Unit 5 Case 1 Flashcards
What is Unit 5 case 1 about?
A 32-year-old gardener fell heavily while skiing in poor visibility, where she felt sudden severe pain in her knee and a ‘pop’. An x-ray and then an MRI scan was ordered revealing a torn anterior cruciate ligament (ACL), requiring ACL reconstructive surgery.
What does the ‘pop’ sound represent in this case?
The tearing the anterior cruciate ligament
What is the normal healing time for ligament injuries?
10-12 weeks
What is the normal healing time for muscle and why is there a difference?
2-4 weeks
-muscle is the fastest healing tissue as it has a more rich blood supply, providing it with the nutrients and oxygen it needs to heal
What are the different grades of ligament injury?
Grade 1- mild sprain, no swelling
Grade 2- small tear, significant swelling
Grade 3- complete tear, unstable, requires surgery to repair
For rehabilitation of ligament injuries, why is motion exercises good?
Promotes circulation, so more blood can get the damaged site. To provide it with the nutrients and oxygen it needs to heal faster
What is the main difference between a tendon and a ligament?
Tendons connect skeletal muscles to bones, allowing the movement of the bone
Ligaments are a fibrous connective tissue that connects bone to bone, serving to hold the structures together and keep them stable
What happens if a ligament does not repair/heal properly?
Ligaments can lose their ability to retain their original shape when stretched or elongated past a certain point for a prolonged period of time
-When this occurs the ligament becomes lax (loose) and cannot properly support the joint. Leading to instability, pain, and eventual osteoarthritis of the joint
What is knee instability?
Knee instability is the sensation of the knee twisting or moving from side to side when doing basic activities
What is the ACL?
The anterior cruciate ligament (ACL) is a band of dense connective tissue which courses from the femur to the tibia
What is the function of the ACL?
Provides stability in the knee joint. Provides approx 85% of the total restraining force of anterior translation. And prevents excessive tibial medial and lateral rotation.
What are the symptoms of an ACL injury?
- A loud ‘pop’ or ‘popping’ sensation in your knee
- Severe pain and inability to continue the activity
- Rapid swelling
- Loss of range of motion
- A feeling of instability or ‘giving way’ with weight-bearing
What happens if you leave a torn ACL untreated?
It leaves the knee very unstable, other structures in the knee try in vain to provide stability. This causes a stretch in those structures and increased instability and then associated cartilage tears. This can cause an increased rate of osteoarthritis.
What causes the pain in an ACL tear?
The ACL actually itself has no pain nerve endings so the torn ligament may not hurt. Pain often comes from injury to other structures in the knee that occurs when the ACL tears and the knee shifts
What causes the swelling in an ACL tear?
Swelling of the knee may be a sign of bleeding inside the knee joint. Or a build-up of excess fluid in or around the knee joint. Swelling that occurs suddenly is usually a sign of serious knee injury
What is knee effusion?
Knee effusion is the swelling of a knee due to accumulation of excess fluid in or around your knee joint.
-Effusion refers to the accumulation of fluid in an anatomical space
What age range is most likely to develop ACL tears?
Between the ages of 15 and 45, mostly due to the more active lifestyle and higher participation in sports
In what sports do most ACL injuries occur?
Sports that involve sudden stops or changes in direction, jumping, and landing. Such as football, basketball, downhill skiing.
What is the common mechanism of injury for a tear in the ACL?
Where an athlete suddenly turns to the opposite side of the planted knee and injuries it. As the athlete turns and pivots the ligaments tears. In basketball, it is usually a result of hyperextension and internal rotation of the tibia on the femur
What are the common tests for knee instability?
The anterior drawer test
The Lachman test
What is the anterior drawer test and how is it done?
A test used in the initial clinical assessment of a suspected rupture of cruciate ligaments in the knee.
- Patient lays in supine position and knees flexed to 45 degrees
- Grab the knee with the thumbs in front of the knee and the fingers behind the knee
- Pull the shin bone forward
- If it slides more on the injured knee than the healthy knee, this is a sign of an ACL injury
What is the Lachman’s test and how is it performed?
The Lachman’s test is a movement test to identify the integrity of the ACL
- Patient lays in the supine position with the injured knee in 20-30 degrees flexion
- Examiner places one hand behind the tibia and the other on the patient’s thigh (with the thumb on the tibial tuberosity)
- Pull the tibia anteriorly, and intact ACL prevents forward movement and has a ‘firm end feel’
- A torn ACL allows for anterior translation and has a ‘soft end feel’
What is arthroscopic surgery?
A type of minimally evasive keyhole surgery used on joints (commonly the knee, ankle, shoulder, elbow, wrists and hip).
-A procedure for diagnosing and treating joint problems
How is an arthroscopic surgery done?
An arthroscopic camera and light source (fibre optic cable) are used to see the joint.
A small incision is made to insert the instruments and then the surgeon guides them to complete the repair
