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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
when do refer for imaging with ligaments
-if area isnt in your scope -if it hasnt healed in timeframe -grade 3 injury
26
patellofemoral joint pain is what and what symptoms
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
27
management for patellofemoral joint pain
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
what tests can be used for patellofemoral joint pain
no individual test could diagnose or exclude PFJP
29
what structures can contribute to PFJP
1. subchondral bone 2. infrapatellar fat pad 3. retinaculum 4. ligamentous structures
30
patellar tendinopathy
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
management of patellar tendinopathy
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
difference between PTFP and PT tendinopathy
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
osgoods schlatters disease
apophysitis of the anterior tibial tuberosity due to repetitive traction of patella tendon on the distal insertion presents in younger active populations
34
4 stage classification of os goods
1- cartilage attachment without ossicle 2- with ossicle 3- insertional cartilage 4- mature attachment
35
differential diagnosis for knee pain that shouldnt be missed
referred pain from hip osteochondritis dessicans slipped capital femoral epiphysis perthes disease tumour
36
function of ACL
limits anterior tibial translation and rotational forces of knee
37
mode of ACL injury
contact: forced valgus(medial knee), hyperextension, hyperflexion non contact: pivot, cut, jump, landing
38
ACL symptoms
loose knee, unstable popping or snapping effusion within 2 hours
39
return to sport for ACL
approx 9 months
40
tests for ACL
lachman anterior draw lever sign
41
acute management of ACL
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
MCL sprain, what does it do
MCL resists valgus, rotation and translation forces most common knee ligament injury, medial knee position
43
testing MCL, grades
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
management of MCL sprain depends on
grade level of tear involvemnt of PMC isolated injury or cruciate tear as well chronicty
45
MCL and ACL injuries management
ROM brace <30deg extension to encourage MCL healing before ACL surgery
46
mangement of isolated MCL tear grade 1/2
conservative grade 1 can heal on own typically grae 2 may require resting, bracing and building strength
47
management for grade 3 isolated MCL tear
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
management of acute MCL tear (with ACL tear)
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
management of MCL, ACL and PCL tear
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
LCL/Posteriolateral corner function
resist varus forces, external rotation of the tibia
51
what are the 3 major stabilizer of the PLC
LCL popliteus tendon popliteofibular ligament
52
testing and grading of LCL
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) 2. dial test 30deg and 90deg if there is an increase of 10deg external rotation than PCL injury
53
management of LCL injury
grade 1/2 - Conservative but not much research grade 3- send for orthopaeic review, evidence suggests poor outcomes when not treated surgically
54
PCL function
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
injury the PCL
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
2 bundles for the PCL
1. anterolateral bundle primary restraint to posterior tibial translation 70-105deg 2. posteromedial bundle primary restraint to posterior tibial translation in 0-15deg
57
assessment of PCL
1. posterior draw test 2. quad active test (most specific) 3. posterior sag (most sensitivte) 4. dial test
58
management of PCL
grade 1/2- conservative grade 3- surgery, some evidence t o show theres risk of degenerative changes with conservative treatment
59
meniscal function
increase congruency, force distribution and protection of articular cartilage/subchondral bone poor healing capacity
60
how can you injure meniscus
when young: twisting/pivoting on loaded flexed knee older: degenerative tears
61
tests of mensicus injury
1. mcmurrays test- pain/clicking 2. joint line tenderness 3. thessalys
62
management of meniscus injury in older pop
conservative where you can
63
patellar instabiliy/dislocation cause, symptoms, when to refer
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
management of patellar dislocation
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
common knee pathologies
meniscus tear MCL/LCL tear ACL/PCL tear articular cartilage injury patellar dislocation patellar tendinopathy patellofemoral joint pain
66

Sportsmed (11 decks)

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