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DPT MSK Fall 22' - Spring 23' > PFPS/patellar dislocation - exam 3 > Flashcards

PFPS/patellar dislocation - exam 3 Flashcards

1
Q

PF GRF:
- walking
- near 30 deg flx
- stair climbing
- squatting
- peak at:

A
  • 50% BW
  • BW
  • 3x BW
  • > 7x BW
  • 90 deg
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2
Q

what % of PFPS is recurrent and persistent?

A

70-90 %

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3
Q

risk factors for PFPS

A

military recruits
dynamic (NOT static) excessive pronation
females
– larger Q angle
– differing hip strength and coordination
patellar and femoral bone shape

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4
Q

is PFPS normally caused by gradual unknown onset or trauma?

A

gradual and unknown onset

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5
Q

what is the theory for the cause of PF malalignment and/or maltracking?

A

patella glides and tilts more laterally relative to femur

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6
Q

Someone with PFPS has ________ surface area contact between the patella and femur

A

decreased

less contact puts more force in a smaller area —-» wear down and causes P!

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7
Q

PF malalignment and/or maltracking is due to:

A
  • patellar and femoral bone shape
  • femoral IR and add
  • quad weakness, incoordination and atrophy
  • unclear contribution from excessive pronation, and tibial IR
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8
Q

pathomechanics of PFPS:

A

overload of patellar subchondral bone, esp lateral facet
tissue ischemia
loss of tissue homeostasis
neural ingrowth and increase in substance nerve fibers that transmit more P!

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9
Q

how does the infrapatellar fat pad become inflamed? where can it refer to?

A

excessive tibial IR and patellar hypermobility
groin

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10
Q

what makes up the bursae?

A

superficial infrapatellar - between skin and patellar tendon
deep infrapatellar - between patellar tendon and tibia

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11
Q

what are other structures involved in PFPS?

A

subchondral bone of patella
quad and patellar tendons
synovium
med & lat retincaculum - help hold patella and tendon in position

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12
Q

what are symptoms of PFPS?
- onset
- location of P!
- P! increased with:

A
  • gradual
  • anteromedial knee p!
  • stairs, squatting, kneeling, or prolonged sitting (holding pressure on a small area for a period of time)
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13
Q

Observation of PFPS:

A

increased Q angle
open chain maltracking of patella
quad atrophy

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14
Q

observation of PFPS: impaired LE control

A

proprioceptive deficits
dynamic excessive pronation
–> possible contributions from impaired DF because if DF limited then more EV may occur
abnormal planar motions, esp in females
consider possible contributions from L4-S1 regional interdependence

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15
Q

observation of PFPS: impaired LE control in frontal and sagittal plane:

A

increased
e.g. hip add
- glue med and/or max incoordination
- hip ext and abd weakness

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16
Q

observation of PFPS: impaired LE control in transverse plane

A

hip ER weakness and incoordination
mixed conclusions with contributions from rotational impairments

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17
Q

Observation: PFPS
Trunk weakness including ___________
Consider possible contributions from __________ regional interdependence

A

excessive trunk lean
L4-S1

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18
Q

signs of PFPS:
- rom:

A

limited and painful, particularly at end ranges if symptomatic
- flx: greater PF compression
- ext: more fat pad irritation

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19
Q

signs of PFPS:
- resisted:

A

possible P! with ext MMT and weakness
likely inhibited quad activity, part. VM
potential anti-gravity trunk and hip weakness

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20
Q

signs of PFPS:
- stress tests:
- neuro tests
- accessory motion

A
  • possible pain with PF compression
  • limited Dural mobility of femoral nerve in 1/3 patients
  • typically excessive lateral motion and limited medial motion
  • all glides could be hypermobile
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21
Q

Which of the following PFPS special test(s) is being described:

compression through inferior medial borders of patella towards underside then ext the leg
- (+) =

A

medial patella plica
(+) = p!, more in ext

22
Q

Which of the following PFPS special test(s) is being described:

ext knee in 90 flx while PT creates resistance

A

resisted testing for knee ext
(+) = P! around patella, esp inf. med border and underneath

23
Q

Which of the following PFPS special test(s) is being described:

hold pressure under patellar tendon. ask patient to ext their knee
(+) = ?

A

Hoffa’s sign (no support)
(+) = P!

24
Q

Which of the following PFPS special test(s) is being described:

knee flexed ~30 deg.
laterally glide patella
(+)= ?

A

PF apprehension test
(+) = excessive motion, instability signs

25
Q

what are possible muscle length tests for PFPS? what are they testing?

A

thomas test for rectus
obers for TFL/IT band
SLR for hamstrings
gastroc

26
Q

in PFPS, where would you feel TTP?

A

peri-patellar (around the patella)

27
Q

where does the patella sit normally?

A

inferior pole aligned with joint space at 90 deg

28
Q

what is patella alta?
due to?

A

patella is sitting higher than normal
due to a short rectus (use thomas test and test inf. glide of PF)

29
Q

what is patella baja?
due to?

A

patella is sitting lower than normal
due to trauma or a contracted patellar tendon

30
Q

PT Rx: PFPS
for acuity:

A
  • POLICED
31
Q

PT Rx: PFPS
taping:
- direction:
- improves:
- effective for:
- less effective:
- benefits:
- not as effective as:
- arch limits:

A
  • start lateral and superior and pull medial. to unload fat pad
  • positioning for better surface contact
  • P!, kinematics, function
  • in patients with higher BMI and smaller Q angle
  • proprioception
  • exercise
  • excessive pronation
32
Q

PT Rx PFPS:
knee orthotic:
- neoprene sleeve with hole:
- J lat brace:
- doesn’t interfere with:

A
  • increases surface contact between patella and femur without changing alignment or tracking. help with function when added to exercise.
  • straps pull patella medial
  • muscle activity
33
Q

PT Rx PFPS:
foot orthotics:
- effective when?
- prefabricated orthotics vs custom:

A

immediately and short and mid-term
no difference at a year

just as effective as custom

34
Q

PT Rx PFPS:
dry needling:
STM and JM:

A

not effective
P! short term, better with exercise

35
Q

PT Rx MET:
Focus on _____:
- direct relationship:
- indirect relationship:
- avoid:

A

quads
- direct relationship as knee extends with Non-WBing
- indirect relationship as the knee extends with WBing
- 45-0 deg OC & 45-90 deg CC

36
Q

PT Rx MET:
addition of _____
earlier benefits due to:
_____ term benefits

A

hip exercises. earlier dissipation of P!, esp addition of ERs, ABD, EXT
improved neuromuscular control
long

37
Q

you get the best progress when combining quad ______ and ________

A

strengthening and stretching

38
Q

how does verbal feedback improve someone with PFPS?
give two “cues” that help with running

A

they’re more conscious of the problem
1. cued to run softly - less heel strike
2. cued to not let knee fall in - helps mechanics

39
Q

what is an example of verbal and visual feedback you can give a runner?

A

contract glutes and keep knee pointing straight ahead
- visual of hip angle w mirror

40
Q

Prognosis: PFPS

80% of individuals who compiled a rehab program for PFPS still experienced __________

74% had _______their physical activity at a 5yr. follow up

How might this lead to OA:

A

P!
reduced
- may lead to OA due to disuse or changing of the bone

41
Q

should your patient with PFPS get a lateral retinacular release? if not, what can it lead to?

A

should only be used in rare instances
will lead to medial instability if additional tissue cut or used in wrong patient

42
Q

should your patient with PFPS get extensor mechanism realignment? what is it?

A

no
repositioning of tibial tuberosity
long term extensor lag problems

43
Q

what is patellar dislocation? is it common?

A

worst case of PFPS
usually dislocates laterally
rare

44
Q

RF for patellar dislocation:

A

pre-existing patellar hypermobility
more common with a shallow sulcus angle or trochlear groove and large positive congruence angle or laterally located patella

45
Q

etiology of patellar dislocation:

A

trauma with lateral patellar displacement
more likely with pre existing patellar hypermobility

46
Q

structures involved with patellar dislocation:

A

patella
med retinaculum and other medial tissues

47
Q

S&S of patellar dislocation:

A

traumatic and worse case of PFPS
patellar apprehension likely to be (+)

48
Q

PT Rx: patellar dislocation
- POLICED:

A

non-WB to PWB up to 3 weeks
immobilizer
taping for protection and muscular control
brace for patellar control

49
Q

what would you focus on with MET for patellar dislocation?
- ____ before _____
- isometrics and isotonics
- extensibility and elasticity of:

A

CC prior to OC - more muscles involved which provides more stability
quads
postlat structures (hams, IT band, gastroc)

50
Q

prognosis of patellar dislocation:
Redislocation

A

up to 44% redislocation rate
higher without sx

DPT MSK Fall 22' - Spring 23' (29 decks)

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