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ortho test 2
Knee
| Question | Answer |
|---|---|
| joints of the knee | •Patellofemoral •Femorotibial |
| what motions do patellofemoral and femorotibial joints allow? | flexion and extension motion of the knee |
| muscles of the knee | •Quadriceps, Hamstring, Gastrocnemius, Pes anserine muscle group, popliteus |
| popliteus mm function | in closed chain activity, allows the knee to unlock and for tibial rotation to occur |
| Screwholm Mechanism in weight bearing | the foot is stabilized on the floor and the femur internally rotates on the tibia during extension and in externally rotates flexion |
| Screwholm Mechanism in non weight bearing | the lower leg is free to move and the tibia externally rotates on the femur during extension and internally rotates in flexion |
| ligaments of the knee | ACL, PCL, MCL, LCL |
| when medial and lateral collateral ligaments taut | full extension and full flexion |
| function of cruciate ligaments | •both prevent shear of the tibia/femur |
| The medial collateral ligament (MCL) connects the ____ aspect of the femur (F) and tibia (T) and is attached to the ___ ____ | medial, medial meniscus (MM) |
| what does ACL prevent | hyperextension, Stops anterior glide of tibia on femur or posterior glide of femur on tibia |
| How does the ACL attach? | •Attaches antero-medial to posterio-lateral |
| posterior cruciate ligament prevents | posterior displacement of tibia, rarely damaged in isolation |
| medial meniscus | Horseshoe "U" shaped, has attachment to MCL |
| lateral meniscus | C shaped |
| functions of menisci | Functions: Shock Absorbers, Provide some stability, Lubrication and Nutrition of Joint |
| how does meniscus provide lubrication and nutrition of joint | squishing motion/ compression brings in lubrication and proper nutrients |
| knee joint capsule functions | hold synovial fluid, vacuum seal |
| shape of knee joint capsule | Cylindrical shape with posterior folds |
| where does joint capsule attach | on the femur, tibia and fibula |
| suprapatellar bursa | under the quads |
| prepatellar bursa | anterior to patella |
| infrapatellar (deep and superficial) bursa | between patellar tendon and tibia |
| popliteal bursa | in the popliteal fossa, irritation can lead to bakers cyst |
| what mm make up the pes anserinus group | Made up of the sartorius, gracilis and semitendinosus; Inserts into medial aspect of tibia |
| pes anserinus mm group function | helps with screw-holm and full knee extension |
| patellar tendon fat pad location and function | distal to the patella under the tendon and helps cushion the patellar tendon |
| iliotibial band | • Inserts into the lateral condyle of the tibia and a slip to the lateral patella |
| what provides static knee stability | Ligaments, capsule, meniscus, bony congruity |
| what provides dynamic knee stability | Muscular, proprioceptive |
| stability of knee depends on equal portions of ____, ____ and ____ elements. | muscular, ligamentous, bony configuration |
| how many stability elements must be met for satisfactory knee stability? | at least 2 |
| individuals with some degree of ligamentous laxity can function if they have well developed ____ | muscular control |
| Individuals with deficient musculature (e.g.. polio) may have satisfactory control as long as their_____ do not stretch or wear out | ligaments |
| Individuals lacking bony congruity may do well as long as they have____ and ____ although this is generally a deteriorating situation | sound ligaments and good muscles, |
| is infant genu varum normal? | yes, can be noted until 3 yrs of age. abnormal if lasts longer than 3 year |
| genu valgum | knock knees |
| genu recurvatum | hyperextension of the knee |
| synovitis | Inflammation of the synovium, common with RA |
| septic arthritis | Caused from a puncture injury of the joint space |
| charco joint | Neuropathic arthritis - inflammatory arthritis initiated by trauma, progressive and degenerative |
| most common knee fractures | •Femoral condyle and Patella |
| tibial plateu fracture | caused by twisting/torsion injuries, can have cartilage involvement |
| epiphyseal plate fx | affect bone growth for either tibia or femur |
| causes of OA | Trauma, Repetitive use of joints, Obesity, Family history |
| symptoms of OA | pain, swelling, decreased ROM, decreased strength |
| diagnosis of OA | plain simple x-ray |
| treatment for OA | Exercise and weight loss, Glucosamine/Chondroitin, NSAIDS (Cox-2 inhibitor- naproxins), Unloader Brace, Injections (Cortisone, Viscosupplementation),Total or Hemi-Arthroplasty |
| viscosupplementation | replaces the synovial fluid |
| grade 1 mm tear | ROM is WNL, pain is present and strength is 4 or 5 MMT |
| grade 2 mm tear | Decreased ROM, pain, strength is 2 - 4 MMT |
| contusion | Bruising of the muscle tissue |
| grade 3 mm tear | Complete tear, 0 - 1 MMT |
| what knee mm is most commonly injured | hamstrings |
| two major causes of muscle strain | •Chronic overuse (inflexibility, postural faults, decondition, faulty body mechanics) •Acute overload ("failure" of contractile elements as a result of mechanical overload) sprinter *all can lead to myositis ossificans* |
| prepatellar bursitis | Housemaid's knee |
| infrapatellar bursitis | clergyman's knee |
| bakers cyst | • Popliteal cyst or a synovial herniation |
| what can cause MCL sprain | valgus strain, such as a blow to the lateral side of the knee or a rotary twist with knee flexed |
| symptoms of MCL sprain | pain, swelling, tear will result in excessive lateral mobility of the knee causing a valgus instability |
| What is the valgus stress test? | For MCL: Tested knee placed in 0 degrees and then 30 degrees, Testing for pain and laxity of joint |
| terrible triad | •Associated tears of ACL, MCL and medial meniscus |
| what causes terrible triad | combination of valgus, flexion, and external rotation forces applied to the knee while the foot is planted causing injury to the ACL, MCL, and medial meniscus |
| what causes lateral collateral ligament tear | Varus strain, such as a blow to the medial side of the knee. The common peroneal nerve is injured resulting in drop foot with decreased dorsiflexion and eversion. |
| is medial or lateral collateral ligament for often injured | MCL more injured, medial side of knee more exposed to injury than lateral side |
| symptoms of LCL injury | Pain, swelling, tear will result in excessive medial motion = varus instability |
| test for LCL injury | varus stress test |
| what causes ACL injury | combination of valgus and external rotation forces applied to the knee while the foot is firmly planted on the ground (football, basketball) •OR: a combo of IR and hyperextension isolated rupture may occur if femur is forcibly driven backward |
| symptoms of ACL injury | feel or hear pop, pain, swelling (sometimes no pain after complete rupture) |
| ACL tests | Anterior drawer sign or Lachman test - excessive forward motion of the tibia on the femur |
| are men or women in sports more likely to have ACL injury? | women, increased Q angle and hormones |
| determinates for ACL surgery | •Age (younger is better) •Activity level •Secondary restraints (hip, ankle issues) |
| what types of graft can be used for ACL? | Patella tendon autograft, Hamstring Autograft, Allograft (cadaver) |
| rehab considerations for ACL rehab are based on | graft selection and patient population |
| what causes PCL injury? | •Force directed in a posterior direction on the proximal tibia which results in a posterior glide of the tibial plateau on the femoral condyles (hyperextension) |
| symptoms of PCL injury | pain, swelling |
| tests for PCL injury | Posterior Drawer Sign - excessive backward mobility of the tibia on the femur or Posterior Sag sign. A single positive test may indicate a sprain while multiple findings are usually a rupture, including posterior sag and hyperextension |
| tx for ligamentous injuries | Immobilization with weight bearing and quad strengthening; Bracing (Controlled motion bracing for isolated MCL and LCL injury); Surgery (Reconstructive surgery with tendon transplant for the ACL and PCL, primary surgical repair) |
| Medial meniscus is injured ____ times more frequently than lateral. medial meniscus is more ___ attached | 5-15, loosely |
| what causes meniscal injury | knee flexion, compression, and rotation in WB that displaces the cartilage and puts a shear stress on the meniscus resulting in peripheral or transverse tears. Also can have degenerative tears. |
| The knee joint must be first rotated in a ____position to trap the meniscus, and then ____ to produce the tearing force (clipping) | flexed, extended |
| red zone of meniscus | outer third of meniscus; blood supply |
| white zone of meniscus | avascular |
| clinical signs of meniscus injury | •Joint line pain, effusion, sensations of joint crepitus or popping •LOM, joint locking, instability with ambulation and pain when ascending stairs |
| special tests for meniscal injury | McMurray's, Apley's Test |
| tx for meniscus injury | Partial meniscectomy and direct repair of torn tissue; Direct repair especially if the tear is at the periphery where there is some vascularization (periphery of meniscus called the red zone) |
| WB status for meniscal injury | NWB 3-6 weeks |
| causes of patellar instability | Direct trauma, Wide pelvis, Excessive Q angle, Insufficiency of VMO, Tight ITB, Shallow patellar groove, Abnormal position of the patella |
| treatment for patellar dysfunction | McConnell Taping, VMO reeducation, Stretching cross joint, hip stretching and strengthening, Surgery |
| surgery for patellar dysfunction | •lateral release or tendon transfer (patellar realignment) •Medial patellofemoral ligament (MPFL) reconstruction •MPFL attaches medial aspect of patella to femur |
| Medial patellofemoral ligament (MPFL) reconstruction | supports MPFL ligament into the femur, better success than tibial tubercle transfer |
| synovial plica | It is a remnant of embryonic pouches of the synovial membrane |
| where is synovial plica most common? | medial side of knee |
| what can happen if synovial plica is not treated? | •potentially damage patellar cartilage and/or meniscus |
| Osgood-Schlatter Disease | Is a mechanical problem not a disease; It is caused from traction apophysitis of the tibial tubercle at the site of the patellar tendon insertion |
| what can be a complication of Osgood Schlatter | •Can cause avulsion fracture |
| who is Osgood Schlatter common in | •adolescents who do jumping sports •Usually resolves age 18-19 |
| patellar fracture is caused by | trauma such as a direct blow, fall or car accident |
| types of patellar fracture | simple or comminuted; displaced or undisplaced |
| treatment for patellar fracture | •Immobilization following closed reduction, WB •ORIF with mobilization - CPM •Patellectomy if badly comminuted - loses lever arm |
| patellar pain syndromes | Patellar tendinitis, Chondromalacia patellae, Patellar malalignment |
| what is chondromalacia patellae? | •A degenerative process with progressive softening and finally degeneration of the articular cartilage on the under surface of the patella •Most likely an overuse syndrome from altered patellar biomechanics |
| who does chondromalacia patellae occur in? | •highest incidence in young adults |
| signs and symptoms of chondromalacia patellae | •Variable pain, catching, instability, "locking", weakness and atrophy of quads, swelling, tenderness to touch |
| Patellar Maltracking | •Patella tracks abnormally higher or lower in its femoral intercondylar articulation: |
| what is patella baja/infra, what can it result in? | Tracks lower and results in restricted knee extension which causes abnormal articular cartilage wear and ultimately OA and chondromalacia and may lead to a knee flexion contracture |
| what is patella alta, what might it result in? | Tracks higher and patella loses mechanical stability from the lateral lip of the femoral intercondylar fossa and may result in recurrent lateral displacement of the patella |
| signs and symptoms of patellar dysfunction | •Pain with descending stairs •Pain directly at the patella or just medial/lateral to patella |
| tx for patellar dysfunction | •Dependent on extent of pathology •May involve reduction of activities •Joint mobilization of patella for improved mobility •Ice, US, ther ex (VMO), taping, patellar stabilizing brace and anti-inflammatories |
| Enlarged Fat Pad (Camel's hump) | Characteristic "camel back" sign of two humps as the knee moves from flexion to extension (normally the fat pad and patella are so close in proximity that there is only one "hump") |
| Osteochondritis Dissecans | articular cartilage defect due to Trauma, Fracture of Bone under cartilage |
| tx for articular cartilage defect | •Carticel implant (ACI - Autologous Chrondrocyte Implantation) |
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