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MSK 2 > Week 6 > Flashcards

Week 6 Flashcards

1
Q

What are the joints that the knee is composed of?

A
  • Tibiofemoral
  • Patellofemoral
  • Superior tibiofibular
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2
Q

__ is an extracapsular joint

A

Superior tibiofibular is an extracapsular joint

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3
Q

What kind of joint is the knee considered to be?

A

• Double condyloid

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4
Q

What does the double condyloid joint of the knee do?

A

Prevents motion in frontal plane

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5
Q

How many degrees of freedom does the knee have? and in what planes does it move?

A
  • 2 degrees of freedom
  • Flex/Ext in sagittal plane
  • Med/Lat rotation in transverse plane
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6
Q

What are the characteristics of the tibiofemoral joint as a femoral articular surface joint?

A
  • Large AP convexity
  • Small curvature posterior
  • Medial condyle
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7
Q

What are the characteristics of the medial condyle?

A
  • Longer than lateral

* Extends further distally for angled femur

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8
Q

Both the medial and lateral tibial plateau are __ and slope ____

A

Both the medial and lateral tibial plateau are concave and slope posteroinferiorly

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9
Q

The articular cartilage of the ____ tibial plateau is 3x thicker than the ___

A

The articular cartilage of the medial tibial plateau is 3x thicker than the lateral

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10
Q

___ plateau is more circular than the ____

A

Lateral plateau is more circular than the medial

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11
Q

Any incongruency between the femur and he tibia, is accommodated for by the ____

A

Any incongruency between the femur and he tibia, is accommodated for by the menisci

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12
Q

What are the functions of the menisci?

A
  • Increase stability by deepening tibial plateau
  • Decreases friction by 20%
  • Increases contact area by 70%
  • Enhances proprioception via mechanoreceptorsn
  • Attenuates forces
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13
Q

What are the characteristics of the medial meniscus?

A
  • C shaped
  • Firm attachment to deep layers of MCL
  • Thick posteriorly
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14
Q

What are the characteristics of the lateral meniscus?

A
  • O shaped
  • Loose attachment to lateral capsule
  • Uniform thickness
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15
Q

Both the medial and lateral meniscus are thicker on ___, and thinner along the ____

A

Both the medial and lateral meniscus are thicker on periphery, and thinner along the inner margin

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16
Q

Shock absorption capability reduced by 20% with complete ____

A

Shock absorption capability reduced by 20% with complete menisectomy

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17
Q

What vascularizes the meniscus?

A

In adults, vascularized by capillaries from joint capsule and synovial membranes

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18
Q

When does the meniscus cease to be well vascularized? And what happens after?

A

Recedes to periphery by age 11

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19
Q

What region of the meniscus is the most vascularized and can be healed on its own?

A

The lateral 1/3

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20
Q

What region of the meniscus is the least vascularized?

A

The middle 1/3

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21
Q

What do the ligaments of the knee control/resist?

A
  • Hyperextension
  • Varus/valgus
  • AP displacement of tibia on femur
  • Med/lat rotation of tibia on femur
  • Combination of AP & rotation motions
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22
Q

What movement does the MCL prevent?

A

Prevents abduction (valgus stress)

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23
Q

What movement does the LCL prevent?

A

Prevents adduction (varus stress)

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24
Q

Which ligament has deep and superficial layers and where does this ligament attach?

A
  • MCL.

- Attaches 7-10cm below joint line

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25
Q

What does the MCL assist with?

A

Assists in prevention of anterior tibial translation

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26
Q

Which ligament attaches to the joint capsule and the meniscus on its side?

A

MCL. LCL does not attach to the joint capsule or menisci

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27
Q

When are the anterior fibers of the MCL taut?

A

Anterior fibers taut in midrange

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28
Q

When are the posterior fibers of the MCL taut?

A

Posterior fibers taut in full flexion

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29
Q

What does the LCL assist with?

A

Assists with IR and ER restraint

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30
Q

What ligament has greater laxity and why?

A

LCL has greater laxity than the MCL, because it has no attachment to the capsule or menisci

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31
Q

When is the LCL tight?

A

Tight in knee extension

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32
Q

When is the LCL loose?

A

Loosens as knee flexes

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33
Q

Which ligament has a better healing potential?

A

Neither, they are both well vascularized and will heal well

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34
Q

What is the LCL shaped like?

A

Pencil-like band of tissue

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35
Q

From where to where does the ACL run?

A

Anterior aspect of tibial to posterior aspect of lateral femoral condyle

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36
Q

What are the 3 bundles of the ACL?

A
  • Anteromedial
  • Posterolateral
  • Intermediate
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37
Q

When is the anteromedial bundle of the ACL lax and taut?

A
  • Lax in extension

- Taut in flexion

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38
Q

What is the anteromedial bundle of the ACL responsible for?

A

Responsible for anterior- posterior control

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39
Q

When is the posterolateral bundle of the ACL lax and taut?

A
  • Lax in flexion

- Taut in extension

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40
Q

What does the posterolateral bundle of the ACL help control?

A

Rotatory stability

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41
Q

What is the function of the ACL?

A
  • Prevent anterior tibial translation

* Checks hyperextension

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42
Q

With assistance from the hamstrings, the ACL works with __ to stabilize against valgus

A

With assistance from the hamstrings, the ACL works with the MCL to stabilize against valgus

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43
Q

___ is one of the most strongest ligament in the body

A

PCL is one of the most strongest ligament in the body

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44
Q

What is the function of the PCL?

A

Prevents posterior translation of tibia on femur

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45
Q

PCL is the the primary restraint to ____ and minor restraint to ____

A

PCL is the the primary restraint to posterior displacement and minor restraint to varus/valgus

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46
Q

What is the tibiofemoral angle with genu valgum?

A

TF angle <165 deg

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47
Q

Genu valgum increases the ____ compressive forces of the knee

A

Genu valgum increases the lateral compressive forces of the knee

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48
Q

What is the tibiofemoral angle with genu varum?

A

• TF angle >180 deg

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49
Q

Genu varum increases the ____ compressive forces of the knee

A

Genu varum increases the medial compressive forces of the knee

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50
Q

What is the Q angle?

A

Angle formed by line drawn from ASIS to mid-patella, and line from mid-patella to tibial
tuberosity

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51
Q

What is the normal Q angle in males?

A

10-14 deg

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52
Q

What is the normal Q angle in females?

A

15-17 deg

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53
Q

What is the normal knee flexion ROM?

A

130-140 deg

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54
Q

What is the normal knee extension ROM?

A

5-10 deg.

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55
Q

True or false

Hyperextension of the knee is normal

A

True

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56
Q

What is genu recurvatum?

A

Excessive hyperextension. Beyond 10 deg

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57
Q

What happens to AROM of the ankle in a closed chain?

A
  • Decreased DF: decreased knee flexion

* Decreased PF: decreased knee extension

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58
Q

How much knee flexion is required for normal gait?

A

60- 70

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59
Q

How much knee flexion is required to get on and off the toilet?

A

75

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60
Q

How much knee flexion is required for stair climbing?

A

70- 80

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61
Q

How much knee flexion is required to sit and rise from a chair?

A

90

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62
Q

How much knee flexion is required to get in and out the bath?

A

90

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63
Q

How much knee flexion is required for advanced function?

A

115

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64
Q

ROM in internal and external rotation influenced by amount of ____

A

ROM in internal and external rotation influenced by amount of flexion

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65
Q

In what position is knee rotation restricted and what causes the restriction?

A

Full extension, rotation is restricted by interlocking of femoral and tibial condyles

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66
Q

What is the range of ER in 90 deg of flexion?

A

0- 45 deg

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67
Q

What is the range of IR in 90 deg of flexion?

A

0- 30 deg

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68
Q

Tibial on femoral extension is an example of what type of arthrokinematic motion?

A

Concave on convex, so they move in the same direction

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69
Q

Femoral on tibial extension is an example of what type of arthrokinematic motion?

A

Convex on concave, so they move in opposite direction

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70
Q

Where is the screw home mechanism of the knee?

A

During the last 5 deg of extension

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71
Q

What happens during the last 5 deg of knee extension?

A
  • Lateral femoral condyle shorter
  • Medial tibial condyle continues to move on femur (that’s why it is larger)
  • Lateral rotation of tibia on femur (IR of femur)
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72
Q

The screw home mechanism/ rotation is augmented by the ___ and ___

A
  • Tension on ACL

* Lateral pull of quadriceps

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73
Q

Flexion requires ___

A

Flexion requires unlocking

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74
Q

What does the femur do in CKC to unlocking required for knee flexion?

A

• Femur must laterally rotate on tibia (CKC)

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75
Q

What does the tibia do in OKC to unlocking required for knee flexion?

A

• Tibia must medially rotate (OKC)

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76
Q

What does the popliteus do in OKC to unlocking required for knee flexion?

A

• OKC: moves tibia medial (IR)

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77
Q

What does the popliteus do in CKC to unlocking required for knee flexion?

A

• CKC: moves femur lateral (ER)

78
Q

The patellofemoral joint is the articulation of the ___ and ____

A

The patellofemoral joint is the articulation of the patella and the femur

79
Q

What kind of bone is the patella?

A

Sesamoid

80
Q

The posterior surface of the patella is covered with ____

A

The posterior surface of the patella is covered with thick hyaline cartilage

81
Q

Where does the patella slide?

A

Patella slides within trochlear groove

82
Q

What is the structure of the medial facet of the patella?

A

Flat to slightly convex

83
Q

What is the structure of the lateral facet of the patella?

A

Longer than medial

84
Q

What is the structure of the odd facet of the patella?

A

Medial angle

85
Q

When do we have the 1st consistent patellofemoral contact?

A

Between 10-20o flexion

86
Q

By ___ deg of flexion all aspects of facets, with the exception of the ____ facet of the patella have made contact with the femur

A

By 90 deg of flexion all aspects of facets with the exception of the odd facet of the patella have made contact with the femur

87
Q

When does the odd facet make contact with the femur?

A

At 135 deg contact is on odd and lateral facets

88
Q

As the angle of knee flexion increases, so do ____ forces

A

As the angle of knee flexion increases, so do compressive forces

89
Q

Greatest patellofemoral compression force at ___

A

Greatest patellofemoral compression force at 90 deg flexion

90
Q

As Q-angle increases, so will ____, due to the pull of the quads

A

As Q-angle increases, so will lateral vector, due to the pull of the quads

91
Q

Fully contracted quad in full extension produces ___ patellofemoral contact force

A

Fully contracted quad in full extension produces little patellofemoral contact force

92
Q

Which facet bears the most force?

A

Medial facet will bear most force

93
Q

What are the transverse stabilizers of the patella?

A
  • Med/lat retinaculum
  • Vastus lateralis (VMO/VL)
  • Medial patellofemoral ligament
94
Q

What are the longitudinal stabilizers of the patella?

A
  • Quad tendon

* Patellar tendon

95
Q

What do the medial patellofemoral ligament of the patella do?

A

Prevents the patella from translating laterally

96
Q

What are the other structures that help the patella stabilize?

A
  • ITB

* Lateral wall of femoral groove

97
Q

What is the meniscus comprised of?

A

Comprised of wedge-shaped fibrocartilage

98
Q

Which meniscus is more mobile?

A

Lateral meniscus

99
Q

What do the menisci serve to do?

A

Distribute stresses or forces across the knee during weight bearing and provide appropriate shock absorption

100
Q

What is the typical mechanism of injury for the meniscus?

A

Twisting injury

101
Q

When is pain worse and when is it better with a meniscus injury?

A

Pain worse with movement, better with rest

102
Q

What is something that a patient with a meniscus injury might complain of?

A

May complain of “locking” sensation

103
Q

What type of tear do patients typically have when they complain of a locking sensation with a meniscal injury

A

Bucket- handle tear

104
Q

What are hallmark signs of a meniscus pathophysiology?

A
  • Joint line tenderness

- Acute effusion (within 2 hours)

105
Q

In what population do we see an acute sudden onset of a meniscus pathophysiology?

A

Younger than 40 years old

106
Q

In what population do we see a chronic non specific mode of injury(MOI) of a meniscus pathophysiology?

A

Older than 50

107
Q

What are the characteristics for a good prognosis of healing of a meniscal pathophysiology?

A
  • Age <35
  • Peripheral damage
  • Longitudinal tear
  • Short tear
  • Acute injury (bloody effusion)
  • Stable knee
108
Q

What are the characteristics for a poor prognosis of healing of a meniscal pathophysiology?

A
  • Older patient
  • Central damage
  • Complete tear
  • Bucket handle tear
  • Chronic injury
  • Unstable knee
109
Q

What are the hallmark signs to be looking for in the objective exam as it relates to a meniscal examination?

A
  • Joint line tenderness: good sensitivity
  • Effusion: mild-moderate over 1-2 days
  • Positive entrapment test: McMurray’s, Apley’s, Squat
  • Quad inhibition: atrophy over first week or two following injury
110
Q

What are the surgical management options for a meniscus pathophysiology?

A
  • Debridement/menisectomy
  • Repair
  • Transplant
111
Q

What are the indications for a meniscus repair?

A
  • Traumatic lesion within vascular zone
  • Intact peripheral circumferential fiber
  • Minimal damage to meniscal body
  • Longer than 8mm
112
Q

Is there a significant difference between surgery then PT or just PT for meniscal injuries?

A

No there isn’t

113
Q

What are the principles for meniscus rehab?

A 
• Understand	surgical	procedure	well		
     • Repair	vs.	debridement	
     • Semimembranosus insertion	on	 
        medial meniscus, so no hamstring therex
     • WB	precautions	
     • Timeline	of	repair	
• Control	effusion	
• Do	NOT push ROM	
• Restore	normal gait	
• Restore	strength and	proprioception
114
Q

What are the main zones in articular cartilage?

A
  • Zone 1: Tangental zone
  • Zone 2: Transitional zone
  • Zone 3: Radial zone
  • Zone 4: Calcified cartilage
115
Q

What type of cartilage is articular cartilage?

A

Hyaline cartilage

116
Q

What is the job of articular cartilage?

A

To reduce the friction at the end of 2 long bones and can be a shock absorber

117
Q

What are the characteristics of a traumatic articular cartilage pathophysiology?

A
  • Often associated with concomitant ligament damage

* Often missed acutely

118
Q

What are the characteristics of a non traumatic articular cartilage pathophysiology?

A
  • Repetitive microtrauma
  • Many lesions are non-progressive and remain asymptomatic
  • Grade I and II lesions are typically asymptomatic
119
Q

What are the things to do or look for during an articular cartilage examination?

A
  • Thorough history
  • Thorough palpation (tenderness or bony)
  • Malalignments
  • Painful crepitus (knee making noise)
  • Mechanical symptoms
  • Quad atrophy
  • Sensitivity to weather changes
  • Pain and effusion after use
  • Deep, dull ache
120
Q

What are the mechanical symptoms we’re looking for in an articular cartilage examination?

A

Cracking, knocking, grinding

121
Q

What are the things to asses in the quad during an articular cartilage examination?

A
  • Quad girth
  • Quad tone
  • Ability to recruit the quads
122
Q

What are the surgical management options for an articular cartilage pathophysiology in order of most conservative?

A
  • Debridement and lavage
  • Microfracture
  • Autologous Chondrocyte Implantation
  • Osteochondral Grafting (OATS)
123
Q

What is a debridement and lavage and what kind of relief symptoms does it have?

A
  • Remove particles of cartilage and inflammatory cells

- Short term pain relief of symptoms

124
Q

Why don’t we see a debridement and lavage anymore?

A
  • Probably does not improve pain or ability to function compared to placebo (sham surgery)
  • Probably leads to little or no difference in pain or ability to function compared to lavage
  • May improve pain compared to washout
  • May not lead to any difference in pain or ability to function compared to closed needle joint lavage
125
Q

What are the characteristics of a microfracture of the articular cartilage?

A
  • Pick holes through tidemark
  • Encourage blood flow
  • Replaced with fibrocartilage
  • WB has to be controlled
  • Long-term data
126
Q

In what population might a microfracture be more indicated and why?

A

In the less active population, because there is alot of NWB with this procedure

127
Q

What does the surgeon do during an Autologous Chondrocyte Implantation (ACI)?

A
  • Small biopsy of autologous articular cartilage is harvested
  • Cartilage is enzymatically digested in lab to release chondrocytes
  • Chondrocytes cultured, and implanted at second surgery
  • Periosteal flap placed as patch
128
Q

What does the surgeon do during an Osteochondral Grafting (OATS)?

A
  • Remove plug from NWB surface

“Press-fit” plugs implanted into lesion

129
Q

What are the factors to help decide the surgical intervention for an articular cartilage pathophysiology?

A
  • The size of the tear

- Patient’s activity level

130
Q

What are the basic rehab principles for articular cartilage lesions?

A
  • Fully understand the surgical procedure
  • Control WB status
  • PROM is key
  • Slow and progressive rehab
  • Rarely return to sports: emphasis on ADL’s without pain
  • Constant communication with MD
131
Q

What is osteoarthritis OA?

A

The degeneration of cartilage and underlying bone

132
Q

Knee OA causes significant limitations in…?

A

Significant limitations in ambulation, stairclimbing, getting up from a chair, carrying groceries, heavy household chores

133
Q

What does articular cartilage function to do?

A

Functions to bear and distribute compressive loads and to reduce friction between joint surfaces

134
Q

What are the types of tissue that the knee joint depend on to function properly?

A
  • Cartilage
  • Bone
  • Capsule and ligaments
  • Muscle and tendon
135
Q

What are the changes that can occur in the structure of a subchondral bone?

A
  • Sclerosis (hardening)

* Cyst formation

136
Q

What does sclerosis do to the bone?

A

A hardening that decreases the ability to withstand repetitive compressive forces

137
Q

What are the types of changes in bone structure that may occur?

A
  • Subchondral bone
  • Osteophyte formation
  • Bone marrow lesions
  • Osteonecrosis and bone attrition
  • Joint deformity
138
Q

What are the generic risk factors for OA?

A
  • Genetics
  • Bone mineral density
  • Occupation
  • Physical activity
139
Q

What are the characteristics of bone mineral density (BMD) as a generic OA risk factor?

A
  • Higher BMD resulted in 2.3x greater incidence of knee OA
  • Higher BMD was not associated with progression of OA in those who already had OA
  • Bony attrition associated with the progression of OA might explain this finding
140
Q

What kind of occupation is a generic OA risk factor?

A

Occupations requiring lots of squatting, kneeling combined with heavy lifting

141
Q

What are the risk factors for knee OA?

A
  • Increased risk with increased age
  • 70/30 Female/Male
  • Obesity
  • Associated with increased incidence of Knee OA
  • Associated with greater progression if you already have knee OA
  • Knee OA + Obesity yields greater disability than Knee OA without obesity
142
Q

What are the characteristics of pervious knee injury as a risk factor for knee OA?

A
  • ACL and/or meniscus injury significantly increases the risk of incident knee OA
  • Surgical management does not prevent the incidence of knee OA at this time
143
Q

Genu varum leads to increased ____ compartment OA

A

Genu varum leads to increased medial compartment OA

144
Q

Genu valgum leads to increased ____ compartment OA

A

Genu valgum leads to increased lateral compartment OA

145
Q

True or false

People with a leg length discrepancy are 2x more likely to have knee OA

A

True

146
Q

True or False

Leg length discrepancy is associated with the incidence of knee OA

A

False

147
Q

What are the typical radiographic signs of knee OA?

A
  • Osteophyte forma:on
  • Joint space narrowing
  • Sclerotic (hardening) changes in the subchondral bone
148
Q

What is a grade 0 in the radiographic grading criteria for knee OA?

A

No radiographic findings of OA

149
Q

What is a grade 1 in the radiographic grading criteria for knee OA?

A

Minute osteophytes of doubtful clinical significance

150
Q

What is a grade 2 in the radiographic grading criteria for knee OA?

A

Definite osteophytes with unimpaired joint space

151
Q

What is a grade 3 in the radiographic grading criteria for knee OA?

A

Definite osteophytes with moderate joint space narrowing

152
Q

What is a grade 4 in the radiographic grading criteria for knee OA?

A

Definite osteophytes with severe joint space narrowing and subchondral sclerosis

153
Q

What are the limitations of radiographic exams?

A

• Can have normal radiographic even though there are early signs of cartilage degeneration
• MRI can pick up early cartilage loss better than radiographs
• Standard MRI may appear normal even though there are degenerative changes within the cartilage
• Specialized enhanced MRI procedures (e.g., gadolinium) are becoming more common to recognize early changes in
cartilage

154
Q

What are the clinical and radiographic classification of knee OA?

A
  • Knee pain and at least 1 of the following 3:
    • Age > 50
    • Morning stiffness < 30 minutes
    • Crepitus + Osteophytes

• 91% Sensitivity, 86% Specificity

155
Q

What are the clinical classification of knee OA?

A
  • Knee pain plus 3 of the following 6:
    • Age > 50
    • Morning stiffness < 30 minutes
    • Crepitus
    • Tenderness
    • Bony Enlargement
    • No palpable warmth

95% Sensitivity, 69% Specificity

156
Q

What are the sources of pain in knee OA?

A
  • Synovium
  • Bone
  • Nerves
157
Q

Why isn’t the cartilage a source of pain in knee OA?

A

It is not innervated

158
Q

How can the synovium cause pain?

A

Synovitis from inflammatory cell infiltration, cartilage and bone debris

159
Q

What may trigger synovitis?

A

Infrapatellar fat pad irritation may trigger synovitis

160
Q

How may bone be a cause of pain in a knee OA?

A 
• Sub-chondral bone	
     • Thinning	of cartilage	
     • Vascular congestion	
           - Intraosseus pressure	
           -  Bone	angina	
           - Bone	attrition	
• Periostitis from osteophyte formation	
• Bone marrow lesions
161
Q

How may nerves be a cause of pain in a knee OA?

A

• Damage to joint tissues may also result in
alterations of nerve structure in tissues
• May result in neuropathic pain source
• Nerves become hypersensitive

162
Q

Is there a direct connection for severity of knee OA and pain?

A

Not in all patients

163
Q

What are the potential modifiable pre-treatment factors influencing the outcome of knee OA?

A
  • Obesity
  • Joint Mobility
  • Lower Limb Alignment
  • Knee Instability
  • Psycho-Social Factors
164
Q

How is obesity a risk factor for knee OA?

A
  • Increased probability of development and/or progression of knee OA.
  • Obese individuals with knee OA have greater disability than those with knee OA who are not obese.
165
Q

How is limited knee motion associated with lower functional scores?

A
  • Reduced flexion/extension excursion associated with lower function score.
  • Reduced maximum knee flexion associated with lower function on WOMAC
166
Q

How does alignment correlate with pain in the knee?

A

Neutral alignment has greater pain relief

167
Q

What interventions are there for alignment in regards for pain and relief?

A

None, some may help individual patients but there is no standard one.

168
Q

Promoting ____ during rehab may help improve overall function even if it
is difficult to overcome physical impairments.

A

Promoting self-efficacy during rehab may help improve overall function even if it
is difficult to overcome physical impairments.

169
Q

What is adherence to HEP and physical activity recommendations associated with?

A
  • Reduced pain (WOMAC-pain)

* Better Function (WOMAC-physical function)

170
Q

How do we encourage adherence in our patients?

A
  • Periodic communication
  • Periodic face-to-face rechecks
  • Use of exercise diaries
  • Use of booster sessions
  • Engaged family
171
Q

What are the indications for total knee arthroplasty (TKA)?

A
  • OA
  • Inflamed synovium (RA)
  • Post-traumatic arthritis
172
Q

What is the protocol for TKA now?

A
  • Admitted morning of surgery
  • Mobilize day of surgery or POD 1
  • Usually WBAT
  • Length of stay (LOS) < 5days
173
Q

What happens to quad strength and activation post TKA?

A

Strength reduces by 60% and activation by 20%

174
Q

What is the role of pre-op education for a TKA?

A

• Inconsistent outcomes, but the studies have generally reported decreased post-op pain, medication use, LOS, and fear/anxiety

175
Q

What is the role of pre-op exercise for a TKA?

A
  • Inconclusive studies

* Improvement with pre-op function but not in post-op recovery, decrease of LOS or complications

176
Q

When does phase 1 of TKA rehab exercise start?

A

0- 1/2 weeks

177
Q

What are the goals of phase 1 of TKA rehab exercise?

A
  • Control postoperative swelling
  • Minimize pain
  • Knee ROM 0-90°
  • Muscle strength 3/5-4/5
  • Ambulation with or without use of an assistive device
  • Establish home exercise program
178
Q

What are the interventions utilized in phase 1 of TKA rehab?

A
  • Passive range of motion (PROM)-CPM as indicated per physician
  • Ankle pumps to decrease risk of DVT
  • Bed mobility and transfers usually initiated
  • Heel slides in supine or sitting to increase knee flexion
  • Muscle setting exercises (Quad sets)
  • Gravity-assisted knee extension in supine
  • NMES
  • Gentle stretches for the hamstrings, calf, and iliotibial band
  • Pain modulation modalities
  • Compression to control effusion
  • Gait training
  • Manual Therapy
179
Q

When should an NMES treatment start post TKA?

A

Started Day 2 Post-op

180
Q

Where is the electrodes placed for NMES treatment for TKA rehab?

A

Electrodes placed over distal vastus medialis and proximal vastus lateralis

181
Q

Where should the leg be during NMES treatment for TKA rehab?

A

Leg secured by Velcro at 60˚ knee flexion

182
Q

What should the intensity of the NMES unit be set to for TKA rehab?

A

Intensity set to maximum tolerance

183
Q

What are the parameters for NMES treatment for TKA rehab?

A
  • Biphasic, 50Hz current
  • Pulse duration: 250s
  • 15 second on-time, 45 second off-time
  • 15 repetitions (2x/day) for 3 weeks, then
  • 15 repetitions (1x/day) for 3 weeks
184
Q

When is phase 2 of TKA rehab exercise?

A

3-6 weeks

185
Q

What are the goals for phase 2 rehab exercise?

A
  • Diminish swelling and inflammation
  • Increase ROM 0-115° or more
  • Increased weight bearing tolerance
  • Muscle strength 4/5-5/5
  • Return to functional activities
  • Adhere to home exercise program
186
Q

What are the interventions utilized in phase 2 of TKA rehab?

A
  • Incision mobilization after suture removal, when incision is clean and dry
  • Progressive passive stretches
  • Stationary bike or peddler
  • Pain-free progressive resisted exercises
  • Proprioceptive training
  • Manual Therapy
  • Closed-kinetic chain strengthening (mini-squats)
  • Gait training (wean off assistive device)
  • Protected, progressive aerobic exercise, such as cycling without resistance, walking, or swimming
187
Q

When is phase 2 of TKA rehab exercise?

A

6 weeks and beyond

188
Q

What are the goals for phase 3 rehab exercise?

A
  • Progress ROM 0-115° as able, to a functional range for the patient
  • Enhance strength and endurance and motor control of the involved limb
  • Increase cardiovascular fitness
  • Develop a maintenance program and educate patient on the importance of adherence, including methods of joint protection
189
Q

What are the interventions utilized in phase 3 of TKA rehab?

A
  • Continue interventions of previous phases; advance as appropriate
  • Implement exercises specific to functional tasks
  • Improve cardiorespiratory and muscle endurance with activities such as bicycling, walking, or aquatic programs
190
Q

What are the red flags to look for in a TKA rehab?

A
  • DVT
  • Pulmonary Embolism
  • Infection
191
Q

What are the characteristics of an infection as it relates to a TKA?

A
  • Persistent fever (higher than 100°F orally)
  • Shaking chills
  • Increasing redness, tenderness, or swelling of the knee wound
  • Drainage from the knee wound
  • Increasing knee pain with both activity and rest

MSK 2 (4 decks)

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