SCS Study Guide-Knee Flashcards
1
Q
sartorius innervation
A
femoral
2
Q
quad group innervation
A
femoral
3
Q
biceps femoris innervation
A
sciatic
4
Q
semitend/semimemb poploteus gasctoc and plantaris innervation
A
tibial
5
Q
gracilis innervation
A
obtruator
6
Q
what does a postiive valgus stress test mean
A
at 0 degrees: Torn MCL, possible ACL/PCLPMC
at 30 deg: torn MCL (check others too)
7
Q
whta does a positive varus stress test mean
A
at 0 deg: torn LCL and possible ACL/PCL
at 30 deg: Torn LCL ( check others too for grade III)
8
Q
positive anterior drawer meaning
A
at 0 deg: torn ACL
at 15 deg ER: torn PMC, ACL possible MCL
at 30 deg IR: Torn PLC and ACL
9
Q
Lelli’s test or lever sign
A
torn ACL
10
Q
pivot shift
A
torn ACL, ALC
11
Q
solcum’s
A
torn ACL ALC
12
Q
Jerk (Hughston) Torn
A
ACL, ALC
13
Q
losee test
A
torn ACL, ALC
14
Q
postrior drawer
A
torn pcl
15
Q
ER recurvatum (tibial ER)
A
torn PCL, PLC
16
Q
posterior sag sign
A
torn PCL
17
Q
reverse pivot shift test
A
torn PCL
18
Q
Mc Murrays’ in IR vs ER
A
IR: torn LM
ER: torn MM
19
Q
Apelys’
A
torn MM
20
Q
thessaly’s
A
torn MM and or LM
21
Q
over ____% ACL tears are non contact
A
70
22
Q
cause of ACL tear
A
deceleration, hyperextension, rotational movement
landing from a jump with minimally flexed knee, inc quad relative to HS can lead to excessive translation
23
Q
signs for the best prognosis of an ACL-R
A
full ROM, decreased swelling, good leg control and excellent mental state
24
Q
signs that a non-op/conservative will do well
A
single/crossovertriple or timed jumping 80% of affected
number of giving way during test less than 1
knee outcome survey of 80%
subjective global rating 60%
25
allograft advantages
decreased morbidity
preservation of knee ext/flex
decreased operation time
availability of larger grafts
decreased incidence of fibrosis
26
disadvantages of allografts
infection, slow healing/incomplete grafts
increased cost
tunnel enlargement
alteration of structural properties with steralization/storage
27
female ACL tears _____ x more likely
2.4-9.7
28
intrinsic factors that risk ACL tear
intercondylar notch size, ACL size, physcioloical laxity and hormonal fluctuations
29
extrinsic factors
kinematics, kinetics, muscle strength and activaiton
30
post op ACL-R when can you add gait training and bike
week 1-2
31
post op ACL-R when can you get ROM to 120, then full ROM
120 at 3 weeks, full by 4 weeks
32
post op ACL-R when can you partial squat to 30 adn when can you partial squat to 60
30: weeks 1-2
60: week 4-8
33
when is the graft state weakest
at 4-8 weeks
34
weeks 8-12 is when more intenser things start to happen such as....
what is a side effect of this stage
SLS to 60 degrees, SLS 60 sec, nearly equal quad girth,
PATELLAR TENDINOPAHTY HERE
35
hopping and jogging/running can start when, assuming what
at 12-16 weeks assuming hop testing was 80% uninvolved side
36
when can cutting and plyo start post op ACL-R
20 weeks
37
what are the criteria to begin plyo training post op ACL-R and what time
12 weeks, with normal gait, ROM, SLR, min swelling, SLS over 60 sec, SLS at 45 with no valgus
38
what are special considerations if a patient had a HS graft ACL-R
no active HS for 2 weeks, no OKC HS exercises for 4 weeks, delay HS ressitance to 12 weeks
39
in a normal PCL, the popliteus helps to do what
control ER, varus and posterior translation
40
MOI for PCL injury
trauma to prox tibia, fall on knee with PF foot, excessive hyperextension
41
what grades PCL are non-op and op
grades I and II are non op and grades III are op
42
PCL non-op protocol ROM first 3 weeks
initially, just 0-60, and in a brace with crutches, and squatting only to 45 (first week) than 60 weeks 2-3
43
when can you start running post PCL no op treatment
around 8-12 weeks if no pain, swelling, laxity and quad testing over 85%
44
post op PCL general guidelines (4)
1. no OCK exercises to start
2. avoid posterior tibial translation
3. resistance of hip resistance ABOVE KNEE
4. more conservative protocol than ACL
45
isolated PCL injury grade I or II management
protective WB and return in 2-4 weeks
46
isloated grade III PCL injury treatment
splint in extension 2-4 weeks for non op
op: active and young folks, (older are non-op)
47
how soon after combined PCL injury should you have surgery
2 weeks
48
first week of PCL-R rehab considerations
locked in 0, with pillow behind tibia to reduce sag
49
____ degress of extension is allowed to lack for ___ months following PCL-R
1o degrees
50
jumping, running and RTS can happen when post op PCL-R
6 months
51
post op PCL-R when can brace be unlocked for everything
6-8 weeks
52
MCL and LCL fibers are tight in what
extension (lax in flexion)
53
exam and imaging of MCL/PCL injury
tenderness joint line, laxity, rotational injury check ACL/PCL
varus/valgus testing and AP, lat, merchant views and a t2 MRI
54
grades of MCL/LCL injuries
grade 1: tenderness at ligament, no opening, RTP 2 weeks
grade 2: 5-10mm opening at joint line, firm end point: 3-4 week RTP
grade 3: over 10 mm opening vague endpoint and 6+ weeks to return to
55
when does an MCL/LCL injury need surgery
bony avulsion, tibial plateau fracture, crutiate ligament issues, or intra articular entrapment of a ligament
56
is lateral or medial meniscus more mobile
laterali
57
is anterior or postreior horn more mobile
anterior
58
why are the posterior horn and medial meniscus more vulnerable
they are less mobile
59
MOI/exam and treat of meniscus injury
contact, rotational movement, cut/pivot or degeneration
pin and stiffness, locking and catching, giving way
treatment: rehab, meiscectomy, meniscus repair
60
what precautions does a meniscus repair have
limited WB and flexion
61
first 3 weeks post op meniscus repair
brace locked at 0, ROM 0-90 and WBAT
62
post op meniscus repair, strengthening and plyo can start when
6-10 weeks
63
runing progression can start when post op meniscus repair
11-15 weeks
64
if the postreior horn was repaired, what must you wait to do
HS exercises for 6 weeks
65
patellar fracture cause, exam and treatment
indirect pull of patellar tendon when partially flexed knee, or a direct blow or fall
swelling, bone separation, x-ray, immob 2-3 months
66
articular cartilage procedures of the knee, WB is begun when (unless what condition)
6 weeks (unless debridement )
67
when can you add ROM and CKC post op articualr cartilage procedure
ROM ASAP and CKC at 6 weeks
68
what is an OCD
partial or complete separation of articular cartilage from subchondral bone due to lack of blood flow
69
where are OCD lesions more common, medial or lateral condyle
medial
70
what view for knee OCD lesion
tunnel view
71
signs and sxs of OCD lesion
clicking, locking, swelling
72
what imaging view and special tests for dislocation
view: sunrise view
tessts: patellar apprehension and lateral glide test
73
treatment for patella dislocation
relocation (with knee ext!) , then braced/splinted 6 weeks.
74
segond fracture MOI,
avulsion of insertion at LCL, from excesssive IR and varus
75
what are some patellar instabilities
patella sublux/disloc (acute or chronic)
76
overuse knee injuries
patellar tendinopathy, Osgood Sclatters, SLJ
77
what are some soft tissue lesions
ITB, plica, hoffa'disease, bursitis, MPFL
78
hoffa's disease
fat pad inflammation
79
j-sign
lateral patella tracking when going from flex to ext
80
patellar glide test
hypomobile is glides less than 1/4 patella
hypermobile if glides over 3/4 patella
81
patellar tilt positive finding
no upward movement due to tight retinaculum
82
basset sign
tenderness over medial epicondyle of femur
83
sulcus sign
line down the medial and lateral walls of trochlea, >150 degrees (shallow) may have instability
84
normal Q angle men and women
men 13
women 18
85
what are the ottawa knee rules
trauma and age over 55, tenderness over patella and fibular head adn unable to flex over 90 degrees and unable to WB 4 steps
86
AP views are best for seeing what at what angles
tibial plateau and
at 30 degrees flex: joint space narrowing
87
lateral view with partial flexion can view
patella and joint effusion
88
sunrise or merchant view can see
relationship between patella and femur
89
tunnel view can see
tibial and femoral condyles
90
what can cause a patella rupture
strong quad contraction in a fixed LE or a fall onto a partially flexed knee
91
findings on exam of patella tendon rupture
inabiltiy to extend knee, inability to WB, effusion and instability
92
first 2 weeks post op patella tendon rupture
TTWB in full extension brace, ROM 0-15 degrees and quad iso
93
bracing ROM for post op patella tendon rupture repair
0-45 at 3 weeks
0-60 at 4 weeks
0-90 at 5 weeks
all WBAT
94
when does full ROM and WB happen post patella tendon rupture
6 weeks
95
when can CKC strengthening not beyond 70 happen
7 weeks
96
agilit, plyo, running and sport interval training can start when post op patella tendon rupture repair
16-24 weeks
97
oscgood schlatter
pain at attahcment of patellar tendon at tibial tuberosity
98
larsen johansson
pain at inferior pole of patella
99
exam of overuse in knee OSGS and SLJ
swelling, pain and point tenderness, pain with kneeling running and jumping
100
treatment for knee overuse OSGS and SLJ
decreased ativity, isometrics strnetghening and ice
101
patellar tendinitis is AKA
cause, exam and treatment
jumpers knee: jumping, kick, run will hurt.
pain at patella tendon, after/during/rest
ice patella tendon strap and friction massage
102
runners knee AKA
cause, exam and treat
ITB friction syndrome
cause: repetitive overuse, structural abnormalities at foot (genu Varum and over pronated )
pain at lateral knee and (+) Ober's test
orthotics, address structure, ice, WU and rest
103
what biomechanical structural things at knee and ankle can cause runners/ITB friction syndrome
over pronation and varus
104
peroneal nerve contusion
cause, exam and treatment
around the back of fibular head, direct contact
pain often radiating down anterior leg into the foot, numbness short time,
RICE, return when sxs go away and no weakness.
105
bursitis in knee cause, exam and treatment
cause: prepatellar most common from kneeling
localized swelling (but not intra-articular) and you need to eliminate the cause (such as kneeling)
