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MSK 3 Fall 2024 > Unit 3 Knee Common Conditions > Flashcards

Unit 3 Knee Common Conditions Flashcards

1
Q

Anterior Knee Pain Causes

A
  1. Patellofemoral syndrome- biomechanical dysfunction
  2. Patellar compression syndrome- excessive lateral pressure syndrome; global pressure syndrome
  3. Patellar instability - chronic patellar subluxation; acute patellar dislocation
  4. Direct patella trauma- articular cartilage lesion (isolated); fracture and dislocation ; articular cartilage lesion with associated malalignment
  5. Soft tissue lesions- plica syndrome; fat pads syndrome; bursitis
  6. Overuse syndromes- tendinitis; apophysitis
  7. osteochondritis dissecans
  8. Neurological disorders- complex regional pain syndrome; sympathetically maintained pain
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2
Q

Patellofemoral Pain Syndrome (PFPS)

A
  • patellofemoral related problems are characterized by pain in the vicinity of the patella that is worsened by sitting and climbing, stairs, inclined walking and squatting
  • Young adult athletes are a big population for this
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3
Q

Global and Local caused of lateral tracking of the patella

A
  • bony dysplasia
  • XS laxity of connective tissue
  • XS tightness of connective tissue
  • Muscle weakness
  • Bony or joint malalignment
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4
Q

Patellofemoral Biomechanical Dysfunction
Common Symptoms

A
  • retro patellar, patellar tendon pain
  • patellar crepitus
  • swelling or locking
  • pain on stairs/squatting
  • pain with prolonged flexed knee postures
  • limitations in functional mobility, ADL’s recreation or sport
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5
Q

Patellofemoral Biomechanical Dysfunction Exam

A
  • Altered lower extremity alignment
  • weak hip abduction/ ER? extension
  • VMO weakness / inhibition/timing
  • decreased flexibility TFL/HS/Q/G-S
  • Overstretched medial ret or tight lateral re/ITB
  • decreased patellar medial glide or tilt
  • pronated foot
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6
Q

Patellofemoral Biomechanical Dysfunction
Treatment / Interventions

A
  • Increase flexibility
  • mobilize patella
  • improve muscle performance and neuromuscular control
  • modify biomechanical stresses (orthotics, bracing, taping)
  • return to functional activities
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7
Q

Excessive Lateral Pressure Syndrome
Common Symptoms

A
  • lateral retinacular pain
  • occasional medial peripatellar pain
  • pain with stairs, squatting, stooping down
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8
Q

Excessive Lateral Pressure Syndrome
Exam Findings

A
  • lateral patella tilt
  • xs tightness of deep lateral retinacular structures
  • decreased patellar medial glide
  • (+/-) patellar subluxation
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9
Q

Excessive Lateral Pressure Syndrome
Treatment/Intervention

A
  • inflammation/pain
  • stretch tight lateral
  • joint mobs/patellar taping (low load, long duration)
  • M-T stretch HS, Q, ITB
  • Strengthen quads (VMO)
  • Biofeedback/estim
  • maintain aerobic conditioning
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10
Q

Global Patellar Pressure Syndrome
Common Symptom

A
  • diffuse global anterior knee pain
  • stiffness (both medial and lateral)
  • MOI= local trauma/immobilization
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11
Q

Global Patellar Pressure Syndrome
Exam Findings

A
  • Restricted patella mobility
  • Restricted tib-fem motion
  • Quad atrophy (especially VMO)
  • Loss flexibility in HS/Q/ITB
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12
Q

Global Patellar Pressure Syndrome
Treatment/Intervention

A
  • Patella mobs
  • STM to quads
  • Knee AROM/PROM
  • Restore full PROM Knee Extension
  • Stretch other MT structures
  • Strengthening: progressing from 1.) Multi angle isometrics, SLR, Mini squats 2.) LP, Lunges, wall squats
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13
Q

Acute Patellar Dislocation/Instability
Common Symptoms

A
  • Significant pain
  • Stiffness
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14
Q

Acute Patellar Dislocation/Instability
Exam Findings

A
  • effusion
  • Limited PROM/AROM
  • TTP medial structures, adductor tubercle ( med Pat Lig)
  • (+) apprehension for patellar mobility
  • Check for ACL, MCL, MMT injury
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15
Q

Acute Patellar Dislocation/Instability
Interventions/Treatments

A
  • Immobilization in extension to allow swift tissue healing
  • Quad neuromuscular re-education
  • decrease inflammation- PRICE, isometric, e-stim
  • begin motion and strengthening as inflammation subsides
  • Bracing
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16
Q

Chronic Patellar Subluxation/Instability
Common Symptoms

A
  • Giving way/unstable
  • Patellar tightness/discomfort
  • jumping/popping out of place
  • Catching/locking/snapping
  • Pain medially
  • Swelling
  • Limited sports participation due to apprehension or instability
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17
Q

Chronic Patellar Subluxation/Instability
Exam findings

A
  • Effusion
  • TTP medial ret
  • (+) apprehension with lat patella glide
  • (+) patella hypermobility
  • Patella alta
  • Quad atrophy
  • Increased q angle
  • extension subluxation during TKE
  • > 50% patella width can be displaced laterally
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18
Q

Chronic Patellar Subluxation/Instability
Interventions

A
  • Patella stability: bracing or taping
  • Pain free quad strengthening for dynamic stability
  • Orthotics to minimize excess pronation and decrease valgus forces
  • Bike/Swimming
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19
Q

Anterior Cruciate Ligament ACL
Common symptoms

A
  • females 4-6x more likely
    MOI= non contact or contact sports related, valgus stress, hyperextension
  • Possible accompanying injuries: meniscus, collateral ligaments, bone bruises, cartilage damage
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20
Q

Anterior Cruciate Ligament ACL
Exam Findings

A
  • Possible abrasion or contusion around knee
  • Min swelling
  • Limited ROM
  • Quad weakness
  • Quadriceps avoidance gait (flexed knee)
  • Symptoms of instability
  • (+) anterior drawer, Lachman’s, pivot shift
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21
Q

Anterior Cruciate Ligament ACL
Interventions/Treatment

A
  • full passive knee extension
  • gradual improvement in knee flexion
  • Muscle strengthen quads/hams
  • proprioceptive training
  • patellar mobility
  • reduce swelling/pain
  • independent ambulation
  • neuromuscular control, core stability, endurance
  • sport specific functional training
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22
Q

Posterior Cruciate Ligament PCL
Common Symptoms

A

MOI= significant trauma, dashboard injury, gall on hyperflexed knee with foot in PF
- May or may not feel a pop
- pain behind the knee
- May or may not have instability
- giving way

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23
Q

Posterior Cruciate Ligament PCL
Exam Findings

A
  • Possible abrasion or contusion on superior or anterior tibia suggesting posterior directed force
  • Min swelling
  • Pain >90 degrees flexion
  • May lack 10-20 degrees of flexion
  • may or may not have neurovascular findings
  • (+) posterior drawer test, post. sag.
  • MRI gold standard
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24
Q

Posterior Cruciate Ligament PCL
Interventions/Treatments

A
  • education
  • quads and calf strengthening
  • CKC: squats, lunges, knee extension
  • OKC: knee extension ( 45-20 degrees flexion to protect PF joint)
  • balance and proprioception
  • return to sport in 12-16 weeks
  • surgery
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25
Q

Posterolateral Corner PLC
Common symptoms

A

MOI= posterolateral directed force to the anteromedial tibia, knee hyperextension and or severe tibia ER while the knee is partially flexed
- pain at medial and or lateral line or posterolateral aspect of knee
- Instability or giving way to hyperextension with stairs or graded ambulation or with pivoting /cutting movements

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26
Q

Posterolateral Corner PCL
Exam Findings

A
  • altered gait
  • varus thrust gait pattern
  • possible hyperextension thrust
  • vascular compromise (pedal and post tibial pulses)
  • possible neural symptoms (common peroneal n.)- numbness of 1st dorsal web space and dorsum of the foot/ DF, EV, great toe extension weakness
    -(+) posterolateral drawer, dial, ER recurvatum, varus stress, reverse pivot shift, standing apprehension
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27
Q

Posterolateral Corner PLC
Intervention/Treatment

A
  • education
  • quad and calf strengthening
  • no isolated hams
  • CKC: squats, lunges, knee extension
  • OKC; knee extension 45-20 degrees flexion protect PF joint
  • balance and proprioception
  • return to sport in 12-16 weeks
  • surgery
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28
Q

Lateral Collateral Ligament LCL
Common Symptoms

A

MOI= varus force to knee with foot planted, severe hyperextension
- may hear or feel pop
- Lateral knee pain
- Locking or catching with movement and giving way
- Stiffness

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29
Q

Lateral Collateral Ligament LCL
Exam Findings

A
  • May or may not have swelling
  • Lateral TTP
  • Antalgic Gait
  • (+) varus at 0 degrees and 30 degrees
30
Q

Lateral Collateral Ligament LCL
Interventions/Treatment

A
  • Avoidance of varus forces and tibial IR forces 6-8 weeks
  • Normalize quad strength
  • facilitate more dynamic stabilization (balance and proprioception)
31
Q

Medial Collateral Ligament MCL
Common symptoms

A

MOI= valgus stress, blow to lateral knee, can be contact or non contact
- May hear or feel a pop
- Medial knee pain
- Locking or catching with movement and giving way
- stiffness

32
Q

Medial Collateral Ligament MCL
Exam Findings

A
  • may or may not have swelling
  • Medial TTP
  • Antalgic Gait
    -(+) valgus at 0 degrees and 30 degrees
33
Q

Medial Collateral Ligament MCL
Intervention/treatment

A
  • Avoidance of valgus forces and tibial ER forces 6-8 weeks
  • Normalize quad strength
  • facilitate dynamic stabilization (balance and proprioception)
34
Q

Meniscus
Common Symptoms

A
  • Twisting injury with a tearing sensation while weight bearing
  • Joint line pain
  • Swelling
  • Catching, popping, locking
    -previous injury or instability
35
Q

Meniscus
Exam Findings

A
  • (+) McMurray’s. Thessaly, Apley’s, bounce home
  • Pain with forced hyperextension or maximum flexion
  • joint line tenderness
  • limited functional activities (running, kneeling, squatting)
  • joint effusion
36
Q

Meniscus
Treatment/Intervention

A
  • control swelling
  • Restore knee PROM
  • Minimize quad strength loss with initial NWB strengthening
  • Avoid squatting/pivoting, cutting, running until healing occurs
  • Meniscectomy
  • Meniscal repair
  • Allograft transplant
37
Q

Articular Cartilage
Common Symptoms

A
  • Can develop overtime or to acute trauma
38
Q

Articular Cartilage
Exam Findings

A
  • pain
  • effusion
  • Limited Functional Activites
39
Q

Articular Cartilage
Treatment/Interventions

A
  • Decrease pain and effusion
  • Increased ROM
  • Regain quad control
  • MM strength
  • MM endurance
40
Q

OA
Common Symptoms

A
  • pain up/down stairs
  • walking on inclines
  • Stiffness
  • pain with weight bearing
  • knee instability
41
Q

OA
Exam Findings

A

-increased temp to the touch
- swelling
- mm weakness
- Loss of ROM ( capsular pattern Flex>extension)
- Genu varum ( may also see valgus)
- radiography’s : decreased joint space, osteophytes, subchondral cysts, varus or valgus deformity

42
Q

OA
Treatment/Intervention

A
  • Joint preservation/sparing education
  • decrease shear forces/compression
  • weight reeducation
  • NWB or low compression activities: swimming , recumbent bike, elliptical
  • Unloading brace
    -joint lubrication injections
  • footwear wedging
  • PT
43
Q

ITB Friction Syndrome
Common Symptoms

A
  • pain with repetitive motion
  • No trauma
  • Pain up/down stairs
  • pain free walking level surfaces
  • lateral knee pain diffuse and difficult to localize
  • changes in training surfaces , increase in training volume
44
Q

ITB Friction Syndrome
Exam Findings

A
  • TTP lateral femoral condyle or gerdys tubercle
  • Pain free MMT
  • Weak hip abduction
    (+) ITB Special Test: Ober’s, noble’s, creak for pain or crepitus
  • anatomically prominent lateral femoral condyle
  • Biomechanical: cavus foot, LLD internal tibial torsion, genu varum
45
Q

ITB Friction Syndrome
Intervention/Examination

A
  • Activity Mod
  • heat or ICE
  • Soft Tissue mobs/cross friction
  • Hip abduction strength
  • ITB strengthening
  • Correct biomechanical faults
46
Q

Plica Syndrome
Exam Findings

A
  • Clicking
  • Anterior knee pain
  • giving way
  • Pseudo Locking
47
Q

Plica Syndrome
Exam Findings

A
  • palpable snapping over medial condyle
    (+) medial plica, medial plica shelf, stutter
    (-) radiographs
  • rule in by exclusion
48
Q

Plica Syndrome
Interventions/Treatment

A
  • E stim for pain
  • Stretch Q, HS, G-S
  • Isometrics
  • Patellar bracing
  • Anti-inflammatory
  • Altered training schedule
  • Steroid injection
  • Surgery
49
Q

Fat Pad Syndrome (Hoffa’s)
Common Symptoms

A
  • Anterior knee pain at inferior patella pole
  • Pain with knee extension in various positions
  • Usually due to a trauma
  • Can lead to infrapatellar contraction syndrome: unable to regain full passive extension due to a scar formation in fat pad area
50
Q

Fat Pad Syndrome (Hoffa’s)
Exam Findings

A
  • Posterior patellar tilt
  • pain with knee extension or hyperextension, not with flexion
  • Inferior patella edema
  • TTP fat pad
    (+) bounce
    (-) radiographs
51
Q

Fat Pad Syndrome (Hoffa’s)
Treatment/Interventions

A
  • Avoid direct pressure
  • rest
  • decrease inflammation via ice/phon or iontophoresis
  • Biomechanical interventions (taping/orthotics)
  • Anti-inflammatories
  • Cortico steroid injections
52
Q

Bursitis
Common Symptoms

A
  • pain
  • infrapatellar: mechanical irritation or trauma (kneeling)
  • pes anserine: swimming/runners, medial pain
53
Q

Bursitis
Exam Findings

A
  • TTP over bursa and surrounding area
  • Local swelling
  • TTP medial joint line/ER tibia (pes anserine)
  • Decreased ROM
  • Increased temp
54
Q

Bursitis
Interventions/Treatment

A
  • Activity modifications
  • Rest
  • Anti-inflammatories
  • stretch/strengthen
  • correct biomechanical faults
  • Corticosteroid injections
55
Q

Patellar Tendinosis (Jumpers Knee)
Common Symptoms

A
  • Insidious onset, usually after running or jumping
  • Inferior patella pain
  • Pain subsides at rest, increases after activity
56
Q

Patellar Tendinosis (Jumpers Knee)
Exam Findings

A
  • TTP patellar tendon/inferior pole of patella
  • Swelling inferior pole patella
  • pain with resisted knee extension
  • Q/HS tightness
57
Q

Patellar Tendinosis (Jumpers Knee)
Interventions/Treatment

A
  • Acute vs. Chronic
  • Rest/activity modification
  • decre4ase inflammation
  • stretching
  • eccentric strength/overload
  • bracing
58
Q

Osgood- Schlatter Disease / SLI Syndrome
Common Symptoms

A
  • 8-13 year olds in girls/10-15 y.o boys
  • pain during athletics, cycling, running, jumping, resisted knee extension
59
Q

Osgood- Schlatter Disease / SLI Syndrome
Exam findings

A
  • TTP tibia tub/ inferior pole patella
  • localized inflammation/ swelling tibial tub or inferior pole patella
  • pain with resisted knee extension
  • Radiographs: tibial tub large and deformed
60
Q

Osgood- Schlatter Disease / SLI Syndrome
Intervention/ Treatment

A
  • rest/activity modification
  • Decrease inflammation
  • Stretch Q, HS, ITB
  • Strengthen Q/HS
  • Self-limiting: continue activity as tolerated
61
Q

Osteochondritis Dissecans
Common Symptoms

A
  • Rare cause of anterior knee pain in young active adults,
  • Retropatellar pain with squatting, kneeling, walking, stairs
  • Catching sensation with knee flexion
  • Giving way/locking
62
Q

Osteochondritis Dissecans
Exam Findings

A
  • Usually unilateral
  • quad weakness
  • Chronic joint effusion
  • May be associated with mal tracking
  • loose bodies
  • seen on radiographs / MRI/CT/bone scan
63
Q

Osteochondritis Dissecans
Interventions/ Treatment

A
  • rest
  • activity limitation : possible NWB 3-6 months
  • decrease inflammation
  • restrict ROM
  • Surgery
64
Q

Direct Patella Trauma
Common Symptoms

A

MOI= direct blow to patella ( MVA/contact sports)
- Diffuse anterior knee pain , some retropatellar pain with motion

65
Q

Direct Patella Trauma
Exam Findings

A
  • direct crepitation
  • pain and dysfunction worsened by Q contraction, stiars, squatting
66
Q

Direct Patella Trauma
Intervention/treatment

A
  • ROM to enhance articular cartilage healing
  • minimize PF forces
  • Swimming, cycling, low resistance
  • Q strength in pain free ROM
67
Q

Complex regional Pain Syndrome
Type 1
Type 2

A

Type 1= pain syndrome triggered by noxious event that is not limited to single peripheral nerve

Type 2= pain syndrome that involves direct partial or complete injury to a nerve

68
Q

Complex Regional Pain Syndrome
Exam Findings

A
  • Limb swollen
  • Painful ( hyperalgesia/allodynia, burning)
  • TTP
  • skin is shiny/mottled
  • hair and nail changes
  • Decreased ROM
69
Q

Complex Regional Pain Syndrome
Interventions

A
  • avoid excessive pain
  • Holistic /team approach
  • Assess for compensatory movement strategies
  • TENS
    AAROM/AROM, stregthen
  • desensitization : vibration, textures, fluidotherapy
70
Q

Knee Joint Fracture
Distal Femur

A
  • Most often due to trauma
  • important to consider proximity to popliteal artery and vein and tibial and common peroneal nerves
71
Q

Knee Joint Fracture
Proximal tibia

A
  • most often due to trauma
72
Q

Knee Joint Fracture
Patella

A
  • 20-25 y.o.
  • direct trauma or indirect ( when Q contraction force exceeds strength of patella)

MSK 3 Fall 2024 (8 decks)

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