Outermost 20% of the meniscus with blood supply -Feels “locked” -Any twisting, squatting or impacting activities -Meniscal tissue doesn’t heal -Most times can be treated without surgery
44
Torn Mesniscus causes
-traumatic tears: twisting injury or a blow to the side of the knee/oftentimes under 30 years old -Can also be degenerative: Natural drying-out of the inner center
45
Dislocated Patella
-Lateral -Patellar groove is shallow -After dislocation, muscle spasm flexing the knee locking the patella lateral to the groove
46
Anterior Cruciate Ligament
-Most commonly injured ligament of the knee -Sports-related
47
ACL Injury occurence
-More common in women than men -“loosely” attirbuted to hamstring/quad strength imbalance -Planting/cutting
48
Lachman’s Test
-Least stressful/most reliable indicator of ACL tear -Patient supine with knee in 20-30 degrees of flexion

NMS 1-3 (27 decks)

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