SCS Study Guide-Knee Flashcards
sartorius innervation
femoral
quad group innervation
femoral
biceps femoris innervation
sciatic
semitend/semimemb poploteus gasctoc and plantaris innervation
tibial
gracilis innervation
obtruator
what does a postiive valgus stress test mean
at 0 degrees: Torn MCL, possible ACL/PCLPMC
at 30 deg: torn MCL (check others too)
whta does a positive varus stress test mean
at 0 deg: torn LCL and possible ACL/PCL
at 30 deg: Torn LCL ( check others too for grade III)
positive anterior drawer meaning
at 0 deg: torn ACL
at 15 deg ER: torn PMC, ACL possible MCL
at 30 deg IR: Torn PLC and ACL
Lelli’s test or lever sign
torn ACL
pivot shift
torn ACL, ALC
solcum’s
torn ACL ALC
Jerk (Hughston) Torn
ACL, ALC
losee test
torn ACL, ALC
postrior drawer
torn pcl
ER recurvatum (tibial ER)
torn PCL, PLC
posterior sag sign
torn PCL
reverse pivot shift test
torn PCL
Mc Murrays’ in IR vs ER
IR: torn LM
ER: torn MM
Apelys’
torn MM
thessaly’s
torn MM and or LM
over ____% ACL tears are non contact
70
cause of ACL tear
deceleration, hyperextension, rotational movement
landing from a jump with minimally flexed knee, inc quad relative to HS can lead to excessive translation
signs for the best prognosis of an ACL-R
full ROM, decreased swelling, good leg control and excellent mental state
signs that a non-op/conservative will do well
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%
allograft advantages
decreased morbidity
preservation of knee ext/flex
decreased operation time
availability of larger grafts
decreased incidence of fibrosis
disadvantages of allografts
infection, slow healing/incomplete grafts
increased cost
tunnel enlargement
alteration of structural properties with steralization/storage
female ACL tears _____ x more likely
2.4-9.7
intrinsic factors that risk ACL tear
intercondylar notch size, ACL size, physcioloical laxity and hormonal fluctuations
extrinsic factors
kinematics, kinetics, muscle strength and activaiton
post op ACL-R when can you add gait training and bike
week 1-2
post op ACL-R when can you get ROM to 120, then full ROM
120 at 3 weeks, full by 4 weeks
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
when is the graft state weakest
at 4-8 weeks
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
hopping and jogging/running can start when, assuming what
at 12-16 weeks assuming hop testing was 80% uninvolved side
when can cutting and plyo start post op ACL-R
20 weeks
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
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
in a normal PCL, the popliteus helps to do what
control ER, varus and posterior translation
MOI for PCL injury
trauma to prox tibia, fall on knee with PF foot, excessive hyperextension
what grades PCL are non-op and op
grades I and II are non op and grades III are op
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
when can you start running post PCL no op treatment
around 8-12 weeks if no pain, swelling, laxity and quad testing over 85%
post op PCL general guidelines (4)
- no OCK exercises to start
- avoid posterior tibial translation
- resistance of hip resistance ABOVE KNEE
- more conservative protocol than ACL
isolated PCL injury grade I or II management
protective WB and return in 2-4 weeks
isloated grade III PCL injury treatment
splint in extension 2-4 weeks for non op
op: active and young folks, (older are non-op)
how soon after combined PCL injury should you have surgery
2 weeks
first week of PCL-R rehab considerations
locked in 0, with pillow behind tibia to reduce sag
____ degress of extension is allowed to lack for ___ months following PCL-R
1o degrees
jumping, running and RTS can happen when post op PCL-R
6 months
post op PCL-R when can brace be unlocked for everything
6-8 weeks
MCL and LCL fibers are tight in what
extension (lax in flexion)
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
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
when does an MCL/LCL injury need surgery
bony avulsion, tibial plateau fracture, crutiate ligament issues, or intra articular entrapment of a ligament
is lateral or medial meniscus more mobile
laterali
is anterior or postreior horn more mobile
anterior
why are the posterior horn and medial meniscus more vulnerable
they are less mobile
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
what precautions does a meniscus repair have
limited WB and flexion
first 3 weeks post op meniscus repair
brace locked at 0, ROM 0-90 and WBAT
post op meniscus repair, strengthening and plyo can start when
6-10 weeks
runing progression can start when post op meniscus repair
11-15 weeks
if the postreior horn was repaired, what must you wait to do
HS exercises for 6 weeks
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
articular cartilage procedures of the knee, WB is begun when (unless what condition)
6 weeks (unless debridement )
when can you add ROM and CKC post op articualr cartilage procedure
ROM ASAP and CKC at 6 weeks
what is an OCD
partial or complete separation of articular cartilage from subchondral bone due to lack of blood flow
where are OCD lesions more common, medial or lateral condyle
medial
what view for knee OCD lesion
tunnel view
signs and sxs of OCD lesion
clicking, locking, swelling
what imaging view and special tests for dislocation
view: sunrise view
tessts: patellar apprehension and lateral glide test
treatment for patella dislocation
relocation (with knee ext!) , then braced/splinted 6 weeks.
segond fracture MOI,
avulsion of insertion at LCL, from excesssive IR and varus
what are some patellar instabilities
patella sublux/disloc (acute or chronic)
overuse knee injuries
patellar tendinopathy, Osgood Sclatters, SLJ
what are some soft tissue lesions
ITB, plica, hoffa’disease, bursitis, MPFL
hoffa’s disease
fat pad inflammation
j-sign
lateral patella tracking when going from flex to ext
patellar glide test
hypomobile is glides less than 1/4 patella
hypermobile if glides over 3/4 patella
patellar tilt positive finding
no upward movement due to tight retinaculum
basset sign
tenderness over medial epicondyle of femur
sulcus sign
line down the medial and lateral walls of trochlea, >150 degrees (shallow) may have instability
normal Q angle men and women
men 13
women 18
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
AP views are best for seeing what at what angles
tibial plateau and
at 30 degrees flex: joint space narrowing
lateral view with partial flexion can view
patella and joint effusion
sunrise or merchant view can see
relationship between patella and femur
tunnel view can see
tibial and femoral condyles
what can cause a patella rupture
strong quad contraction in a fixed LE or a fall onto a partially flexed knee
findings on exam of patella tendon rupture
inabiltiy to extend knee, inability to WB, effusion and instability
first 2 weeks post op patella tendon rupture
TTWB in full extension brace, ROM 0-15 degrees and quad iso
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
when does full ROM and WB happen post patella tendon rupture
6 weeks
when can CKC strengthening not beyond 70 happen
7 weeks
agilit, plyo, running and sport interval training can start when post op patella tendon rupture repair
16-24 weeks
oscgood schlatter
pain at attahcment of patellar tendon at tibial tuberosity
larsen johansson
pain at inferior pole of patella
exam of overuse in knee OSGS and SLJ
swelling, pain and point tenderness, pain with kneeling running and jumping
treatment for knee overuse OSGS and SLJ
decreased ativity, isometrics strnetghening and ice
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
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
what biomechanical structural things at knee and ankle can cause runners/ITB friction syndrome
over pronation and varus
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.
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)
