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KNPE331 > Week 6 > Flashcards

Week 6 Flashcards

1
Q

Anatomy of the knee joint

A
  • tibiofemoral joint
  • patellofemoral joint
  • superior tibiofibular joint
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2
Q

Compartments of the lower leg

A
  • lateral
  • anterior
  • posterior
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3
Q

Lateral compartment of the leg

A
  • peroneal group
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4
Q

Anterior compartment of the leg

A
  • extensor group
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5
Q

Posterior compartment of the leg

A
  • flexor group
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6
Q

What muscles make up anterior compartment of the leg?

A
  • tib anterior
  • extensor hallucis longus
  • extensor digitorum longus
  • fibularis tertius
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7
Q

Anatomy of the lower leg lateral compartment

A
  • peroneus (fibularis) longus
  • peroneus (fibularis) brevis
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8
Q

What muscles make up the deep posterior compartment of the lower leg- “deep plantarflexors”

A

Tom, Dick and Harry
- tib posterior
- flexor digitorum longus
- flexor hallucis longus

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9
Q

Role of the deep plantarflexors

A
  • dynamically help stabilize medial ankle
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10
Q

Superficial posterior compartment of the lower leg

A
  • gastrocnemius
  • soleus
  • achilles tendon
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11
Q

Intracapsular structures of the knee

A
  • anterior cruciate ligament
  • posterior cruciate ligament
  • lateral and medial meniscus
  • cartilage
  • joint surface
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12
Q

Why is it important to know which structres are intracapsular vs extracapsular?

A
  • inflammation caught under joint capsule
  • can help identify which structures are intracapsular
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13
Q

Special test for intracapsular swelling

A
  • wipe/swipe/sweep/brush test
  • swipe up on medial side of knee and then down on lateral side
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14
Q

How do you know if the wipe test is positive?

A
  • if fluid moving towards knee is visible
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15
Q

Medial meniscus

A
  • c shaped
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16
Q

Lateral meniscus

A
  • o shaped
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17
Q

What are the muscles of the quadriceps?

A
  • rectus femoris
  • vastus lateralis
  • vastus intermedius
  • vastus medialis
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18
Q

Functional anatomy and biomechanics of quads

A
  • 3 pull laterally
  • 1 pulls medially
  • natural imbalance
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19
Q
A
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20
Q

Which quad muscles have a lateral pull on the patella?

A
  • rectus fem
  • vastus lateralis
  • vastus intermedius
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21
Q

Which quad muscles have a medial pull on the patella?

A
  • vastus medialis
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22
Q

Medial hamstrings

A
  • semimembranosus
  • semiteninosus
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23
Q

Lateral hamstrings

A
  • biceps femoris
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24
Q

Pes anserine group function

A
  • dynamic stability to medial aspect of knee
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25
Q

Muscles of pes anserine group

A
  • semitendonosis
  • gracilis
  • sartorius
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26
Q

Functional anatomy and biomechanics of glute medius

A
  • hip abduction
  • prevents pelvis on stance side from dropping during gait
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27
Q

Action of anterior fibres of gluteus medius

A
  • internally rotate
  • assist with hip flexion
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28
Q

Action of posterior fibres of gluteus medius

A
  • extension
  • external rotation
  • eccentrically controls internal rotation of femur in weight bearing
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29
Q

Trendelenburg gait

A
  • sign of a weak glute medius
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30
Q

Quads:hams ideal ratio

A

3:2

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31
Q

Quads:hams ration post ACL injury

A

1:1

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32
Q

Medial tibial stress syndrome (MTSS)

A
  • shin splints
  • exercise induced pain over the anterior tibia and is early stress injury in the continuum of tibial stress fractures
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33
Q

Compartment syndrome

A
  • excessive pressure within a muscle/fascial compartment
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34
Q

Acute compartment syndrome

A
  • trauma following a long bone fracture (ex. tibia- most common, distal radius)
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35
Q

Overuse compartment syndrome

A
  • often overlooked as shin splints
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36
Q

SIgns and symptoms of compartment syndrome

A
  • red
  • hot
  • shiny
  • very painful
  • numb
  • weak
  • faint pulse distal to site
  • pale skin over damaged tissue
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37
Q

Acute management of compartment syndrome

A
  • no pressure
  • reduce inflam
  • no RTP
  • NWB
  • refer to sport med dr.
  • fasciotomy to release pressure
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38
Q

Where is compartment syndrome most common?

A
  • anterior compartment
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39
Q

Gastroc/soleus strains

A
  • overstretch in dorsiflexion with knee extension (gastrocs) especially with forceful contraction
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40
Q

Signs and symptoms of gastroc/soleus sprain

A
  • pop or pull
  • sharp pain
  • swelling
  • bruising
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41
Q

Special tests for gastroc/soleus sprain

A
  • muscle test for gastrocs, soleus, deep flexors
  • thompson test to rule out achilles rupture
  • toe raises
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42
Q

Acute management of gastroc/soleus strains

A
  • PIER (pressure, ice, elevation, rest)
  • pressure pad with wrap
  • NWB
  • avoid stretch or contraction
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43
Q

RTP post gastroc/soleus strain?

A
  • no, usually self limiting
  • once rehabbed can tape with heel lift for initial RTP
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44
Q

Achilles rupture MOI

A
  • sudden forceful contraction
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45
Q

In which sports in an achilles rupture common?

A
  • basketball
  • tennis
  • squash
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46
Q

Signs and symptoms of achilles rupture

A
  • sudden sharp pain
  • feeling of being kicked in back of leg
  • unable to plantarflex
  • swelling
  • delayed onset bruising
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47
Q

Special tests for achilles rupture

A
  • thompson test
  • two foot–> 1 ft toe raise
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48
Q

Acute management of achilles rupture

A
  • PIER
  • NWB
  • pressure pad with tensor
  • educate
  • refer for consult with sports med dr.
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49
Q

Patellofemoral pain syndrome (PFPS) MOI

A
  • poor tracking of patella in femoral condyle
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50
Q

Signs and symptoms of PFPS

A
  • tenderness on palpation of posterior aspect of patella
51
Q

What to check for when looking for PFPS?

A
  • mechanics from bottom up and top down
  • stable base
  • quad imbalance (med vs lat pull? static quad contraction)
  • 1 leg squat (does femur collapse into IR?)
52
Q

Sign that someone has PFPS when they perform a static quad contraction

A
  • patella moves laterally
53
Q

What type of injury is PFPS usually?

A
  • most often overuse
  • occasional acute onset
54
Q

Patellar dislocation MOI

A
  • valgus force with foot planted, causing IR of femur
55
Q

Who is a patellar most common in?

A
  • active children ages 10-17
56
Q

Signs and symptoms of patellar dislocation

A
  • patella positioned on lat side of knee
  • significant pain, usually in knee flexion
57
Q

Patellar dislocation vs subluxation

A
  • dislocation: goes out and stays out
  • subluxation: goes out and comes back in
58
Q

Special tests for patellar dislocation

A
  • non if dislocated
  • subluxed= apprehension test
59
Q

What needs to be ruled out if someone has a first time patellar dislocation?

A
  • osteochondral fracture
60
Q

Osteochondral fracture

A
  • can affect patella or femoral condyle
  • occurs in 25-75% of cases and requires surgical intervention
61
Q

Acute management of patellar dislocation

A
  • r/o fracture
  • PIER if reduced
  • refer
  • braced in full extension for 3 wks
  • ROM and VMO (vastus medialis oblique) strengthening
62
Q

Patellar tendonitis MOI

A
  • excessive traction on patellar tendon
63
Q

Signs and symptoms of patellar tendonitis

A
  • pain
  • swelling
  • heat
  • pain with jumping, running, quick COD, strong quad contraction
  • pain with flexion and extension
  • can often train through the pain
64
Q

Special tests for patellar tendonitis

A
  • thomas test
  • resisted quads
65
Q

Acute management for patellar tendonitis

A
  • PIER
  • roll/soft tissue mobility for quads
  • lower extremity mechanics
66
Q

Tendinopathy rehab for patellar tendonitis

A
  • eccentrics
  • x-training
67
Q

RTP for patellar tendonitis

A
  • patellar tendonitis tape job
68
Q

Bursas

A
  • fluid filled sacs
  • lay flat btwn areas of friction
69
Q

Knee bursitis MOI

A
  • direct trauma
  • friction from tight muscles/tendons
70
Q

Signs and symptoms of knee bursitis

A
  • rebound pain
  • often painless
  • visible fluid filled sac
71
Q

Acute management of knee bursitis

A
  • protect with padding to avoid repeat insult
  • soft tissue mobility of tight muscles
72
Q

What can chronic bursitis develop?

A
  • granular rice-like texture
73
Q

Fractures of knee and lower leg

A
  • stress fractures
  • patellar fracture
  • tibial plateau fracture
74
Q

Stress fracture of lower leg

A
  • medial tibial stress syndrome/shin splints
75
Q

Medial tibial stress syndrome/shin splints MOI

A
  • overuse/poor mechanics
76
Q

Patellar fracture MOI

A
  • direct blow
  • patellar dislocation
77
Q

Tibial plateau fracture MOI

A
  • varus or valgus load
  • direct blow
78
Q

Function of the meniscus

A
  • cushion joint during loading
  • poor blood supply (low ability to heal)
79
Q

Types of meniscus tears

A
  • vertical
  • transverse
  • peripheral
  • bucket-handle
  • parrot break
  • flap
80
Q

Meniscus tears MOI

A
  • plant and twist
  • contact
  • wear and tear/degeneration
81
Q

Signs and symptoms of meniscus tears

A
  • sharp pain at specific ROM, loaded rotation and deep squat
  • catching/clicking/locking
  • swelling
82
Q

What are meniscus tears often associated with?

A
  • ACL injuries
83
Q

Special tests for menisicus tears

A
  • mcmurray’s
  • apley’s
  • duck wall
84
Q

Acute management of meniscus tears

A
  • PIER
  • NWB
  • educate
85
Q

What is another condition that might present the same as a meniscus tear?

A
  • plica
  • develops at birth
86
Q

RTP post meniscus tear?

A
  • no, need rehab
87
Q

Is bracing effective for a meniscus tear?

A
  • wont prevent another injury
  • can be effective to draw awareness to injury
88
Q

When should athlete be referred when they have a meniscus tear?

A
  • if there is locking
89
Q

Which meniscus tear types get in the way of ROM?

A
  • bucket-handle
  • flap
90
Q

Ligament sprains of the knee

A
  • MCL
  • LCL
  • ACL
  • PCL
91
Q

Where does the ACL run?

A
  • anterior to medial aspect of intercondylar area of tibial plateau
  • passes up and back to posterior-medial aspect of lateral femoral condyle
92
Q

Two bundles of the ACL

A
  • posterolateral
  • anteromedial
93
Q

Posterolateral bundle of ACL

A
  • taught in extension with <30 degree rotation
94
Q

Anteromedial bundle of ACL

A
  • taught going into flexion and with rotation
95
Q

Function of the ACL

A
  • prevents anterior translation of tibia on femur
  • limits IR if tibia
  • major stabilizer of knee
  • major proprioceptors
96
Q

ACL MOI

A
  • sudden cut or pivot (rotational force)
  • added external force from a tackle/collision (valgus, hyperextension)
97
Q

Signs and symptoms of ACL

A
  • swelling
  • extreme pain
  • difficulty/unable to WB
  • delayed onset bruising
98
Q

Incidence of ACL

A
  • higher in females bc females have a larger Q angle (quad angle)
  • 30% from direct contact
  • 70% from wrong movement
99
Q

Special tests for ACL

A
  • anterior drawer
  • lachman’s
  • pivot shift
100
Q

Acute management of ACL

A
  • PIER
  • NWB
  • educate
101
Q

Types of ACL surgery

A
  • autograft (person’s tissues) vs allograft (cadaver)
  • bone-tendon-bone graft
  • hamstring graft
  • unilateral vs contralateral
  • BEAR
102
Q

BEAR

A
  • bridge enhanced ACL repair
  • new technique
103
Q

RTP post ACL?

104
Q

Where does thew PCL run?

A
  • from anterior-lateral aspect of medial femoral condyle within the notch
  • inserts along posterior aspect of tibial plateau
105
Q

PCL MOI

A
  • hyperflexion
  • forced post translation of tibia on femur
106
Q

Signs and symptoms of PCL

A
  • swelling
    -extreme pain
  • difficulty/unable to WB
  • delayed onset bruising
107
Q

Special tests for PCL

A
  • posterior drawer
  • sag sign
108
Q

Acute management of PCL

A
  • PIER
  • NWB
  • educate
109
Q

Fibres of MCL

A
  • superficial and deep
110
Q

What injury is MCL injury associated with?

111
Q

MOI of MCL

A
  • valgus stress on knee (direct blow on outside of knee)
  • plant and twist (lat rotation of femur on tibia)
112
Q

Special test for MCL

A
  • valgus stress
113
Q

Acute management of MCL

A
  • PIER
  • NWB
  • pressure pad to approx ends
114
Q

LCL MOI

A
  • varus stress to knee
115
Q

Signs and symptoms of LCL

A
  • lateral knee pain and swelling
  • tenderness on palpation of LCL
  • stiffness
116
Q

Special test for LCL

A
  • varus stress
117
Q

Acute management of LCL

A
  • PIER
  • NWB
  • pressure pad to approx ends
118
Q

Which ligaments are more commonly repaired?

A
  • ACL not collateral ligaments
119
Q

Knee special tests summary

A
  • wipe test–> intracapsular swelling
  • valgus at 0 degrees (superficial fibres) and 30 degrees (deep fibres)–> MCL
  • varus at 0 degrees–> LCL
  • Lauchman’s-> ACL
  • anterior drawer–> ACL
  • posterior drawer–> PCL
  • mcmurray’s–> meniscus
  • apley’s–> meniscus and ligamentous
120
Q

Indications of resisted muscle testing of tibialis posterior

A
  • medial ankle sprain mechanism
  • posterior shin splints
121
Q

Indications of resisted muscle testing of tibialis anterior

A
  • anterior shin splints
  • excessive PF mechanism
122
Q

Indications of resisted muscle testing peroneals

A
  • suspected peroneal strain or tendonitis
123
Q

What does a positive thompson test look like?

A
  • no plantarflexion = complete achilles rupture
124
Q

What does a negative thompson test look like?

A
  • plantarflexion occurs
  • then do double heel raise in weightbearing
  • then single heel raise

KNPE331 (8 decks)

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