tuhod ni daddy nermy Flashcards
exp why the knee is highly predisposed to injuries
bcs the ligaments not intact
what is the effect on the knee if dorsiflexors are weak
weak dorsiflexors = inc anterior pressure on the knee during a squat
compare medial and lateral meniscus in terms of shape
medial meniscus - C-shaped
lat meniscus - circular
which meniscus is more injured and why
medial meniscus d/t it being less movable or has more attachments
motion of patellar during knee ext
superior tracking
motion of patellar during knee flex
inferior tracking
which motions does ACL check
hyperextension, ant translation of tibia, valgus stress and IR of tibia
which motions does PCL check
flexion, post translation of tibia, varus stress and ER of tibia
if pt complains of aching what should you consider
more of degenerative changes
if pt complains of sharp pain or catching what should you consider
meniscal or plica
if pt complains of stiffness in the morning that improves with activity
more of arthritic in nature - RA or OA
if pt complains of pain in anterior knee what should you consider
PFPS
bursitis
fat pad irritation
OSD
if pt complains of pain during activity what should you consider
structural deformity - subluxation or patellar tracking disorders
if pt complains of pain after activity what should you consider
overuse, tendinosis, paratenonitis, inflammatory disorders - jumper’s knee/SLJ
if pt complains of generalized pain what should you consider
contusions of partial tear
why does joint swelling cause pain
inc fluid in synovium = inc psi = inc pain
ligament involved if MOI is valgus force c or s rotation
MCL
ligament involved if MOI is hyperextension and ant translation of tibia
ACL
ligament involved if MOI is flexion c posterior translation of tibia
PCL
ligament involved if MOI is varus force
LCL
what could the affectation be if it is sudden in onset
ligamental - cruciates and collateral
what could the affectation be if it is traumatic in onset
avulsion or tear ng muscle
what could the affectation be if it is slow in onset
more of arthritic or wear and tear
if pt complains of difficulty in stairs what do we consider
patella problem or PFPS
if MOI is twisting or pivoting while WB what can we consider
meniscal injury
if pt hears a click or pop
ACL or osteochondral fx
if lateral - popliteus
if injury occurred during acceleration + twist
consider meniscus
in injury occurred during deceleration
consider cruciate
what to look for in PMHx
check for hip or ankle injury history bcs usually compounded na injuries
knee gives away during uphill or downhill
retropatellar lesion - ACL, PCL or hamd
knee gives away bcs patella slips out of place
subluxation or plica
how to compare locking vs catching
locking - cant fully extend knee with flexion normal
catching - momentary locking or giving way
causes of locking
loose bodies, meniscus pathology or hamstring spasm; spasm locking
causes of catching
reflex inhibition or pain
discuss grating or clicking
d/t degeneration or structure snapping over another
what to look for in OI
deformities, abnormal protrusions, dislocations, subluxations or bony enlargements
contusions, ecchymosis and swelling
differentiate contusion vs strain
contusion - direct blow or trauma to area
strain - over stretch or fast eccentric
both will present as ecchymosis
discuss baker’s cyst
fluid part of the bursa goes out d/t excessive flex-ext
what to consider if painful c resistance and active motion
active structures
what to consider if painful c passive motion and joint play
passive structures
what is the reverse J sign
seen in PFPS - patella moves superolaterally; normal is superomedial
possible causes of reverse J sign
weak VMOs or tight ITB
normal lateral movement of patella
1/2
normal medial movement of patella
1/4
capsular pattern of knee
flex > ext
possible causes of extension lag
reduced force production of quads
excessive resistance from connective tissues
faulty arthrokinematics
discuss heel height difference
if may mas mataas = extension lag
highest point of calcaneus as reference
at what position can you palpate meniscal cysts
45deg flexion
at what position can you palpate joint line
90deg flexion
possible diagnosis if pain is felt or there are palpation findings on apex of patella
jumper’s knee
possible diagnosis if pain is felt or there are palpation findings on patellar tendon
paratenonitis or tendinosis
possible diagnosis if pain is felt or there are palpation findings on infrapatellar bursa
parson’s or vicar’s knee
possible diagnosis if pain is felt or there are palpation findings on over the patella
prepatellar bursitis or housemaid’s knee
possible diagnosis if pain is felt or there are palpation findings on articular facets of patella
chondromalacia patellae
possible diagnosis if pain is felt or there are palpation findings on suprapatellar pouch
effusion, pathology
possible palpation findings on quadriceps
tenderness, atonia, myositis ossificans, tightness
possible palpation findings on MCL
sprain, pellegrini-steida syndrome
possible palpation findings on pes anserine
strain/bursitis
possible palpation findings on distal TFL or ITB
strain or tenderness
what is myositis ossificans
calcification of quads d/t to contusions
what is pellegrini-steida
calcification of MCL
possible palpation findings on medial joint line c tibia IR
medial meniscus lesion/cyst
possible palpation findings on lateral joint line c tibia ER
lateral meniscus lesion/cyst
possible palpation findings on tibial plateau
coronary ligament sprain
possible palpation findings on femoral condyles
osteochondritis dissecans and adductor insertions
how to palpate for LCL
figure 4
possible palpation findings on post knee
baker’s cyst
possible palpation findings on popliteus core or arcuate lig
strain/sprain
possible palpation findings on semimebranosus corner
strain/sprain
possible palpation findings on hamstrings and gastrocsoleus
tenderness, swelling and patholgy
what are the ottawa knee rules
younger than 55 or older than 18
fibular head tenderness
patellar tenderness
inability to flex knee at 90°
inability to WB and walk 4 steps when examined and at time of injury
