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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
Posterolateral Corner PLC Common symptoms
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
26
Posterolateral Corner PCL Exam Findings
- 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
27
Posterolateral Corner PLC Intervention/Treatment
- 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
28
Lateral Collateral Ligament LCL Common Symptoms
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
29
Lateral Collateral Ligament LCL Exam Findings
- May or may not have swelling - Lateral TTP - Antalgic Gait - (+) varus at 0 degrees and 30 degrees
30
Lateral Collateral Ligament LCL Interventions/Treatment
- Avoidance of varus forces and tibial IR forces 6-8 weeks - Normalize quad strength - facilitate more dynamic stabilization (balance and proprioception)
31
Medial Collateral Ligament MCL Common symptoms
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
Medial Collateral Ligament MCL Exam Findings
- may or may not have swelling - Medial TTP - Antalgic Gait -(+) valgus at 0 degrees and 30 degrees
33
Medial Collateral Ligament MCL Intervention/treatment
- Avoidance of valgus forces and tibial ER forces 6-8 weeks - Normalize quad strength - facilitate dynamic stabilization (balance and proprioception)
34
Meniscus Common Symptoms
- Twisting injury with a tearing sensation while weight bearing - Joint line pain - Swelling - Catching, popping, locking -previous injury or instability
35
Meniscus Exam Findings
- (+) 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
Meniscus Treatment/Intervention
- 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
Articular Cartilage Common Symptoms
- Can develop overtime or to acute trauma
38
Articular Cartilage Exam Findings
- pain - effusion - Limited Functional Activites
39
Articular Cartilage Treatment/Interventions
- Decrease pain and effusion - Increased ROM - Regain quad control - MM strength - MM endurance
40
OA Common Symptoms
- pain up/down stairs - walking on inclines - Stiffness - pain with weight bearing - knee instability
41
OA Exam Findings
-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
OA Treatment/Intervention
- 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
ITB Friction Syndrome Common Symptoms
- 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
ITB Friction Syndrome Exam Findings
- 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
ITB Friction Syndrome Intervention/Examination
- Activity Mod - heat or ICE - Soft Tissue mobs/cross friction - Hip abduction strength - ITB strengthening - Correct biomechanical faults
46
Plica Syndrome Exam Findings
- Clicking - Anterior knee pain - giving way - Pseudo Locking
47
Plica Syndrome Exam Findings
- palpable snapping over medial condyle (+) medial plica, medial plica shelf, stutter (-) radiographs - rule in by exclusion
48
Plica Syndrome Interventions/Treatment
- E stim for pain - Stretch Q, HS, G-S - Isometrics - Patellar bracing - Anti-inflammatory - Altered training schedule - Steroid injection - Surgery
49
Fat Pad Syndrome (Hoffa's) Common Symptoms
- 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
Fat Pad Syndrome (Hoffa's) Exam Findings
- Posterior patellar tilt - pain with knee extension or hyperextension, not with flexion - Inferior patella edema - TTP fat pad (+) bounce (-) radiographs
51
Fat Pad Syndrome (Hoffa's) Treatment/Interventions
- Avoid direct pressure - rest - decrease inflammation via ice/phon or iontophoresis - Biomechanical interventions (taping/orthotics) - Anti-inflammatories - Cortico steroid injections
52
Bursitis Common Symptoms
- pain - infrapatellar: mechanical irritation or trauma (kneeling) - pes anserine: swimming/runners, medial pain
53
Bursitis Exam Findings
- TTP over bursa and surrounding area - Local swelling - TTP medial joint line/ER tibia (pes anserine) - Decreased ROM - Increased temp
54
Bursitis Interventions/Treatment
- Activity modifications - Rest - Anti-inflammatories - stretch/strengthen - correct biomechanical faults - Corticosteroid injections
55
Patellar Tendinosis (Jumpers Knee) Common Symptoms
- Insidious onset, usually after running or jumping - Inferior patella pain - Pain subsides at rest, increases after activity
56
Patellar Tendinosis (Jumpers Knee) Exam Findings
- TTP patellar tendon/inferior pole of patella - Swelling inferior pole patella - pain with resisted knee extension - Q/HS tightness
57
Patellar Tendinosis (Jumpers Knee) Interventions/Treatment
- Acute vs. Chronic - Rest/activity modification - decre4ase inflammation - stretching - eccentric strength/overload - bracing
58
Osgood- Schlatter Disease / SLI Syndrome Common Symptoms
- 8-13 year olds in girls/10-15 y.o boys - pain during athletics, cycling, running, jumping, resisted knee extension
59
Osgood- Schlatter Disease / SLI Syndrome Exam findings
- 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
Osgood- Schlatter Disease / SLI Syndrome Intervention/ Treatment
- rest/activity modification - Decrease inflammation - Stretch Q, HS, ITB - Strengthen Q/HS - Self-limiting: continue activity as tolerated
61
Osteochondritis Dissecans Common Symptoms
- 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
Osteochondritis Dissecans Exam Findings
- Usually unilateral - quad weakness - Chronic joint effusion - May be associated with mal tracking - loose bodies - seen on radiographs / MRI/CT/bone scan
63
Osteochondritis Dissecans Interventions/ Treatment
- rest - activity limitation : possible NWB 3-6 months - decrease inflammation - restrict ROM - Surgery
64
Direct Patella Trauma Common Symptoms
MOI= direct blow to patella ( MVA/contact sports) - Diffuse anterior knee pain , some retropatellar pain with motion
65
Direct Patella Trauma Exam Findings
- direct crepitation - pain and dysfunction worsened by Q contraction, stiars, squatting
66
Direct Patella Trauma Intervention/treatment
- ROM to enhance articular cartilage healing - minimize PF forces - Swimming, cycling, low resistance - Q strength in pain free ROM
67
Complex regional Pain Syndrome Type 1 Type 2
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
Complex Regional Pain Syndrome Exam Findings
- Limb swollen - Painful ( hyperalgesia/allodynia, burning) - TTP - skin is shiny/mottled - hair and nail changes - Decreased ROM
69
Complex Regional Pain Syndrome Interventions
- avoid excessive pain - Holistic /team approach - Assess for compensatory movement strategies - TENS AAROM/AROM, stregthen - desensitization : vibration, textures, fluidotherapy
70
Knee Joint Fracture Distal Femur
- Most often due to trauma - important to consider proximity to popliteal artery and vein and tibial and common peroneal nerves
71
Knee Joint Fracture Proximal tibia
- most often due to trauma
72
Knee Joint Fracture Patella
- 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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