The Knee Flashcards
What are 3 possible signs of a meniscal tear?
- Clicking
- Locking
- Buckling
What is a possible sign of knee OA?
Grinding or grating
What 4 areas should be cleared using a lower quarter screen examination when dealing with pathologies of the knee?
- Lumbar Spine
- Sacroiliac Joint
- Hip
- Foot/Ankle
Palpation at the knee is used to detect what primarily?
Effusion (intracellular swelling)
What 5 muscles should be assessed for length when examining the knee?
- Iliopsoas
- Rectus Femoris
- Hamstring
- TFL/ITB
- Gastrocnemius
Tibial internal rotation is characterized by _________ deviation of the knee/patella?
Knee likely to deviate laterally with tibial IR
Tibial external rotation is characterized by _________ deviation of the knee/patella?
Knee will likely deviate medially with tibial ER
What is genu recurvatum?
Excessive hyperextension at the tibiofemoral joint.
Tenderness to palpation is a valid tool for diagnosing _______________ muscle pain.
Hamstring muscle pain
What is the capsular pattern of the tibiofemoral joint?
Flexion > Extension
Flexion is more limited than extension
What is the quality of intrarater reliability of pain and resistance judgements at the knee and shoulder?
High intrarater reliability
Likely to obtain the same results for pain and resistance measures with the same examiner
What is the quality of inter-rater reliability of pain and resistance judgements at the knee and shoulder?
Low inter-rater reliability (not acceptable)
Not likely that same pain and resistance results will be obtained from examiner to another
What are the 2 ways to test for a quad lag?
- Patient completes SLR. Passive joint angle is subtracted from active joint angle.
- Patient completes long arc quad contraction from 90 deg of flexion to maximum extension that they can achieve. (Passive and active joint angles subtracted)
True or False: Resisted isometric (RI) testing at the knee is not valid and reliable.
FALSE
RI is a valid and reliable measure to use for examining the knee.
What are 4 special tests used to assess alignment at the knee?
- Tibial Torsion
- Valgus / Varus Alignment
- Genu Recurvatum
- Patella Alignment
What are 2 tests used to assess intra-articular swelling at the knee?
- Patella Tap Test (Ballotable Patella)
2. Fluctuation Test
List 10 special tests that can be used to assess ligamentous laxity.
- Apley’s Test
- (Abduction) Valgus Stress Test
- (Adduction) Varus Stress Test
- Anterior Drawer Sign
- Lachman’s Test
- Slocum’s Test
- Lateral Pivot Shift Maneuver (Test of MacIntosh)
- Posterior Drawer Sign
- Posterior Sag Sign (Gravity Drawer Test)
- Active Drawer Test
List 3 special tests used to identify meniscal tears.
- McMurray Test
- Apley’s Test
- Thessaly Test
What special test is used to test for ITB syndrome?
Noble Compression Test
What tool is used to determine if a patient needs a referral for X-rays following a traumatic fracture?
Ottowa Knee Rules
What are the 4 rules that make up the Ottowa Knee Rules?
Any of the following is present following the trauma:
- Patient is older than 55 years
- Isolated tenderness to the patella or fibula
- Unable to flex the knee greater than 90 degrees
- Unable to weight bear 4 weight-bearing steps immediately after the injury or in the emergency room (PT clinic)
What is the common cause of stress fractures? What 2 populations are they typically seen in?
Severe repetitive loading
Populations: Athletes (sports) and military
A stress fracture is also known as a _________.
Insufficiency fracture
Fractures that occur with normal stress to abnormal/ weak bone
What are 3 characteristics of stress/insufficiency fractures?
- Usually insidious onset
- Could present with swelling
- Point tenderness to palpation
What is avascular necrosis/Osteochondritis dessicans? Prevalence? Age? Male vs Female?
Bone tissue death due to decreased blood supply
- Prevalence ~4.5/10,000
- Twice as common among females than males
- Age 5-50 years old
What are 2 characteristics of avascular necrosis/osteochondritis dessicans?
- Pain with activity, stiffness after inactivity
2. Pain with weight bearing
What is the incidence of bone tumors? Age range? Is it commonly misdiagnosed?
- More common in individuals under 20 years (incidence is 5/1,000,000)
- Both malignant and non – malignant tumors are seen
- Age range between 15 and 55
- Often misdiagnosed, could be attributed to athletic injury
What are 3 possible post-op conditions that can affect the knee? Prevalence?
- Sepsis: 1-2/100 after knee replacement, check vital signs, incision, loss of ROM over time
- Periprosthetic fracture: 1-2/100 after knee replacement
- Deep vein thrombosis
What is the incidence of DVTs? Characteristics? What clinical tool is used to identify the presence of a DVT?
- Incidence is 1/1,000
- Characterized by swelling / calf pain
- Refer based on Wells Clinical Decision Rules
What are the 4 types of straight plane instability that indicate ligamentous laxity at the knee?
- Medial (medial collateral ligament impairment)
- Lateral (lateral collateral ligament impairment)
- Anterior
- Posterior (posterior cruciate ligament impairment)
What are the 5 types of rotary instability that indicate ligamentous laxity at the knee?
- Anteromedial (if ACL, MCL and medial meniscus are also torn this is called an ‘Unhappy Triad’)
- Anterolateral (anterior cruciate ligament impairment)
- Posteromedial
- Posterolateral
- Multidirectional
Rotary instability is based on movement of the __________.
Tibial Plateau
What are three interventions to consider incorporating when treating knee ligament sprains as suggested by the JOSPT CPG?
- Incorporate exercises (duh) in the clinic, supplemented with an HEP
- Use non-WB (open chain) exercises in conjunction with WB (closed chain) exercises
- Use neuromuscular training as a supplement to strength training
What 5 characteristics suggest the presence of a meniscal tear?
- Joint line tenderness
- Thessaly’s test
- History of locking and giving way
- Pain with overpressure to knee extension
- Pain with end range knee flexion
What 2 treatments are suggested following a meniscectomy?
- Strength training and functional exercise to increase quad and hamstring strength/endurance/functional performance
- Neuromuscular electrical stimulation to increase quad strength
What are 4 signs/symptoms of knee OA? Age?
- Knee pain
- Age > 39
- Morning stiffness
- Bony enlargement
What interventions are recommended for treating knee OA?
- Exercise and weight reduction reduces pain and improves physical function
- Acupuncture, TENS, low level laser reduce pain
- Psychoeducational interventions improve psychological outcomes
What population is patellar tendinopathy (jumpers knee) prevalent in? What symptom is used to diagnose patellar tendinopathy?
- Prevalence of up to 32-45% in elite volleyball and basketball players
- History of pain with high intensity jumping/ running, change in training
- Pain with palpation of the patellar tendon
What intervention is used to treat patellar tendinopathy?
Eccentric exercises
- **Pain should be minimal to moderate with exercise
- **If no pain, increase load
What are 6 physical findings are associated with ITB syndrome?
- tibial, genu and subtalar varus
- subtalar valgus
- pronation
- leg length discrepancy
- excessively prominent lateral femoral condyle
- tight iliotibial band
What is one possible way to treat ITB syndrome?
Foam rolling
