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Knee

QuestionAnswer
Muscles of the Quadriceps Vastus intermedius, rectus femoris, vastus lateralis, vastus medialis oblique
Muscles of the Hamstrings Biceps femoris (long head, short head), semitendinosus, semimembranosus
Muscles of the Pes Anserinus Sartorius, gracilis, semitendinosus
Characteristics of Grade I MCL sprain Little fiber tearing/stretching, stable valgus test, little or no jt effusion, some stiffness & point tenderness on lateral aspect, relatively normal ROM
Characteristics of a Grade II MCL sprain Complete tear of deep capsular lig & partial tear of superficial layer of MCL, no gross instability (laxity at 30° of flexion), slight swelling, mod to severe jt tightness w/ decreased ROM, pain along medial aspect
Characteristics of Grade III MCL sprain Complete tear of supporting ligs, complete loss of med stability, min to mod swelling, immediate pain followed by ache, loss of motion due to effusion & HS guarding, + valgus stress test
Etiology of a LCL sprain Result of VARUS force, generally w/ tibia IR, damage can also occur to the cruciate ligs, ITB, and meniscus
Etiology of a MCL sprain Result of severe blow from lateral side, VALGUS force
Signs & symptoms of a LCL sprain Pain & tenderness over LCL, swelling & effusion around LCL, joint laxity w/ VARUS testing, may cause irritation of the peroneal nerve
Etiology of a Non-contact ACL tear 80% more likely, multiple forces collectively acting on jt, decelerating from jump or running, foot contacts geound with heel or flatfoot, WB creates axial force with knee near full ext & ABD or in knee valgus
Etiology of a Contact ACL tear Decelerating & usually changing directions, foot is planted with knee abducted, contact occurs lat & post forcing knee into valgus & IR with ant shear
Signs & Symptoms of an ACL tear Experience a pop with severe pain & disability, rapid swelling at joint line
Etiology of a PCL tear Most risk at 90° of flexion, fall on bent knee is most common, can also be as a result of a rotational force, “dashboard injury”
Signs & Symptoms of a PCL tear Feel a pop in back of the knee, tenderness & relatively little swelling in the popliteal fossa
Etiology of Meniscal Lesions Med meniscus more commonly injured due to ligamentous attachments & decreased mobility (torsional & valgus forces), most common MOI is rotary force with knee flexed/extended, tears may be long, obl, or transverse
Sign & Symptoms of Meniscal Lesions Effusion developing over 48-72 hr period, jt line pain & loss of motion, intermittent locking & giving way, pain w/ squatting, portions may become detached, if chronic recurrent swelling or muscle atrophy may occur
Etiology of Knee Plica Irritation of the plica, mediopatellar plica & often associated w/ chondromalacia
Signs & Symptoms of Knee Plica Possible history of knee pain/injury, recurrent episodes of painful pseudo-locking, possible snapping & popping, pain w/ stairs & squatting, little or no swelling, and no lig laxity
Etiology of Osteochondral Fractures Same MOI as collateral/cruciate ligs or meniscus injuries, twisting, sudden cutting or direct blow, fractures of cartilage & underlying bone varying in size & depth
Signs & Symptoms Osteochondral Knee Fractures Hear a snap & feeling of giving way, immediate swelling & considerable pain, diffuse pain along jt line
Etiology of Osteochrondritis Dissecans Partial or complete separation of articular cartilage & subchondral bone, cause is unknown but may include blunt trauma, endocrine abnormalities, prominent tib spine impinging on fem condyle, or impingement due to patellar facet
Signs & Symptoms of Osteochrondritis Dissecans Aching pain with recurrent swelling & possible locking, possible quad atrophy & point tenderness
Etiology of Peroneal Nerve Contusion Compression of peroneal nerve due to direct blow
Signs & Symptoms of Peroneal Nerve Contusion Local & possible shooting pain, numbness & paresthesia in cutaneous distribution of nerve, added pressure may exacerbate cond, generally resolves quickly but if it does not, can result in foot drop
Etiology of Bursitis Acute, chronic or recurrent swelling, prepatellar = continued kneeling, infrapatellar = overuse of patellar tendon
Signs & Symptoms of Bursitis Prepatellar Bursitis may be localized swelling above knee that is “ballotable”, swelling popliteal fossa may indicate Baker’s Cyst
Signs & Symptoms of Baker’s Cyst Swelling in popliteal fossa, associated with semimem bursa or med head of gastroc, commonly painless & causes little disability, may progress & should be treated accordingly
Etiology of Patellar Fracture Direct or indirect trauma (severe pull of trauma), semi-flexed position with forcible contraction (falling, jumping, or running)
Signs & Symptoms of Patellar Fracture Hemorrhaging and joint effusion w/ generalized swelling, indirect fractures may cause capsular tearing, separation of bone fragments, & possible quad tendon tearing, little bone separation w/ direct injury
Etiology of Acute Patellar Subluxation or Dislocation Deceleration w/ simultaneous cutting in opposite direction (valgus force), quad pulls patella out of alignment, some individuals may be predisposed, repetitive subluxation will stress medial restraints
Signs & Symptoms of Acute Patellar Subluxation or Dislocation Pain and swelling, restricted ROM, palpable tenderness over adductor tubercle, results in total loss of function
Etiology of Injury to Infrapatellar Fat Pad Irritated by chronic kneeling, pressure or trauma, capillary hemorrhaging and swelling, chronic irritation may lead to scarring and calcification
Signs & Symptoms of Injury to Infrapatellar Fat Pad Pain below the patellar lig (esp during knee ext), may display weakness, mild swelling and stiffness during mvmt
Etiology of Chondromalacia of the Patella Softening and deterioration of articular cartilage, often associated with abnormal patella tracking
Three Stages of Chondromalacia 1) swelling and softening of cartilage 2) fissure of softened cartilage 2) deformation of cartilage surface
Signs & Symptoms of Chondromalacia of the Patella Pain w/ walking, running, stairs, and squatting, possible recurrent swelling, grating sensation w/ flex & ext, painat inf border during palpation.
Etiology of Patellofemoral Stress Syndrome Result of lat deviation of patella while tracking in femoral groove (tight structures, pronation, increased Q-angle, insufficient medial musculature)
Signs & Symptoms of Patellofemoral Stress Syndrome Tenderness of lat facet of patella & swelling associated w/ irritation if synovium, dull ache in center of knee, patellar compression will elicit pain & crepitus, apprehension when patella is forced laterally
An apophysitis occuring at the tibial tubercle (repeated avulsion of patellar tendon), begins cartilaginous & develops a bony callus, enlarging the tubercle, resolves with maturation Osgood-Schlatter Disease
Signs & Symptoms of Larsen-Johansson Disease Elicits swelling, hemorrhaging, and gradual degeneration of the apophysis due to impaired circulation, pain with running and jumping, pain with sudden ext
Etiology of Patellar Tendinitis (Jumper’s or Kicker’s Knee) Jumping or kicking - placing tremendous stress and strain on patellar or quad tendon, sudden or repetitive ext
Signs & Symptoms of Patellar Tendinitis Pain and tenderness at inf pol of patella
Three Phases of Patellar Tendinitis 1) pain after activity 2) pain during and after 3) pain during and after (possibly prolonged) and may become constant
Etiology of PatellarTendon Rupture Sudden, powerful quad contraction, generally does not occur unless chronic inflam cond persists resulting in Tissue degeneration, occurs primarily at point of attachment
Signs & Symptoms of Patellar Tendon Rupture Palpable defect, lack of knee ext, considerable swelling & pain (initially)
General expression for repetitive/overuse cond attributed to malalignment & structural asymmetries, irritation at band’s insertion, commonly seen in individual that have genu varum or pronated feet Iliotibial Band Friction Syndrome (Runner’s or Cyclist’s Knee)
Result of genu valgum and weak vastus medialis, often occurs due to running w/ one leg higher than the other (running on a slope or crowned road) Pes Anserine Tendinitis or Bursitis
Created by: natamccl