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KNPE 331 > Week 6: Knee and Lower Leg > Flashcards

Week 6: Knee and Lower Leg Flashcards

1
Q

Knee Joint (3 Joints)

A
  1. Tibiofemoral joint
  2. Patellofemoral joint
  3. Superior tibiofibular joint
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2
Q

Compartments of Lower Leg (3)

A
  1. Lateral: peroneal group
  2. Anterior: extensor (DF) group
  3. Posterior: flexor (PF) group
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3
Q

Muscles of Anterior Compartment (4)

A
  1. Tibialis anterior
  2. Extensor hallucis longus
  3. Extensor digitorum longus
  4. Peroneus tertius
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4
Q

Muscles of Lateral Compartment (2)

A
  1. Peroneus longus
  2. Peroneus brevis
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5
Q

Muscles of Deep Posterior Compartment (3)

A

-Tom, Dick & Harry:
1. Tibialis posterior
2. Flexor digitorum longus
3. Flexor hallucis longus
*Together they dynamically help to stabilize medial ankle

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6
Q

Muscles of Superficial Posterior Compartment (3 +1)

A
  1. Gastrocnemius
  2. Soleus
  3. Plantaris

*Achilles tendon

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7
Q

Intracapsular Structures of the Knee (5)

A
  1. Anterior cruciate ligament (ACL)
  2. Posterior cruciate ligament (PCL)
  3. Meniscus (medial and lateral)
  4. Cartilage
  5. Joint surface

*important to know which structures are intracapsular vs extracapsular because only certain ones are in each space, so it is easy to rule out injuries if you know which is which and where structures are affected

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8
Q

Special Test: Wipe Test

A

*for intracapsular swelling

-Wipe up medial side, then down lateral side (swelling will pop out medial side)
-Great starter test to narrow in on structures affected (capsule will be full/swollen if intracapsular, if you tear capsule whole knee will be swollen)

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9
Q

Quadriceps Muscle (4)

A
  1. Rectus femoris
  2. Vastus lateralis
  3. Vastus intermedius *3 lateral pull on patella
  4. Vastus medialis *1 medial pull on patella
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10
Q

Hamstrings (3)

A

Medial:
1. Semimembranosus
2. Semitendinosus
Lateral:
3. Biceps femoris

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11
Q

Pes Anserine Group

A

*Insert medial proximal tibia, “say grace [before] tea” = medial to lateral

  1. Sartorius
  2. Gracilis
  3. Semitendinosus
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12
Q

Functional Anatomy and Biomechanics

A

-Gluteus medius= hip abduction
-Anterior fibers: internal rotation of hip, assists with hip flexion
-Posterior fibers: extend and externally rotate hip *eccentrically controls IR of femur in WB
-Prevents pelvis on stance side from dropping during gait (Trendelenburg gait= can’t stabilize on one side so the other side drops)
*What happens down the chain if this is weak? Increases forces at the ankle and puts strain on other structures

-Quadriceps= 3 pull. Laterally, 1 pulls medially= natural imbalance
-Quads: Hams ratio ideally 3:2, post ACL injury 1:1

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13
Q

Shin Splints (Medial Tibial Stress Syndrome- MTSS)

A

-Involves exercise-induced pain over anterior tibia and is an early stress injury in the continuum of tibial stress fractures
-Do not train through shin splints
-Treat cause more than just localized area (tape arches/other supporting structures)

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14
Q

Compartment Syndrome

A

-Excessive pressure within a muscle/fascial compartment (tap at top open, tap at bottom closed, builds pressure)
-MOI: Acute- trauma or following long bone fracture (e.g. tibia- most common, distal radius). Overuse- often overlooked as shin splints
-S&S: Red, hot, shiny, very painful, numb, weak, faint pulse distal to site, some describe pale skin over damaged tissue
-Acute management: no pressure, reduce inflammation, no RTP, NWB, refer to sport med Dr. (proper management essential), occasional need for fasciotomy to release pressure

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15
Q

Gastrocnemius/Soleus Strains

A

-MOI: Gastrocs/soleus overstretch in DF with knee extension (gastrocs) especially with forceful contraction
-S&S: “Pop” or “pull”, sharp pain, swelling, bruising
-Special tests: muscle test for gastrocs, soleus, deep flexors, Thompson Test to rule out Achilles rupture, toe raises
-Acute management: PIER, pressure pad with wrap over injured sites, NWB, avoid stretch or contraction
-RTP: No- usually self-limiting; once rehabbed, can tape with heel lift for initial RTP

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16
Q

Achilles Rupture

A

-MOI: Sudden forceful contraction
-Common in stop and go sports- basketball, tennis, squash
-S&S: Sudden sharp pain (partial rupture) or feeling of being kicked/hit in back of leg, unable to PF or go up on toes, swelling, delayed-onset bruising (becomes extensive)
-Special tests: Thompson Test, 2 foot-1ft toe raise
-Acute management: PIER, NWB, pressure pad over injured tissues with tensor, educate, refer for consult with sports med Dr.

17
Q

Patellofemoral Pain Syndrome (PFPS)

A

-MOI: Poor tracking of patella in femoral condyle
-S&S: Posterior aspect of patella TOP
-Check:
-Mechanics from bottom up and top down
-Stable base?
-Quad imbalance- medial vs lateral pull? Static quad contraction- what happens?
-1 leg squat- what happens? Does femur collapse into IR?
-Most often overuse condition; occasionally acute onset

18
Q

Patellar Dislocation

A

-MOI: Valgus force with foot planted, causing IR of femur
-Most common in active children ages 10-17
-S&S: Patella positioned on lateral side of knee, significant pain, usually in knee flexion
-Special tests: none if dislocated; sublexed= apprehension test
-1st time dislocation need to rule out osteochondral fracture (can affect patella or femoral condyle, occurs in 25-75% of cases and requires surgical intervention)
-Acute management: rule out fracture, PIER if reduced, refer, braced in full extension for 3 weeks then ROM and VMO strengthening (and top down/bottom up biomechanics corrections)

19
Q

Patellar Tendonitis

A

-MOI: Excessive traction on patellar tendon
-S&S: Pain, swelling and heat over patellar tendon, pain with jumping, running, quick change in direction or strong quad contraction, pain with flexion and extension, can often train/compete through pain
-Special tests: Thomas Test; resisted quads
-Acute management: PIER, roll/soft tissue mobility for quads, lower extremity mechanics- how are they moving for components of their sport?
-NB to train hamstrings to prevent anterior translocation of tibia on femur, and stability at hip and knee
-Tendinopathy rehab- eccentrics, x-training
-RTP: patellar tendonitis tape job (common in basketball)

20
Q

Knee Bursitis

A

-Bursas: fluid-filled sacs, lay flat b/t areas of friction
-MOI: Direct trauma, friction from tight muscles/tendons
-S&S: Rebound pain, often painless, visible fluid-filled sac (sometimes extreme)
-Acute management: protect with padding to avoid repeat insult, soft tissue mobility of tight muscles
-Chronic bursitis can develop granular rice-like texture

21
Q

3 Fractures of Lower Leg

A
  1. Stress fractures- MTSS/Shin splints
    -MOI: Overuse/poor mechanics
  2. Patellar fracture
    -MOI: Direct blow, patellar discolouration
  3. Tibial plateau fracture
    -MOI: Varus or valgus load, direct blow
22
Q

Meniscus Structure and Function

A

-Medial “C”, lateral “O”
-Poor blood supply
-Function: cushion joint during loading

23
Q

Types of Meniscus Tears (6)

A
  1. Vertical
  2. Transverse
  3. Peripheral
  4. Bucket-handle (arch flips up)
  5. Parrot-beak
  6. Flap

*if they can save meniscus they will suture it, but will do surgery if severe (and depends on person’s goals)

24
Q

Meniscus Tears

A

-MOI: Plant and twist, contact, wear and tear/degeneration
-S&S: Sharp pain at specific ROM, loaded rotation deep squat, catching/clicking/locking, swelling (often presents 24 hours later)
-Commonly associated with ACL injuries
-Special tests: McMurray’s (gold standard), Apley’s, duck walk
-Acute management: PIER, NWB, educate, conservative treatment first choice unless locking- refer
-Plica? Often presents same way
-Bracing can’t stop all movement so not effective for that, but brings awareness to area (proprioception)

25
Q

Ligament Sprains

A
  1. Medial collateral ligament (MCL)
  2. Lateral collateral ligament (LCL)
  3. Anterior cruciate ligament (ACL)
  4. Posterior cruciate ligament (PCL)
26
Q

ACL

A

-Anterior-medial aspect of intercondylar area of tibial plateau (passes up and back to posterior-medial aspect of lateral femoral condyle)

2 bundles:
-Posterolateral- taught in extension with less than 30 degree rotation
-Anterolateral- taught going into flexion and with rotation
-Prevents anterior translation of tibia on femur and limits internal rotation of tibia
-Major stabilizer of the knee

27
Q

ACL Sprains

A

-MOI: Sudden cut or pivot (rotational force), sometimes from added external force from a tackle/collision (valgus, hyperextension)
-S&S: Swelling, extreme pain often throughout knee joint, difficulty/unable to WB, delayed-onset bruising depending on structures affected

Incidence:
-Higher incidence in female’s vs males
-30% from direct contact, 70% from wrong movement
*Special tests: Anterior drawer, Lachman’s, Pivot Shift
-Next steps: NWB off field, pressure and ice to prevent swelling, refer to doc

28
Q

ACL Surgery- 5 Techniques

A
  1. Autograft (person’s tissues) vs allograft (cadaver)
  2. Bone-tendon-bone graft (consider sport- not as strong for jumping sports)
  3. Hamstring graft
  4. Unilateral vs contralateral (same side as injury or opposite, better to do same side to prevent weakening of other side)
  5. BEAR- new technique (suture in plug with own blood in it to see if body can heal itself with that, need more evidence but positive outcomes possible)
29
Q

PCL Sprains

A

-Anterior-lateral aspect of medial femoral condyle within the notch- inserts along posterior aspect of tibial plateau
-MOI: Hyperflexion, forced post translation of tibia on femur
-S&S: Swelling, extreme pain often throughout knee joint, difficulty/unable to WB, delayed-onset bruising depending on structures affected
*Special tests: posterior drawer, sag sign
-Acute management: PIER, NWB, educate

*PCL doesn’t need reconstruction as much as ACL

30
Q

MCL Sprains

A

-Superficial and deep fibers
-Commonly associated with ACL injuries
-MOI: Valgus stress on the knee (direct blow to outside of knee), plant and twist (with lateral rotation of femur on tibia)
*Special test: Valgus stress (with 30-degree flexion)
-Acute management: PIER, NWB, pressure pad to approx. ends
-Collateral ligaments not as commonly repaired as ACL

31
Q

LCL Sprains

A

-MOI: Varus stress to the knee
-S&S: Lateral knee pain and swelling, LCL TOP (tender on palpation), stiffness
*Special test: Varus stress (full extension)
-Acute management: PIER, NWB, pressure pad to approx. ends
-Collateral ligaments not as commonly repaired as ACL
-Importance of strengthening dynamic stabilizers, focusing on movement patterns, biomechanics and proprioception

32
Q

Knee Special Tests Summary (6)

A
  1. Intracapsular swelling- Wipe Test
  2. MCL: Valgus at 0 degrees (superficial fibers) and 30 degrees (deep fibers)
  3. LCL: Varus at 0 degrees
  4. ACL: Lachman’s, Anterior Drawer
  5. Posterior Drawer, Sag Sign
  6. Meniscus: McMurray’s,
    Apley’s, duck walk

KNPE 331 (12 decks)

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