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Sportsmed > wk 7- knee injuries > Flashcards

wk 7- knee injuries Flashcards

1
Q

what is an acute injury

A

an injury as a result of a single identifiable traumatic event

occurs when the force applied is greater than the tissue capacity

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2
Q

pathophysiolgical response to acute injury

A
  1. acute inflammation/ degeneration
  2. regeneration
  3. repair
  4. remodelling
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3
Q
  1. inflammatory/degeneration phase
A

force applied above the capacity of tissue

this process peaks at 48hours and lasts 5-7days

  1. tear of tissue
  2. damage to blood vessels causing a clot (haematoma)
  3. WBCs migrate releasing inflamamtory mediators
  4. clean up the area by breaking down unhealth tissue
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4
Q
  1. regeneration phase
A
  1. regeneration of myofibers from satellite cells that are connected to the part of myofiber that survived the trauma
  2. these mature
  3. vascular supply thorugh the formation of new capillaries (angiogenesis)
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5
Q
  1. repair phase
A

formation of connective tissue (scar tissue)

  1. fibrin and fibrinogen are laid in a cross link formation
  2. fibrobalsts invade and for extracellular matrix tissue to form connective tissue
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6
Q
  1. remodelling phase
A
  1. maturation of repaired cells
  2. reorganisation of sca tissue through contraction
  3. recovery of functional capacity of msucle
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7
Q

muscial injury can involve either

A

myofascial
musculotendinous unit
intratendionous unit

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8
Q

grading muscle injuries using british athletics muscle injury classification

MRI typically needed to grade correctly

A

0-generalised muscle soreness (DOMS) with normal MRI

symptoms:
-focal muscle soreness usually after exercise. little to no inhibition or reduced strength

1- small injury or tear

symptoms:
pain during or after activity
pain on contraction, strength normal

2- moderate injury or tear

symptoms:
pain during activity that forces them to stop. ROM limited at 24 hours post injury. pain and weakness on contraction

3- extensive tear

symptoms:
sudden onset pain-may be fall to ground
ROM significtly reduced 24 hours post injury
pain walking and obvious weakness on contraction

4- complete tear of muscle or tendon

symptoms:
sudden onset with significant and immediate limitation to activity
palpable gap
may be less pain on contraction than grade 3

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9
Q

muscle injuries report pain on

A

stretch
contraction
palpation

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10
Q

management of acute muscle injury

A

protection
elevation
avoid anti inflamms
compression
education

load
optimism
vascularisation
exercise

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11
Q

if an athlete has persistent symptoms from a msucular injury >3-4weeks what should you suspect

A

intramuscular tendon involvement or injury to a tissue other than the musculotendinous junction

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12
Q

when and who do u refer to for muscle injury

A

suspicious of high grade injury
high level athlete

refer to
physiotherapist
sports physician

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13
Q

complications of acute fractures

A

extensive bleeding
acute compartment syndrome
infection
DVT/pulmonary embolism
delayed non union of fracture

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14
Q

ottawa rules for knee

A

age 55 years plus
tenderness at head of fib
isolated tenderness of patella
inability to flex 90 degrees
inability to weight bear 4 steps

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15
Q

what is dislocation

A

articulating surfaces are no longer in contact

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16
Q

what is sulaxation

A

articulating surfaces are partially in contact

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17
Q

what effects the ability to dislocate/sublax a joint

A
  1. anatomal properties of the joint
  2. individual factors of the stabilising structures (hypermobile/previous injury)
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18
Q

when assessing a fracture/dislocation always check for

A

neurovascular compromise- sensation and pulses before an after intervention

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19
Q

what is articular cartilage, its function, and healing status

A

lines articular surface (hyaline cartilage- known as)

absorbs and distributes loads on the subchondral bone

poor healing due to lack of blood supply

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20
Q

what is fibrocartilage, function

A

additional structure within the joint (meniscus, labrum)

enhanes joint congruency and distribution of stress

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21
Q

symptoms of fibrocartilage injuries

A

sometimes clicking, catching or locking

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22
Q

what are ligaments, what do they do

A

fibrous connections from bone to bone that support the passive stability/intergrity of joints

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23
Q

ligament tears grade 1, 2, 3

A

1- localised tenderness on palpation
minimal swelling
little functional deficit, end point on drawer test but can be painful

2- significant tenderness, swelling, increased laxity but end point is present, moderate functional deficit

3- pop may have been heard
immediate pain, swelling, no end point, significant functional deficit

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24
Q

management of ligament injuries

A

PEACE AND LOVE

immobilise/surgery for grade 3

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25
Q

when do refer for imaging with ligaments

A

-if area isnt in your scope
-if it hasnt healed in timeframe
-grade 3 injury

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26
Q

patellofemoral joint pain is what and what symptoms

A

pain around, behind the patella which is worse when loaded where knee is bent (squatting, stairs, running, jumping)

symptoms:
crepitus/grinding when knee bending
tenderness of patella on palpation
effusion
pain during or after sitting

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27
Q

management for patellofemoral joint pain

A
  1. exercise to reduce pain and improve function, combined hip and knee exercises
  2. foot orthosis to reduce pain short term
  3. patella taping for support

-do not do isolated mobilsations or electrophysical agents

28
Q

what tests can be used for patellofemoral joint pain

A

no individual test could diagnose or exclude PFJP

29
Q

what structures can contribute to PFJP

A
  1. subchondral bone
  2. infrapatellar fat pad
  3. retinaculum
  4. ligamentous structures
30
Q

patellar tendinopathy

A

localised inferior patella pole pain, decreased tendon function and degeneration

symptoms
localiased pain
pain increases with exercises like squats, jumps that stressed the tendon
pain may improve when warm

common in males and jumping sports

31
Q

management of patellar tendinopathy

A
  1. isometric loading
    5 reps 45 secs 2-3times a day
    quad ext hold, quarter squat hold
  2. isotonic loading
    4 sets 8-12 reps progressing intensity
  3. energy storage loading
    jumping
    acceleration, decelleration
    cutting
  4. return
32
Q

difference between PTFP and PT tendinopathy

A

onset:
PTFP: knee flexion
PTT: jumping/cutting

location:
PTFP: vague
-: inferior pole of patella

clicking/crepitus:
PTFP: occasional
-: no

contraction of quads:
-: can be painful, often normal
PTT: painful

movement:
-: restricted medial glide
-: normal

taping:
-: helps
-: doesnt

33
Q

osgoods schlatters disease

A

apophysitis of the anterior tibial tuberosity due to repetitive traction of patella tendon on the distal insertion

presents in younger active populations

34
Q

4 stage classification of os goods

A

1- cartilage attachment without ossicle
2- with ossicle
3- insertional cartilage
4- mature attachment

35
Q

differential diagnosis for knee pain that shouldnt be missed

A

referred pain from hip
osteochondritis dessicans
slipped capital femoral epiphysis
perthes disease
tumour

36
Q

function of ACL

A

limits anterior tibial translation and rotational forces of knee

37
Q

mode of ACL injury

A

contact: forced valgus(medial knee), hyperextension, hyperflexion

non contact: pivot, cut, jump, landing

38
Q

ACL symptoms

A

loose knee, unstable
popping or snapping
effusion within 2 hours

39
Q

return to sport for ACL

A

approx 9 months

40
Q

tests for ACL

A

lachman
anterior draw
lever sign

41
Q

acute management of ACL

A
  1. control swelling- peace
  2. ROM exercises/ quad activtion/ strength /NMC

knee immobilisation at 90 degrees in a brace for 4 weeks

progressive increase in ROM each week until brace is removed at 12 weeks

42
Q

MCL sprain, what does it do

A

MCL resists valgus, rotation and translation forces

most common knee ligament injury, medial knee position

43
Q

testing MCL, grades

A

valgus stress test
at 0 deg
at 30 deg: isolates MCL

gapping 3.5mm Grade 1
5-10mm grade 2
more than 10 grade 3

44
Q

management of MCL sprain depends on

A

grade
level of tear
involvemnt of PMC
isolated injury or cruciate tear as well
chronicty

45
Q

MCL and ACL injuries management

A

ROM brace <30deg extension to encourage MCL healing before ACL surgery

46
Q

mangement of isolated MCL tear grade 1/2

A

conservative
grade 1 can heal on own typically
grae 2 may require resting, bracing and building strength

47
Q

management for grade 3 isolated MCL tear

A

if theres a
- type 2/3 tibial side avulsion
-bony avulsion
-MCL entrapment
-bipolar MCL tear

MCL surgery with or without augmentation

if none of these then conservative treatment (rest, brace, build strength)

48
Q

management of acute MCL tear (with ACL tear)

A

grade 1/2 MCL
MCL: conservative
ACL Conservative

grade 3 MCL
MCL: conservative
ACL: surgery within 3-6weks
intraoperative valgus stress test after ACL surgery, if no significant valgus opening in flexion than stick with conservative treatment for MCL, if yes then surgery for MCL

49
Q

management of MCL, ACL and PCL tear

A

grade 1/2 MCL
MCL: conservative
ACL/PCL surgery within 3-6weeks

grade 3 MCL
MCL: conservative
ACL/PCL surgery within 3-6 weeks
intraoperative valgus stress test after surgeries, if significant opening in flexion than surgery for MCL, if not then conservative treatment

50
Q

LCL/Posteriolateral corner function

A

resist varus forces, external rotation of the tibia

51
Q

what are the 3 major stabilizer of the PLC

A

LCL
popliteus tendon
popliteofibular ligament

52
Q

testing and grading of LCL

A
  1. Varus stress test
    0 and 30deg, if just 30 then isolated LCL, if both then LCL PCL and cruicate ligament
    pain, amount of movement and end feel

grde 1- 0-5mm gapping or 0-5deg rotational instability
2- 5-10mm or 6-10deg
3- more than 10mm or more than 10deg (soft end point)

  1. dial test
    30deg and 90deg
    if there is an increase of 10deg external rotation than PCL injury
53
Q

management of LCL injury

A

grade 1/2 - Conservative but not much research
grade 3- send for orthopaeic review, evidence suggests poor outcomes when not treated surgically

54
Q

PCL function

A

restraint for posterior tibial translation at all flexion angles
primary restraint for internal rotation in more than 90deg flexion
secondary restraint for external rotation in more than90deg flexion

55
Q

injury the PCL

A

rarely occurs in isolation
usually with other ligaments and meniscal injuries

happens when theres a blow to anterior aspect of tibia or hyperflexion/hyperextension

56
Q

2 bundles for the PCL

A
  1. anterolateral bundle
    primary restraint to posterior tibial translation 70-105deg
  2. posteromedial bundle
    primary restraint to posterior tibial translation in 0-15deg
57
Q

assessment of PCL

A
  1. posterior draw test
  2. quad active test (most specific)
  3. posterior sag (most sensitivte)
  4. dial test
58
Q

management of PCL

A

grade 1/2- conservative
grade 3- surgery, some evidence t o show theres risk of degenerative changes with conservative treatment

59
Q

meniscal function

A

increase congruency, force distribution and protection of articular cartilage/subchondral bone

poor healing capacity

60
Q

how can you injure meniscus

A

when young: twisting/pivoting on loaded flexed knee
older: degenerative tears

61
Q

tests of mensicus injury

A
  1. mcmurrays test- pain/clicking
  2. joint line tenderness
  3. thessalys
62
Q

management of meniscus injury in older pop

A

conservative where you can

63
Q

patellar instabiliy/dislocation cause, symptoms, when to refer

A

twisting, jumping, contact

popping out / moving with immediate swelling
tenderness on palpation of the medial border of the patellar

often reduces spontaneously but need to refer to ED if it doesnt

64
Q

management of patellar dislocation

A

if first time- conservative treatment unless theres
-osteochondral fracture
-substantial disruption of medial patellar stabilisers
-laterally sublaxed patellar at rest
-subsequent dislocations
-not improving with rehab
(refer to GP for x ray and orthopedic referral for first time dislocation)

if recurrent, can lead to apprehension and patellofemoral joint OA- extension bracing

65
Q

common knee pathologies

A

meniscus tear
MCL/LCL tear
ACL/PCL tear
articular cartilage injury
patellar dislocation
patellar tendinopathy
patellofemoral joint pain

66
Q
A

Sportsmed (11 decks)

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