Quiz #9 Flashcards
1
Q
do SCFEs happen more in younger or older populations?
A
younger (12 for girls, 14 for boys)
2
Q
what is the most common disorder of the hip in adolescents?
A
SCFE
3
Q
what is SCFE?
A
displacement of the femoral neck from the capital femoral epiphysis
the neck migrates up and out as the head remains in the acetabulum
4
Q
does coxa vara or coxa valga cause more shear forces?
A
coxa valga
5
Q
t/f: SCFEs often occur from innocuous causes
A
true, things that you wouldn’t expect to cause damage do
6
Q
what is the initial symptom of a SCFE in 45% of cases?
A
knee and lower thigh pain
7
Q
what is done to determine if the hip is stable or unstable with a SCFE?
A
radiographs, physical exam, and symptoms
8
Q
t/f: intervention for SCFE is focused on relief of symptoms and containment of the femoral head
A
true
9
Q
what is the PT focus on SCFE treatment?
A
strength and ROM once stability is achieved (don’t often see them prior to surgery)
10
Q
SCFE is bilateral in ___% of cases
A
20
11
Q
if a SCFE is found in one leg, there is a __% chance it will occur in the other leg too
A
40
12
Q
t/f: there is a risk for AVN in SCFEs
A
true
13
Q
what are the 2 types of femoroacetabular impingement syndromes?
A
cam impingement
pincer impingement
14
Q
what is a cam impingement?
A
abnormal shape of the sup/ant FEMORAL head and neck
15
Q
what is the ratio of males to females affected by cam impingements?
A
14:1 (young males mostly)
16
Q
t/f: cam impingements are associated with future development of osteoarthritis
A
true
17
Q
what is a pincer impingement?
A
abnormal bone growth of ant/sup ACETABULUM
18
Q
what is the ratio of females to males (age 40) affected by pincer impingements?
A
3:1
19
Q
t/f: both cam and pincer impingements can occur together and most have an element of both
A
true
20
Q
what is the presentation of femoroacetabular impingement syndrome?
A
loss of ROM prior to onset of pain
unilateral ant hip/groin pain
pain and decreased flex and IR
pain with sitting, squatting, and sports
clicking/popping w rotation
may just initially feel stiff with no pain
21
Q
how is femoroacetabular impingement syndrome diagnosed?
A
(+) FADIR (flex, add, IR)
plain film x-ray
MRI arthrogram (labrum)
22
Q
will putting a pt into ant or post pelvic tilt help with a femoroacetabular impingement?
A
posterior pelvic tilt will help, anterior pelvic tilt will irritate it
23
Q
what are the surgical interventions for a pincer impingement?
A
peel off labrum
resect bone
repair labrum
24
Q
what are the surgical interventions for a cam impingement?
A
remove excess bone
contour the head
25
can increased lower abdominal strength reduce anterior pelvic tilt in impingements at the hip?
possibly
26
what are the PT interventions for femeroacetabular impingement syndrome?
hip jt manual therapy
strengthening (adductors, abductors, extensors, ERs and trunk)
functional progression and education targeted at individual physical impairments
not fixing the impingement but improving ROM and relieving symptoms
27
t/f: there is chondrocyte proliferation of the labral fibrocartilage at the border of an acetabular labral tear
true
28
where is there increased microvascularity in an acetabular labral tear?
at the base of the tear adjacent to the bone insertion
29
t/f: there is osteophyte formation with an acetabular labral tear
true
30
which type of femoroacetabular impingement can lead to calcification of the labrum, further deepening the acetabulum?
pincer impingment
31
do acetabular labral tears occur more in younger or older populations?
younger
32
what is a common cause of hip dysfunction in the active populations?
acetabular labral tears
33
what position can cause an acetabular labral tear?
ER with hyperextension of the hip
34
what is the cause of athletes with groin pain in more than 20% of cases?
acetabular labral tears
35
what can put an older person at risk for acetabular labral tears?
hx of hip or acetabular dysplasia
36
how are acetabular labral tears classified?
by location, etiology, and anatomic features
37
order these from most to least common location for an acetabular labral tears: posterior, superior (lateral), anterior
anterior>posterior>superior (lateral)
38
what are the etiologies of acetabular labral tears?
degenerative, traumatic, and idiopathic
39
what are the anatomic features of various acetabular labral tears?
radial flap, radial fibrillation, longitudinal, and detached
40
what is the most common anatomical feature of an acetabular labral tear?
radial flap
41
what is the least common anatomical feature of an acetabular labral tears?
longitudinal
42
how is an acetabular labral tears diagnosed?
with resisted straight leg raises
pain in groin, trochanter, and buttock with flexion and rotation
sharp pain with clicking, catching or locking
confirmation with MRI arthrogram
43
what is the test for an anterior acetabular labral tears?
reproduction of symptoms with abd, ER, flex TO add, IR, ext
44
what is the test for a posterior acetabular labral tear?
reproduction of symptoms with add, IR, ext TO abd, ER, flex
45
what are the interventions used to treat acetabular labral tears?
body mechanics
manage forces
avoid pivoting
strengthening through progressive ROM
open/closed, arthrotomy/osteotomy, labral resection, labral repair
46
what is the post-op intervention for an acetabular labral tear in phase 1 (wk 1-4)?
WB may be none to 50% per surgeon
not more than 90 deg flexion
0 deg ext
25 deg abd
0-25 deg ER (per surgeon)
0-10 deg add (per surgeon)
light PREs
STM
47
what is the post-op intervention for an acetabular labral tear in phase 2 (wk 4-8)?
progressive WB to full WB
restore full ROM
progress strengthening
initiate CKC (light)
improve neuromuscular control
might have them using 1 crutch for a week or so
48
what is the post-op intervention for an acetabular labral tear in phase 3 (wk 8-12)?
advance strengthening
improve neuromuscular control
advance CKC strengthening
49
what is the post-op intervention for an acetabular labral tear in phase 4 (wk 12 to return to sport/fxn)?
progress strengthening
advance to multiplanar hip strengthening
advance to plyometrics bilaterally to unilaterally
sports specific training
50
order the following from most to least common causes of greater trochanter pain syndrome: glut min tendinopathy, glut med tendinopathy, bursitis
glut med tendinopathy>glut min tendinopathy>bursitis
51
what is a frequent cause of lateral hip pain?
greater trochanter (GT) pain syndrome
52
what actions can cause GT pain syndrome?
direct trauma or repeated friction
53
t/f: pts with GT pain syndrome may be TTP over the GT
true
54
what are the symptoms of GT pain syndrome?
pain with stretching the ITB into add, ER, and IR (Ober sign)
pain with resisted abd, ext, and IR
tightness of adductors
weakness of abductors and ERs
LBP
55
t/f: GT pain syndrome is associated with LBP
true
56
in pts with lateral hip pain what tests will be positive?
(+) GT palpation
(+) resisted abduction
57
t/f: MRI alone is sufficient to diagnose GT pain syndrome
false
58
at the pre-clinical/sub-clinical stages of GT pain syndrome, will pts have symptoms?
they may have no/little symptoms and will not be at the level of pain or dysfunction that they feel the need to do anything about it
59
what is the Trendelenburg sign?
hip drop on the opposite side of glut med weakness
(R weakness=L hip drop, L weakness=R hip drop)
60
what are the interventions for GT pain syndrome?
stretching the ITB and TFL
TFM
glut med (and max) ER PREs
correct biomechanical causes anywhere along the chain
maybe modalities but not sure about its effectiveness
stretching and manual techniques may have more benefits
61
t/f: the knee is triplanar
true
62
what are the shapes of the medial and lateral menisci?
lateral=O
medial=C
63
is the medial or lateral condyle more posterior?
the lateral condyle
64
is the med or lat meniscus attached to the popliteus?
lat
65
is the med or lat meniscus more mobile?
lat
66
what pulls the lat meniscus back a bit?
the hamstrings and popliteus
67
is the med or lat meniscus attached via the coronary ligs, tibfib jt capsule, and MCL?
med
68
t/f: the med meniscus has a larger diameter but covers a smaller % of the knee
true
69
is there a higher incidence of injury in the med or lat meniscus?
med
70
is the med or lat condyle more distal and curved?
med
71
t/f: the knee capsule secretes synovial fluid and has a supracondylar pouch
true
72
what happens to the synovial fluid in the knee with flexion?
it moves posteriorly
73
what happens to the synovial fluid in the knee with extension?
it moves anteriorly
74
does the knee capsule become more taught anteriorly or posteriorly with knee flexion?
anteriorly
75
does the knee capsule become more taught anteriorly or posteriorly with knee extension?
posteriorly
76
what is the plica?
a fold in the synovial layer of the knee capsule that wraps around the patella
usually on the medial side
not everyone has it
77
t/f: the plica can mimic patellofemoral problems
true
78
do ligs have greater affects at mid or end range?
end range
79
are the ACL and PCL extra synovial or intraarticular?
both
80
when are the ACL PCL taught?
with rotation
81
where does the PCL go from and to?
from the posterior tibia to the lateral aspect of the medial femoral condyle
82
where does the ACL go from and to?
from the anterior tibia to the posterior aspect of the medial side of the lateral femoral condyle
83
is the PCL more taught in flexion or extension?
in flexion
84
does the ACL or PCL prevent posterior translation of the tibia on the femur?
PCL
85
how is the PCL often injured?
with a fall on the tib tub and a posterior force
86
does the ACL or PCL prevent anterior translation of the tibia on the femur?
ACL
87
does the ACL or PCL draw the femur into the skrewhome mechanism when the knee is fully extended?
ACL
88
what are the 2 bundles of the ACL?
AM and PL
89
is the ACL most taught in flexion or extension?
extension
90
does the ACL or PCL control med/lat (valgus/varum) and rotational motion?
ACL
91
t/f: the MCL inserts onto the medial meniscus
true
92
are the MCL and LCL most taught in flexion or extension?
extension
93
do the MCL and LCL play a greater role in controlling varus/valgus in flexion or extension?
extension
94
what is the "terrible triad"?
ACL, MCL, and medial meniscus injuries together
95
why are there less LCL injuries than MCL?
it's not as common to experience a hit from the medial side
96
what is a bi-partite patella?
extra bone formed off the lateral aspect of the patella that may look like a fx on imaging
can lead to PF problems
97
is med or lat patellar tracking usually at the heart of many patella problems?
lateral tracking
98
how does the patella move?
in a C pattern
99
at the greatest degree of extension, should the patella pull medially or laterally?
medially bc of the pull of the VMO
100
when is there max contact bw the patella and the femur?
at 45-60 deg of flexion at the knee
101
where does the knee generate the most forces and can be a problem area for wearing and p!?
45-60 deg of knee flexion
102
should the patella be more sup or inf with knee ext?
sup
103
should the patella be more sup or inf with knee flex?
inf
104
what is patella alta?
patella pulling sup
105
what is patella Baja?
patella pulling inf
106
what is the shape of the femoral trochlea?
should be higher laterally to prevent lateral subluxation/dislocation
107
should we focus more on the "track" or the "train" with PF pain syndrome?
the track
108
what other things should we look at with PFPS?
the hip and ankle
109
when the talus moves medially or laterally, what happens with the tibia?
it follows
110
does overpronation lead to increased medial tibial rotation or lateral tibial rotation?
medial tibial rotation
111
does medial tibial rotation lead to genu valgus or genu varum?
genu valgus
112
what can be strengthened in the foot to help with PFPS?
the foot intrinsics
113
what is chondromalacia patella?
softening of the cartilage on the posterior aspect of the patella that may occur from extra forces
114
what population is PFPS most common in?
ectomorphic female athletes (tall and slender)
115
what is blanket term for the following?:
excessive lat compression syndrome
global patella compression syndrome
patella instabilities
biomechanical dysfunction
trauma
suprapatellar plica syndrome
IT band friction syndrome
fat pad syndrome
overuse syndrome
PFPS
116
what are some causes of PFPS?
muscles imbalances (VMO vs lateralis)
inflammation
instability
anatomic variance
abnormal Q angle
foot contributions (bottom up)
hip contributions (top down)
117
what are some anatomic variantions that can cause PFPS?
femoral condyle dysplasia (femoral condyle not as high as it should be)
patellar congruence
patellar position
118
what happens when the femoral condyle is high up than it should be?
higher chance of lateral tracking and subluxation/dislocation
119
how is the Q angle measured?
ASIS--> mid patella--> tib tub
120
is the Q angle larger in males or females?
females
121
is there genu valgus or varum with increased Q angle?
valgus
122
t/f: the Q angle is usually observed and not measured
true
123
what are some top down contributions to PFPS?
the hip goes into excessive IR with WB
significant weakness of the hip ERs and abductors often in women
quad overuse
excessive hip adduction
excessive femoral IR
124
what are top down causes of increased PF rxn forces?
excessive hip adduction
quad overuse
125
what is a top down cause of decreased PFJ contact area?
excessive femoral IR
126
is there increased glut work with increased trunk lean or with upright posture?
increased trunk lean
127
is there more PF compression with increased trunk lean or with upright posture?
with upright posture
128
in the CKC, does the patella move laterally on the femur or does the femur rotate medially under the patella?
the femur rotates medially under the patella
129
in the OKC, does the patella move laterally on the femur or does the femur rotate medially under the patella?
the patella moves laterally on the femur
130
what are some bottom up causes of PFPS?
pronation of the talonavicular and talocalcaneal jts
131
how does pronation at the mid foot affect PFPS?
increased tibial IR
increased genu valgus
increased lat PFJ contact
lower arch height=ant knee p!
132
what is the step down test?
looking at the WB limb, have pt take a step down from a platform and see if the patella/knee moves in (dynamic valgus)
133
what is a (+) step down test?
the knee moves into dynamic valgus
134
what is the typical intervention for PFPS?
taping/bracing (may be helpful)
PF mobilization (helpful)
ITB stretching (may be helpful)
VMO PREs (not helpful)
135
what are effective treatment goals for PFPS?
reduce swelling and p!
restore volitional mm control
emphasize quads
control the knee through the hip
emphasize hip and and ER strengthening
enhance soft tissue flexibility
improve soft tissue mobility
enhance proprioception and nm control
normalize gait
shoe/orthotics recommendations
136
are there better results from strengthening the knee or the knee and hip together for PFPS?
knee w /hip
137
do pts with PFPS have more problems going up or down stairs? why?
down bc the quads work more in upright posture and we tend to stand more upright when going down stairs
138
what is movie goers sign?
anterior knee pain from long periods of sitting
139
does an EMG show increased glut med, max, and TFL in the stance limb or moving limb during sidestepping?
in the stance limb
140
when squatting in sidestepping, does the glut activity increase or decrease?
increase
141
when squatting in sidestepping, does the TFL activity increase or decrease?
decrease
142
in sidestepping, is the abduction increased in the stance limb or moving limb?
the stance limb
143
does a lateral J brace pull the knee medially or laterally?
medially
144
is bracing or taping more effective?
bracing
145
what is the likely reason taping may work for someone?
increased proprioceptive input to the muscle
146
at 5 years, does surgery with a HEP or the HEP alone provide better results for PFPS?
both provide similar results
147
what is the Elmslie-Trillat surgery for PFPS?
transverse osteotomy of the tibial tubercle
take off the tib tub and move it medially for better tracking
148
what is the Maquet-Straight surgery for PFPS?
anterior shift of the tib tub by splitting the tibia and pulling the patella of the femur more
149
what is the Fulkerson surgery for PFPS?
a combo of the Elmslie-Trillat and Maquet-Straight surgerical methods
med and ant shift of the tib tub w/oblique osteotomy
150
what is the most common cause of mechanical knee pain?
meniscal injury
151
what motions cause meniscal injury?
turn/twist/change in direction in WB
med/lat contact with the foot planted
152
t/f: aging leads to delamination of the menisci
true
153
t/f: edema produces symptoms in meniscal injuries
true
154
is there greater med or lat meniscal motion?
lat
155
what can a longitudinal tear of the meniscus that separates out lead to?
a bucket handle tear
156
which meniscal tear tends to have the poorest prognosis?
radial tears
157
what are the symptoms of a meniscal tear?
swelling, popping, clicking, catching at the jt line
no immediate swelling, it's more delayed
locked in flex position (bucket handle)
p! w/flexion and WB
tender medial jt line (esp with med men injury)
158
would delayed swelling indicate a meniscal injury or a ligamentous injury?
meniscal
159
would immediate swelling indicate a meniscal injury or a ligamentous injury?
ligamentous
160
what are the tests for meniscal injury?
(+) McMurray
(+) Appley
(+) Thessaly
161
what is the McMurray test for meniscal injury?
varus and valgus stress w/rot at the knee to feel for pop/p!
ER and valgus force moving the knee into flex/ext tests the med meniscus
IR and varus force moving the knee into flex/ext tests the lat meniscus
162
what is the Appley test for meniscal injury?
prone, knee flexion, and grind on the tibia to see if it produces p!
163
what is the Thessaly test for meniscal injury?
pt stands on one leg with their arms crossed out in front of them for you to steer them into rot both ways
pt may do this in full ext or squatting position
164
does a meniscectomy involve the inner third or peripheral third of the meniscus?
inner third
165
does a meniscal repair involve the inner third or peripheral third of the meniscus?
peripheral third (red red zone)
166
t/f: the ACL extends superiorly, posteriorly, and laterally
true
167
does the ACL have vascular supply?
yes, some but not a lot so it will still swell
168
what muscles works with the ACL?
the hamstrings
169
what are the intrinsic factors in ACL injury?
narrow intercondylar notch
generalized jt laxity
LE malaignments
hormonal influence (estrogen, estadiol, relaxin)
ACL size
strength and recruitment
170
do men or women tend to have a more narrow intercondylar notch?
women
171
t/f: the ACL get impinged on the anterior intercondylar notch in full extension
true
172
what are the extrinsic factors in ACL injury?
altered neuromuscular control
playing surface
playing style
shoe wear
173
what sports tend to cause ACL injuries in younger populations?
soccer
football
basketball
174
what sports tend to cause injuries in older populations?
skiing
trampoline
175
the risk factors for ACL injury are __ to ___ times higher in ___ basketball and soccer players
4, 8, female
176
is there an increased rate of ACL injuries in female or male collegiate athletes?
female
177
is there increased incidence of ACL injury in males or females?
males
178
is there higher ACL injury exposure in males or females?
males
179
is there higher ACL injury risk factors in males or females?
females
180
do men or women have:
smaller intercondylar notch
smaller ACL
wider pelvis
increased hamstring flexibility
generalized jt laxity
quads dominance
increased post tibial slope
females
181
what is only a female risk factor in ACL injury?
increased tibial slope
182
why does increased hamstring flexibility put one at risk for ACL injury?
looser hamstrings can't provide secondary support to the ACL
183
what is a grade 1 ACL injury?
stretched out (attenuation/attenuated)
184
what is a grade 2 ACL injury?
partial tear
185
what is a grade 3 ACL injury?
complete full thickness tear
186
t/f: almost all complete tears of the ACL are mid-substance
true
187
what does mid-substance mean in an ACL tear?
the tear is in the middle of the tendon
188
how much force can the ACL handle before it tears?
2160 N of force
189
what are some MOI for ACL injury?
strength of the lig (force >2160 N)
deceleration injury (non-contact)
hyperextension
valgus stress
sports related
contact injury (hyperext or foot planted w/rot then contact)
190
what is the MOI in 70% of ACL injuries?
deceleration (non-contact) injury
191
in ACL tears, a pop is heard/felt in __% of cases
70
192
what % of ACL injuries are sports related?
80%
193
is there immediate or delayed disability and hemarthrosis with ACL injury?
immediate
194
there is hemarthosis in ACL injuries within __ hours
2-6
195
how is the ACL injured in non-contact injuries?
hip straight, hip IR, tib rot, straight knee
deceleration/acceleration
valgus moment
feet flat
anterior shear
increased ground rxn force
muscles don't dissipate the forces so the ligs take the brunt of it
196
in what zone do ACL injuries usually occur?
in the transformational zone
197
how is the ACL injured in contact injuries?
hyperextension or foot planted in rotation then contact
198
what are the s/s of ACL injury?
pop at time of injury
giving away
hemarthrosis
quads atrophy
(+) ant drawer
(+) Lachman
(+) KT-1000 findings
rotary instability
(+) MRI
199
what are the different rotary instabilities that lead to ACL injury?
AMRI, ALRI, PMRI, and PLRI
200
t/f: MRI is sensitive for the presence of an ACL tear and MCL or meniscal involvement
true
201
t/f: an MRI is sensitive for discriminating b/w partial and complete tears
false
202
in an ACL physical exam, the side to side difference is <___mm in 95% of pts
3
203
what is the most sensitive test for ACL injury?
Lachman test
204
what other special test can be used for ACL injury?
pivot test
205
what is the Lachman test?
hold the pt knee stable and pull forward on the tibia
reverse: in prone pull the tibia down towards the table
206
what % of acute ACL injuries also have a meniscal tear?
45%
207
what % of chronic symptomatic ACL tears have meniscal tears?
about 88%
208
what imaging can be done for ACL injury?
x-ray, MRI
209
what fx is common assocaited with ACL injury?
Segond fx
210
what is a Segond fx?
avulsion fx from IR w/varus force
211
what % of ACL cases have Segond fx?
9-12%
212
what % of Segond fx are indicative of ACL tears?
75%
213
what would be found in an MRI for acute ACL injury?
lateral meniscal tear
214
what indicates bone bruising from an ACL injury on a x-ray?
whiteness on the lateral femoral condyle (central) and lateral tibial plateau (posterior)
215
what would be found on an MRI for chronic ACL injury?
med meniscal tear due to instability
chondral injury
216
what is the general non-operative management of complete ACL tears?
progressive rehab program
brace for activities (NM feedback)
217
what are the 3 outcomes after ACL rehab?
1/3 pursued recreational activities (copers)
1/3 compensated by eliminating activities (partial copers)
1/3 required ACL reconstruction (non-copers)
218
t/f: choice of treatment affects fxn but not development of arthritis in ACL recovery
true
219
why do most ppl post ACL injury eventually develop arthritis?
bc the jt is never quite as stable as it was pre-injury
220
what are typical ACL pre-hab goals?
no flexion contractures or quad lag
quad contraction w/sup patellar slide
normal PF mobility
little to no effusion
walk w/o a limp
221
what are the benefits of pre-hab in ACL injury
provides platform to guide decisions
may be able to work pt to the point of not needing surgery anymore
222
what is the preferred surgical intervention for ACL tears?
autografts
223
what tendons can be used in ACL autografts?
patellar tendon (BPTB)
hamstrings (semiten)
quad tendon
Achilles tendon
224
t/f: there is a higher incidence of patellar tendinopathy w/BPTB procedures in ACL repair bc of moving the patellar tendon to use as an ACL
true
225
what is one of the most important factors in good recovery from ACL repair?
good graft positioning
226
what are the principles of post ACL surgery?
consult the surgeon for updated protocol
understand potential risk factors of graft disruption
control p! and edema
utilize locked brace (0-90 deg) early during some PREs
respect healing contraints
emphasize early restoration of ROM
emphasize closed chain training
emphasize hamstrings recruitment
focus on fxn
227
what is ligamentization?
when a tendon is used in ACL graft itreorganizes and becomes more dense
becomes weaker at 3-4 months post-op
228
what is superficial and deep infrapatellar bursitis?
inflammation from mechanical irritation, or direct trauma
229
what is prepatellar bursitis (housemaid's knee)?
from recurrent trauma or prolonged kneeling
easily observable
230
what is superficial pes anserine bursitis?
seen in swimmers, runners
medial knee p!
tibia in ER
231
what is MCL bursitis?
deep to the MCL
misdiagnosed
palpable mass
tender w/ER/IR of tibia
232
what is the intervention for bursitis?
correct malalignement
correct mechanics
stretching
strengthening (look at the hip too)
surgical resection
233
what can cause patellar tendinopathy?
eccentric overload
234
where is a pt tender with patellar tendinopathy?
at the tibial insertion site or mid-substance
235
can patellar tendinopathy be self-limiting?
yes
236
what can be done to help with patellar tendinopathy?
RICE
tendon strap around the patellar tendon(Chopat strap) during activity
TFM
correct malalignement
237
what is IT band friction syndrome (ITBFS)?
a common overuse injury in runners caused by repeated friction of the ITB at 30 deg of knee flexion
increased with road chamber (curve) downhill
better with faster speeds
238
where would someone with ITBFS be tender?
over Gerdy's tubercle
239
what may cause ITBFS?
structural or functional malalignment
weak abductors/ERs
240
what tests would be positive with ITBFS?
(+) Ober
(+) Noble
241
what is Osgood Schlatter Disease?
osteochondritis (patellar tendon pulls small bit of immature bone off the tib tub)
irritation of the growth plate
form of patellar tendonitis (patella tendon pulling on the growth plate)
242
when does Osgood Schlatter Disease tend to occur in life?
12-15 yo
during growing years when the muscles can't keep up with bone growth
243
what are possible cuases of Osgood-Schlatter Disease?
indirect trauma
sudden forceful quad contraction
repetitive stress (knee flexion against a tight quad)
longitudinal traction during bone growth (tension on patellar tendon during growth spurts)
malalignment
rigorous activity in young adults
244
what malalignment pmay contribute to Osgood Schlatter Disease?
bilateral genu valgus
pes planus
patella alta
245
what is the presentation of Osgood-Schlatter Disease?
p! at the tib tub
enlarged tib tub
possible swelling and warmth
tenderness
p! w/activities involving forceful quads contraction
potential inflexibility of the quads or hamstrings
246
how is Osgood-Schlatter Disease managed?
rest/activity modification (2-3 wks to 2-3 months)
NSAIDS and ice
exercise to stretch
possible bracing
patellar tendon strap top reduce quad pull
247
can Osgood-Schlatter Disease be self-limiting?
yes
248
what are the primary reasons someone gets TKA?
OA (72.7%) or RA (21.2%)
249
other than RA and OA, what are reasons for getting a TKA?
fx, AVN, septic arthritis
250
what are indications for TKA?
DJD on radiograph (not difinitive criteria)
breakdown of tibfib jt area
pt lossing fxning
251
t/f: higher p! prior to TKA surgery is associated with poorer outcomes
true
252
is the severity of DJD seen on radiographs predictive of outcomes of TKA?
no
253
what are TKA prognositic indicators of poor outcomes?
female
older age
low socioeconomic status
># of comorbidities
poor p! coping strategies
somatization of p!
low social support
unrealistic expectations
BMI >40
254
what is the most popular TKA surgical approach?
medial parapatellar (paramedian)
255
what are the pros of the paramedian TKA approach?
familiar
popular
256
what are the cons of the paramedian TKA approach?
incision through the quad tendon
detaches the VM from the extensor mechanism
reduces blood flow to the patella
257
what is the general TKA procedure?
ACL, PCL, and menisci are removed (PCL may be spared)
femur and tibia ends are excised using a cutting jig
implanted metal tibial and femoral components
polyethylene tibial spacer bw the metal tibial and femoral components
patellar surface (patellar button)
258
t/f: PCL substituting implants may give better roll-back kinematics for lunging and step-ups
true
259
is a unicompartmental TKA usually medial or lateral?
medial
260
does a bi or tricompartmental TKA involve the patella?
tri
261
what are the indications for a unicompartmental TKA?
non-inflammatory OA
unicompartmental degernation
low impact sports
job with repetitive squatting
intact cruciate ligs
near normal weight
jt space narrowing is isolated to one side of jt
malalignment is correctable w/o a major tissue release
flexion contracture not >10 deg
adequate flexion
valgus/varus <10-15 deg
262
are more or less ppl going to a rehab hospital following TKAs?
less
263
what is the early focus of TKA rehab?
p! control and functional recovery
264
are pt usually WB following TKA?
yes! and often notes decreased p! w/WB
265
when beginning ROM post TKA, what exercise may be done?
heel slides in supine or sitting
266
what strengthening exercises may be done post TKA?
quad activation (QS and SLR)
SAQ
sidelying abd
progressive closed chain strengthening
267
what is a major LE risk post-op?
DVTs
268
what is a DVT?
occlusion of deep veins from a thrombus that interrupts blood flow
results in edema and p!
269
what is done prophylactically post TKA to prevent DVTs?
pts are given blood thinner and monitored regularly so blood isn't too thin
270
what are symptoms of a DVT?
p! in the calf or associated muscles
(+) Homan's sign (passive dorsiflexion-not done anymore)
271
what does a Wells score of >3 mean?
high probability of DVT risk
272
what does a Wells score of 1-2 mean?
moderate probability of DVT risk
273
what does a Wells score of 0 mean?
low probability of DVT risk
274
how are DVTs treated?
anticoagulant therapy
275
how is a DVT dx?
US imaging
