Remaining Exam 2 Material [CH 16 + 17] Flashcards
what type of joint is the knee
hinge joint
how many bones make up the knee joint
4
-femur
-tibia
-fibula
-patella
articulations of the knee joint
3 total
-tibiofemoral: femur + tibia
-patellofemoral: femur + patella
-proximal tibiofibular: tibia + fibula
menisci
fibrocartilage disks that lie on top of the tibial plateau
shape of medial menisci
C-shaped
shape of lateral menisci
O-shaped
function of menisci
-increase stability of the knee joint
-cushion any stresses placed on the knee
describe blood supply in menisci
-outer ring has greater blood supply than inner
-affects healing
-inner menisci cannot heal on its own
inner/outer menisci can heal on its own
outer, because more blood supply
anterior cruciate ligament
-prevents tibia from moving forward relative to the femur
-stabilizes tibia against excessive internal rotation
posterior cruciate ligament
prevents the tibia from sliding backward relative to the femur
ACL prevents tibia from moving forward/backward
forward
PCL prevents tibia from moving forward/backward
backward
medial collateral ligament
-stabilize the knee against valgus forces
-force to lateral aspect
lateral collateral ligament
-stabilize the knee against varus forces
-force to medial aspect
purpose of MCL
shock absorber against hits from the outside
purpose of LCL
shock absorber against hits from the inside
movement of the quadriceps
knee extension
quadriceps muscles (4)
-rectus femoris
-vastus medialis
-vastus intermedius
-vastus lateralis
hamstrings movement
-knee flexion
-hip extension
hamstrings muscles (3)
-biceps femoris
-semitendinosus
-semimembranosus
be able to label muscles ch16 ppt
accessory knee flexor muscles (5)
-gracilis
-sartorius
-gastrocnemius
-popliteus
-plantaris
external tibial rotation muscles (1)
biceps femoris
internal tibial rotation muscles (5)
-popliteus
-semitendinosus
-semimembranosus
-sartorius
-gracilis
prevention of knee injuries- physical conditioning + rehabilitation
-total body conditioning (strength, flexibility, cardiovascular endurance, agility, balance)
-agonist/antagonist muscles must be properly balanced because increases joint stabilization
should agonist/antagonist pair muscles have the same strength
no
ex: quadriceps to hamstring strength ratio is 3:2
quadriceps: hamstring strength ratio
3:2
can an AT or PT do more rehab to PREVENT injuries
AT because PTs work under insurance rules
-insurance companies aren’t looking for prevention programs for rehab; PTs work on people that already need rehab
-ATs have more room to do prevention programs with athletes to prevent injury
prevention of knee injuries- shoe type
-grip the playing surface when sprinting forward
-don’t stick when cutting or changing direction
prevention of knee injuries- shoe + cleat design
-greater rotational stiffness may increase injury risk
-rotational stiffness greater on synthetic grass than with natural grass
prevention of knee injuries- knee braces
-effectiveness of protective knee braces is controversial
-can restrict anterior/posterior tibial translation when combined with an appropriate rehab program
assessing the knee joint- history
-what were you doing when the knee was hurt?
-what position was your body in?
-did the knee collapse?
-did you hear a noise or feel any sensation?
-where is the pain?
-have you hurt your knee before?
assessing the knee joint- chronic injury history
-when did you first notice the condition?
-does the knee ever catch or lock?
-does your knee feel like its going to give out?
-have you changed your running shoes?
assessing the knee joint- palpation
assess bony structures for areas of tenderness, pain, or deformities
assessing the knee joint- observation
-athlete should be observed in numerous situations (walking, half-squatting, going up/down stairs, etc.)
-do the knees appear symmetrical?
-is one knee swollen?
-is muscle atrophy apparent?
-redness, discoloration, bruising?
knee joint palpation- which ligaments should be palpated
-lateral collateral ligament (LCL)
-medial collateral ligament (MCL)
knee joint palpation- which ligaments CANNOT be palpated
-ACL
-PCL
tenderness at the knee joint line may indicate what injury
meniscal injury
special tests for knee joint
-assess ligament stability
-performed by a trained professional
what does Lachman’s + Anterior Drawer test
ACL
cause of MCL injury
-medially directed force valgus from the lateral side
-lateral rotation of the tibia
signs of MCL injury- grade 1
-few ligament fibers are torn
-joint stable
-minimal swelling
-mild stiffness + tenderness
-full ROM
signs of MCL injury- grade 2
-moderate tearing of fibers
-pain at medial aspect
-general weakness/instability
signs of MCL injury- grade 3
-complete tear
-complete loss of medial stability
-mild to moderate swelling
-severe pain
-loss of ROM
what athletes are more prone to MCL injury
football offensive lineman
-because of this, all football offensive lineman wear knee braces
care for MCL injury
-POLICE
-crutches may be used if athlete is unable to walk
-conservative non-operative treatment is recommended for isolated sprains at any grade (limited immobilization, rehab program, possible use of functional hinge brace)
-return to play when knee has regained full ROM + strength
cause of LCL injury
-laterally directed varus force from the medial side
-medial rotation of the tibia
is MCL or LCL sprain more prevalent
MCL
signs of LCL injury
-pain + tenderness over the ligament
-swelling + effusion
-joint laxity with varus stress
LCL injury pain is greatest with which grades
grades 1 + 2
describe pain of grade 3 LCL injury
-pain severe initially
-subsides to dull ache
care for LCL injury
same procedures as for MCL injuries
-POLICE
-crutches may be used if athlete is unable to walk
-conservative non-operative treatment is recommended for isolated sprains at any grade (limited immobilization, rehab program, possible use of functional hinge brace)
-return to play when knee has regained full ROM + strength
cause of ACL injury
-most ACL injuries are non-contact
-deceleration, rotation, valus stress
most ACL injuries are contact/non-contact
non-contact
common mechanism for ACL injury
dynamic valgus
-valgus force
-medial tibial rotation
-hip adduction
ACL injury risk factors
-previous injury
-general predisposition
-quad dominance
ACL injury risk factors- previous injury
-biggest predictor of a future injury is history of previous injury
-full neuromuscular control was likely not regained on injured side
ACL injury risk factors- general predisposition
-anatomical structure
-biomechanics
-hormonal imbalance
ACL injury risk factors- quad dominance
-increased strength in quads compared to hamstrings
-results in landing with increased knee extension
signs of ACL injury
-audible pop
-rapid swelling at the joint line
-intense pain initially
-loss of extension
care for ACL injury
-POLICE
-surgery to repair torn ACL (bone patellar bone or hamstring graft)
-recovery generally 6-9 months
ACL injury swelling begins within ____ hours; peaks within ____ hours
-1-2 hours
-4-6 hours
how long is ACL injury recovery
recovery says it is generally 6-9 months
-it is more like 12-18 months in reality
-most people take 6 months to even get back to starting activity
how do you choose which ACL surgery to get
-choose whichever method the surgeon is better at
-both bone patellar bone + hamstring graft are equally successful
if you did hamstring graft…
you’d be weaker in the back
if you do bone patellar bone…
you will be wear in the front
-this might be better because we don’t want to make hamstrings weaker
cause of PCL injury
-falling with full weight on the anterior aspect of the bent knee (knee hyperflexed, ankle plantarflexed)
-dashboard injury car crash
what injury is caused by car accident
PCL injury
signs of PCL injury
-pop in back of knee
-tenderness in popliteal fossa
-little swelling
-laxity on posterior drawer test
care for PCL injury
-POLICE immediately
-generally non-operative treatment with rehab
tearing outer/inner meniscus has better chance at repairing itself
-outer
-tearing inner won’t repair because no blood supply
cause of meniscus injuries
-weight bearing combined with a rotational force
-tears within cartilage fail to heal due to lack of blood supply
medial/lateral meniscus has higher incidence of injury
medial
signs of meniscus injury
-effusion gradually over 48-72 hours
-joint like pain; loss of motion
-intermittent locking + clicking
-feels like the knee is “giving way”
care for meniscus injuries
-POLICE
-MRI to confirm diagnosis
-non-operative treatment (rehab similar to MCL sprain)
-surgical intervention
rehab for meniscus injuries is similar to what other rehab
MCL sprain
surgical interventions for meniscus injuries
type of surgery depends on type + location of tear
-meniscectomy
-partial meniscectomy
-microfracture
-repair
meniscectomy
removal of meniscus
cause of knee plica
-thickened fold of synovial membrane lining the inside of the joint capsule
-medial plica most subject to injury
-blunt force or fall on the knee with a twisting mechanism
signs of knee plica
-painful feeling that the knee is locked when the patient has been sitting for a period of time
-snapping with knee flexion
-pain with stairs or squatting
care for knee plica
-rest
-NSAIDs
cause of bursitis (knee)
-continued falling directly on the knee or overuse
-prepatellar + deep infrapatellar bursae have the highest incidence of irritation in sports
signs of bursitis (knee)
-localized swelling above the knee that is similar to a balloon
-redness + increased temperature
care for bursitis (knee)
-reduce swelling
-rest
-compression wrap
-NSAIDs
cause of loose bodies within the knee
-repeated trauma to the knee during sports activities
-can result from:
-OCD lesion (osteochondritis dissecans)
-fragments from menisci
-torn synovium
-torn cruciate ligament
signs of loose bodies within the knee
-locking + popping
-pain, instability, + feeling the knee is going to give out
care for loose bodies within the knee
surgical removal
cause of IT band syndrome
-overuse condition commonly occurring in runners + cyclists
-repeated knee flexion + extension
signs of IT band syndrome
-tenderness over lateral femoral condyle
-pain increases during running or cycling activities
-people tend to feel this in their knee
-therefore, people often foam roll knee which won’t help, must foam roll the actual IT band
care for IT band syndrome
-stretching + reducing inflammation
-correction of foot + leg alignment
cause of patella fx
-direct fall
-most result from indirect trauma:
-severe pull of the patellar tendon against the femur when knee is semi-flexed
-forcible muscle contraction may fracture the patella at its lower half
most patella fx result from direct/indirect trauma
indirect
signs of patella fx
-swelling
-pain + tender to palpation over patella
cause of patella fx
-x-ray confirmation
-cold wrap, compression, splinting
cause of patella subluxation/dislocation
-athlete plants the foot, decelerates + simultaneously cuts in an opposite direction from the weight bearing foot
-medially directed valgus force at the knee
signs of patella subluxation/dislocation
-dislocate laterally
-complete loss of knee function while patella rests in abnormal position
-pain + swelling
care for patella subluxation/dislocation
-knee should be immobilized
-physician should reduce patella
-x-ray to rule out fx
cause of jumper’s knee (patellar tendinosis)
-repetitive running/jumping
-places extreme tension on the knee extensor muscle complex
-on rare occasions, the patellar tendon may completely fail + rupture
can an athlete get patellar tendinosis/jumper’s knee instantly from doing something
NO
-takes time to develop
signs of jumper’s knee (patellar tendinosis)
-vague pain + tenderness
-worsens with activity
care for jumper’s knee (patellar tendinosis)
-rest, NSAIDs, ice
-brace or strap
-transverse friction massage
transverse friction massage
reminds muscle to heal
cause of Osgood-Schlatter disease
-common in rapidly growing immature adolescent’s knee
-repeated pull of patellar tendon at the tibial tubercle on the front of the tibia
-bony callus forms + the tubercle enlarges
signs of Osgood-Schlatter disease
-swelling
-gradual degeneration
-severe pain with kneeling, jumping, + running
care for Osgood-Schlatter disease
-conservative treatment
-decrease activity intensity
-protect tubercle
-isometric strengthening of quads + hamstrings
be able to label pelvis bones see ch17 ppt
thigh bone
femur
pelvis bones (3)
-ilium
-ischium
-pubis
hip joint name
femoroacetabular joint
femoroacetabular joint (hip)
-articulation of femur + acetabulum
-stabilized by strong iliofemoral ligament + joint capsule
hip flexors muscles (3)
-rectus femoris
-iliopsoas
-sartorius
hip adductors muscles (5)
-gracilis
-pectineus
-adductor magnus, longus, + brevis
hip extensor muscles (2)
-hamstrings
-glute max
hip abductor muscles (2)
-glute med
-tensor fasciae latae (TFL)
assessment of hip/groin/pelvis injuries- history
-do you remember a specific incident that caused your pain?
-have you ever had a probelm with the area before?
-describe the type of pain (sharp, dull, burning, aching)
-does the pain radiate down the back or front of your legs?
assessment of hip/groin/pelvis injuries- observation
-postural asymmetry
-do the hips look even?
-is there any tilting of the pelvis?
-walking, bending, + sitting
assessment of hip/groin/pelvis injuries- palpation
-bony palpation should include:
-iliac crest
-femur
-sacrum + coccyx
-soft tissue palpation on anterior + posterior thigh
-assessing for point tenderness or discomfort
Thomas test is for
tight hip flexors
strong muscles of thigh/hip/groin/pelvis are less/more resistant to injury
more resistant to injury
prevention of thigh/hip/groin/pelvis injuries
-maintain strength + flexibility of muscles that act on the hip
-dynamic stretching
-strengthening exercises could include: squats, lunges, leg presses, core
core includes what muscles
all the muscles that go around
-diagragm
-pelvic floor muscles
cause of quadricep contusion
-traumatic blow
-compresses quad against the hard surface of the femur
signs of quadricep contusion
-intense pain + weakness
-painful to touch
-athlete may limp
-loss of ROM
care for quadricep contusion
-POLICE
-compression by elastic bandage with knee flexed to 120 degrees to minimize loss in ROM
what is one of the most limiting contusions in athletics
quadricep contusion
what sport is most susceptible to myositis ossificans
MMA
-because constant hits in th same place
cause of myositis ossificans
-severe or repeated blows to the thigh
-bone formation in the quadriceps muscle
-contusion causes disruption of muscle fibers
-irritated tissue may produce tissue formations resembling cartilage
signs of myositis ossificans
-pain + swelling
-history of quad contusions
-motion restriction
care for myositis ossificans
-conservative treatment at first
-if loss of motion continues, bone formation may be removed after 1 year
cause of quadriceps strain
sudden stretch or sudden contraction
signs of quadriceps strain
-pain + discomfort
-tender to palpate
-spasm +/or loss of function
care for quadriceps strain
-rest + POLICE
-neoprene sleeve for protection
cause of hamstring muscle strain
-highest incidence of being strained
-quick change from knee stabilization to extension of the hip when running
what muscle has highest incidence of being strained
hamstring
signs of hamstring muscle strain
-can involve muscle belly or tendon attachments
grade 1 hamstring strain
-muscle soreness
-point tenderness
grade 2 hamstring strain
-severe pain
-loss of knee flexion
grade 3 hamstring strain
-rupture
-major hemorrhage + disability
care for hamstring muscle strain
-POLICE
-eccentric training exercises
-at risk for reinjury
cause of acute femoral fx
-MVA or fall from a great height
-in sport, fx often occurs at the shaft
signs of acute femoral fx
-deformity
-shortened thigh
-loss of thigh function
-pain, point tenderness, swelling
care for acute femoral fx
-medical emergency–call 911 if femoral
-potential femoral artery damage
-risk of shock
cause of hip sprain
violent twist
signs of hip sprain
-athlete unable to circumduct the thigh
-hip rotation increases pain
care for hip sprain
-x-ray to rule out fx
-POLICE + NSAIDs PRN
-may restrict weight bearing
-delay ROM + PRE until pain free
cause of dislocated hip joint
-rarely occurs in sports, often MVA
-traumatic force from the long axis of the femur or by an athlete falling on their side
signs of dislocated hip joint
-typical position- slightly flexed, adducted, internally rotated
-palpation may reveal femoral head posterior to acetabulum
care for dislocated hip joint
-immediate medical attention
-immobilization + crutches
cause of hip labral tear
repetitive movements such as running or pivoting of the hip causing degeneration + breakdown of the labrum
signs of hip labral tear
-asymptomatic
-catching, locking, or clicking
-pain in hip/groin
-feeling of stiffness or limited ROM
care for hip labral tear
-maxmimize hip ROM + hip strengthening + stability exercises
-if pain persists more than 4 weeks, surgery may be indicated
cause of piriformis syndrome
sciatic nerve compressed or irritated by a tight piriformis
signs of piriformis syndrome
-pain
-numbness
-tingling
-may worsen aftering sitting for a long time
care for piriformis syndrome
-stretching + massage
-NSAIDs
cause of groin strain
-overextension of the groin musculature
-running, jumping, or twisting with external rotation
signs of groin strain
-pain
-weakness
-internal bleeding can occur
care for groin strain
-POLICE first 48-72 hours
-protective spica bandage
cause of Legg-Calve-Perthes disease (coxa plana)
-loss of blood to the articular surface at the head of the femur
-children ages 3-12
-affects more boys
Legg-Calve-Perthes disease (coxa plana) age group
children ages 3-12
Legg-Calve-Perthes disease (coxa plana) affects girls or boys more
boys
signs of Legg-Calve-Perthes disease (coxa plana)
-pain in groin that is sometimes referred to the abdomen or knee
-limping
-limited hip movement + pain
care for Legg-Calve-Perthes disease (coxa plana)
-bed rest
-brace to avoid direct weight bearing
-if not treated properly, can produce osteoarthritis later in life
cause of slipped capital femoral epiphysis
-disorder of the epiphysis of the femur that slips from the femoral head
-occurs during periods of rapid growth in adolescent boys
-occurs more in boys than girls
-ages 10-17
age group of slipped capital femoral epiphysis
10-17
slipped capital femoral epiphysis affects boys or girls more
boys
care for MINOR displacement slipped capital femoral epiphysis
-minor displacement: rest + non-weight bearing
signs of slipped capital femoral epiphysis
-pain in groin
-hip movement limitations
-limp
care for MAJOR displacement slipped capital femoral epiphysis
surgery
cause of iliac crest contusion (hip pointer)
direct blow that results in extremely painful contusion to the iliac crest
signs of iliac crest contusion (hip pointer)
-immediate pain
-muscle guarding
-unable to rotate the trunk or flex the thigh without pain
care for iliac crest contusion (hip pointer)
-cold + compression
-x-ray to rule out fx
-utilize protective pad when returning to play
cause of osteitis pubis
repetitive stress on the pubic symphysis
signs of osteitis pubis
-pain in groin region
-tenderness on pubic tubercle
-pain with running
care for osteitis pubis
-rest + anti-inflammatory medications
-gradual return to activity
cause of acute fx of the pelvis
direct trauma
signs of acute fx of the pelvis
-severe pain
-loss of function
-shock
care for acute fx of the pelvis
-immediately treated + referral to physician
-manage shock
signs of avulsion fractures
-ASIS pain- sartorius
-AIIS pain- rectus femoris
-ischial tuberosity- hamstrings
-swelling + point tenderness
cause of avulsion fractures
forceful contraction of the muscle causing bone to pull apart attached to the tendon
ASIS pain indicates which muscle
sartorius
AIIS pain indicates which muscle
rectus femoris
ischial tuberosity pain indicates which muscle
hamstrings
care for avulsion fractures
-rest + limited activity
-gradual return to activity
