Week 11 - Knee Flashcards
History Knee Questions?
Can you still move or is it locked?
Weight bearing?
Delayed or immediate swelling?
Lock or catching?
Giving way?
Grind or grating?
How does it feel when going up or down stairs?
Recent changes to training?
Recent changes in footwear?
Observation for Knee?
SHARP
atrophy
Ecchymosis
Posture
- Genu dalgum or varum
- Hypertension and hyper flexion
- LLD
- Patella alta or baja?
- Patella weird rotation?
Gait
- walking
- run
- half squat
- up/ down stairs
- jumping
Q
Palpation for Knee?
Know anatomy
- find what hurts - what structure is it?
Bony landmarks
SHARP
Swelling?
- intra - vs extra capsular swelling
- Intracapsular swelling = effusion (synovial fluid or blood in joint –> do SWIPE test
Extracapsular swelling –> usually localized over injured area/ structure
- Lose contour of the patella/ shape of knee
- Can migrate to calf/ foot/ ankle
Special Tests for knee?
Active/ passive/ resisted
- first check joints above and below
Flex (130-140), extension (0), IR, ER,
Screw Home Mechanism –> As the knee extends, the tibia externally rotates b/c medial femoral condyle is larger than the lateral –> provides increased end-range stability (closed pack position)
Neuro tests
- Dermatomes and Myotomes
Stress Tests for Knee Instability
- end feel helps determine stability
-translation
Greater damage = increased laxity and translation
Patellar Fracture MOI?
MOI
- Direct trauma
- Indirect trauma (severe pull on tendon, semi-flexed position w/ forcible contraction)
Patellar Fracture S&S?
Hemorrhage
Joint Effusion
General swelling
Little bone separation w/ direct injury
Indirect fracture may lead to other capsular injuries
Patellar Fracture immediate treatment?
POLICE
splint if # suspected
Radiograph for confirmation
Immobilize for 2-3 months
- very hard to get mvm/ glide back
- Immobilized in full extension
- Takes longer than normal #
Patellar sublux/ dislocation MOI?
Deceleration w/ cutting in opposite direction (valgus force)
Quad pulls patella out of alignment
Repeated sublet imposes stress to medial mscs
Women are more common b/c Q angle
Some individuals are predisposed
Patellar sublux/ dislocation S&S?
Sublux = pain, swell, restricted ROM, tenderness
Patellar sublux/ dislocation Tx?
Sublux = POLICE
Dislocation
Immobilize
POLICE
reduction w/ hip flexion and slow knee extension
Immobilize for 4 weeks
Patellar sublux/ dislocation prevention?
Correct med-lat msc imbalances
Strengthen hip mscs
Patellar brace
Correct biomechanics risk factors
possible surgery to release tight structures.
MCL Sprain MOI?
Severe blow from lat side (Valgus)
S&S + Tx of G1 MCL Sprain?
SSx:
* Stable valgus test
* Little/no joint effusion
* Some joint stiffness
* Point tenderness on medial aspect
* Normal ROM
* Immediate Tx:
* POLICE for at least 24 hours
* Crutches if necessary
* Functional recovery 2-14 days
S&S + Tx of G3 MCL Sprain?
Complete loss of medial stability
* Minimum to moderate swelling
* Immediate pain followed by ache
* Decreased ROM due to effusion and
hamstring guarding
* Positive valgus stress test
* Immediate Tx:
* POLICE, crutches to decrease WB
* Possible surgery
* Progressive WB over 2 weeks, hinged brace
for additional 2-3 weeks
* Functional recovery 1-3 months (can be up to
6 months)
S&S + Tx of G2 MCL Sprain?
No gross instability; laxity at 5-15 degrees
of flexion
* Slight swelling
* Joint tightness, decreased knee extension
ROM
* Pain along medial knee
* General weakness
* Immediate Tx:
* POLICE, crutches if painful weight-
bearing
* Functional recovery 2 weeks-2 months
* Hinged brace for RTP
LCL Sprain MOI?
Varus force, commonly with tibia internal
rotation
* Can be Grade I – III
* Possible damage also to the cruciate
ligaments, iliotibial band, and meniscus,
producing bony fragments
S&S + Tx for G1 LCL Sprain
Can be Grade I – III
* Possible damage also to the cruciate
ligaments, iliotibial band, and meniscus,
producing bony fragments
* SSx:
* Pain, swelling, effusion around LCL
* Joint laxity with varus testing
* According to grade (see MCL SSx)
* Possible peroneal/fibular nerve irritation
* Immediate Tx:
* Follows management of MCL injuries
(depending on severity)
S&S + Tx for G2 LCL Sprain
Can be Grade I – III
* Possible damage also to the cruciate
ligaments, iliotibial band, and meniscus,
producing bony fragments
* SSx:
* Pain, swelling, effusion around LCL
* Joint laxity with varus testing
* According to grade (see MCL SSx)
* Possible peroneal/fibular nerve irritation
* Immediate Tx:
* Follows management of MCL injuries
(depending on severity)
S&S + Tx for G3 LCL Sprain
Can be Grade I – III
* Possible damage also to the cruciate
ligaments, iliotibial band, and meniscus,
producing bony fragments
* SSx:
* Pain, swelling, effusion around LCL
* Joint laxity with varus testing
* According to grade (see MCL SSx)
* Possible peroneal/fibular nerve irritation
* Immediate Tx:
* Follows management of MCL injuries
(depending on severity)
Prevention of Collateral Sprains?
Proper strengthening and flexibility of the
lateral and medial knee musculature
* Neuromuscular/proprioceptive training
* Protective braces post-injury
Peroneal/ Fibular N. Contusion - MOI, S&S, Tx?
MOI:
* Direct blow causing compression
of peroneal/fibular nerve
SSx:
* Local pain and possible shooting
nerve pain
* Numbness and paresthesia in
distribution of nerve
* Positive Tinel’s test
* If chronic, could result in drop foot (cant actively dorsiflex - need custom orthodic)
Immediate Tx:
* POLICE and RTP once symptoms
resolve and full strength
* Padding for fibular head for a few
weeks
Patellar Tendonitis MOI + S&S?
MOI
- Run, jump, kick
S&S
- Pain (after), Pain in active and passive flex, and active extension
- Possible crepitus
3 Phases
Patellar Tendonitis Tx?
Load management
- stop plyometric exercises
Patellar tendon bracing
Transverse friction massage
Functional recover in 1-3 weeks for phase 1/2
Patellar Tendonitis Prevention?
Stretch and strengthen quads (especially eccentric)
Appropriate training progression
Osgood-Slatters Disease MOI + S&S?
MOI
- Apophysitis at tib tubercle
- Bony callus can result
- Resolves w/ age (18-20 years)
S&S
- swelling/ hemmorrhage
- Pain
- Tenderness
Enlarged tib tubercle
Osgood-Slatters Disease Tx?
Osgood-Slatters Disease Prevention?
Bursitis MOI?
Acute, chronic, or recurrent swelling
of bursa
Commonly:
* Prepatellar – continued kneeling
* Infrapatellar – overuse of patellar
tendon
* Pes anserine– overuse of medial
knee structures
Knee Bursitis S&S, Tx, Prevention?
SSx:
* Extracapsular swelling, pain over
location of involved bursa, heat,
redness
Immediate Tx:
* POLICE
* Load management
* Reduce activity intensity
* Proper padding, if applicable
Prevention:
* Proper padding, if applicable
* Stretching tight structures
* Correcting biomechanical risk
factors
IT Band Syndrome MOI + S&S?
Repetetive rubbing of ITB on lateral femoral condyle and irritation at ITB insertion
- malalignment, genu varum or pronated feet
- msc imbalances
IT band Tx & Prevention?
Chondramalacia Patella MOI + S&S?
MOI
- articular cartilage on pack of patella begins to breakdown
- abnormal patellar tracking (genu valgum, foot pronation, shallow femoral groove, increased Q angle, laxity of quad tendon
- Often starts as PF stress syndrome
S&S
- pain w/ walk, run, stairs, squat
Recurrent swelling
Crepitus w/ flexion
Chondramalacia Patella Tx & Prevention?
Osteochondritis Dessicans MOI?
MOI:
* Lack of blood flow to femur and
posterior patella
* Separation of articular cartilage and
subchondral bone at patellofemoral
joint
* Cause is unknown, but may include:
* Blunt trauma
* Possible skeletal or endocrine
abnormalities
* Prominent tibial spine impinging on
medial femoral condyle
* Impingement due to patellar facet
* Most common in adolescent athletes
Can also be in elbow
Piece of cartilage breaks off
Osteochondritis Dessicans S&S and Prevention?
SSx:
* Aching pain with recurrent swelling
and possible locking
* Possible quadriceps atrophy
* Possible point tenderness on affected
femoral condyle in knee flexion
- Kind of feels like a meniscal lesion
- Recurring deep pain
- Can become a total loose body - needs to be removed
Immediate Tx:
* Possible surgery if loose body in joint
is causing symptoms
* Rest and crutches for children
* Surgery may be necessary in adults
* Drilling to stimulate healing (micro # to increase blood flow for healing)
* Pinning
* Bone grafts
- More likely to get surgery for younger people (more common or them) –> less likely to get surgery or recover as well for older people
Knee Rehab Considerations?
Strength
- eccentric msc action
- Start w/ closed kinetic chain exercises post-op (especially for ACL) - Foot is in contact with something (squat, leg press) -> Open = knee extensions
neuromsc Control
- loss of control/ proprioception results in pain/ swelling
- needs to be regained or else risk of reinsure is high
Bracing
- Get specific brace for injjury
- usually worn for 3-6 weeks post surgery (some use for first year of activity)
- Limit ranges for period of time
Considerations for ACL injury?
Compensation for non-injured limb
- Dont assume that bilateral strength exercises are sufficient to strengthen injured knee
-
ACL Prevention?
Exercise programs
- strength, neuromsc control, balance
- Target the hip - baseline hip strength ( ER & Abd) = reduced injury
- Landing strategies/ biomechanics, balance boards, single leg performance, core strength, multi-direction mvms.
Shoe type
- Cleats increase injury - shorter clear is better
