The Knee - Ch. 20 Flashcards
which part of the menisci has the most adequate blood supply? minimal? and nothing?
adequate: red-red zone
minimal: red-white
na da: white-white
what mvmnts does the ACL prevent?
posterior translation of femur in wt bearing anterior trans. of tibia in non-wt bear tibial IR hyperextenion to a degree of valgus and varus
what mvmnts does the PCL prevent?
anterior trans of femur in wt bear
posterior trans of tibia in non wt bear
hyperextension
tibial IR
attachment of superficial MCL?
which angle is it isolated?
medial condyle and just underneath pes anserine attachment
20-30 degress of knee flexion
when is the deep medial capsular ligament taut? slack?
taut: extension
slack: flexion
what aspects of the deep medial capsular ligament attach to the medial meniscus?
medial and posterior deep capsule
describe the 4 ‘corners’ of the knee joint capsule? what other structures protect each ‘corner’
postlat: ITB, popliteus, biceps fem, LCL
postmed: pes anserine, semitmemb tendon, post lig.
antlat. : ITB, lateral retinaculum, patellar tendon
antmed: medial retinaculum, MCL
what muscles are innervated by the femoral nn?
sartorious
all quadricep mm
what mm are innervated by the sciatic nn?
biceps femoris
what mm are innervated by the obturator nn?
gracilis
what mm are innervated by the tibial nn?
semimemb. semitend. gastroc soleus popliteus plantaris
describe the screw home mx
femur must IN ROT for full extension
last 15 degress - tibial ER and ACL unwinds
popliteus must unlock knee into flexion by internally rotating the tibia after full extension
how do you measure tibial torsion?
have pt kneel on stool
make a staight line from thigh to middle of heel and another line from middle of foot to centre of heel
**if angle is >15 than likely a tibial torsion
4 components to assess for patellar orientation?
glide, (M-L) & (A-P) tilt, rotation
measuring structural leg length vs. functional leg length
structural: ASIS - med mall
functional: umbilius - med mall
what does a (+) test indicate for apley’s distraction test?
joint capsule ligament sprain
meniscus should not be painful
describe slocum’s test (anterior drawer remix)
knee flexed to 90
internally rotated 15 - (+) laxity ACL, postlat. capsule
externally rotated 30 - (+) laxity ACL, post med, MCL
what to look for in a pivot shift test?
tibia subluxes in extension and reduces itself after 20-30 of knee flexion - indicates anterolateral instability
what to look for in jerk test?
reverse-pivot:
same as pivot shift but start in flexion and tibial will sublux as you bring it into extension
describe the external rotation recurvatum test
grab big toe and patient’s straight leg
watch for tibia externally rotating and sagging down - indicates torn PCL
which menisci are you testing for during int/ext rot in a Mcmurrey’s?
int rot. - lateral meniscus
ext. rot - medial meniscus
same as apley’s compression
q-angle, normal and abnormal
M - 10
F - 15
abnormal: > 20
A-angle, abnormal
from patellar line to tib tub line
> 35 is pathological
what’s the typical % one needs for adequate quad to hamstring strength?
60-70%
after a grade 3 MCL tear, what are the typical ranges one is allowed to have post injury - in a brace?
1st 2-3 wks: 0-30
2nd 2-3 wks: 0-90
mx of a ACL tear
non-contact - decel/ stop to change direction - int rot of tibia and planted foot with eccentric contraction of quads
direct- direct valgus force (lat/post)
indirect - pertubations to shift COM
mx of PCL aka ?
dashboard injury
falling or getting hit on a hyperflexed knee w/ PF foot
what’s the mx of drop foot? and what structure is primarily affected?
mng?
direct blow
common peroneal nerve - affects the deep peroneal branch (dorsiflexors)
no RTP until weakness and radiating pain cease
protective padding
true reason why a baker’s cyst occurs and where it’s located?
mng?
cyst swells due to a problem in the joint itself and not from bursitis - located behind the medial gastroc
mng: compression wraps and NSAIDs
mng of infrapatellar fat pad syndrome?
decrease hyperextension with use of tape or heel lift
difference between larson-johansen vs osgood schlatter
same condition but larson-johan is at the inferior pole of patella
osgood schlatter’s is a tib tub
