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msk: menis rehab

QuestionAnswer
what portion of the menisci are water? 74%
what portion of the menisci are avascular, where? inner 2/3rds
during motion, menisci move on what, with what? move on tibial plateau, with femoral condyles
what pulls menisci during knee flexion? medial pulled by semimembranosus tendon, lateral pulled by popliteus
are meniscal injuries more or less common in adolescents? less frequent
where is tenderness common with a meniscal injury? at the joint line
apleys test? pt prone w knee at 90, compress and rotate, distract and rotate
mcmurray test? (what for lateral and what for medial menisc) when positive? MR of tibia and extend knee to test lateral meniscus. LR of tibia and knee extension for medial meniscus. positive w snap click or PAIN
bounce home test, when positive? allow knee to passively extend - positive if ext is incomplete or there is a springy block
what kind/process of swelling occurs with a ligament tear, ostechondral fx, or peripheral meniscal tear? hemarthrosis: 1-2 hour onset, taut skin w doughy or hard feel, warm
what will swelling be like with infection? pus, warm/hot to touch, maybe red
common limitations with meniscal tears? loss of ext, decreased flex, pain/weakness
functional limitations with meniscal tears? decreased ability to walk, cannot climb stairs, dancing, long sitting periods
disability of meniscal tears? impairments = functional limitations = disability; such as going to school, playing sports
have one or both surgical forms of meniscal repair been linked to early degenerative OA? both total or partial meniscectomy and allograft transplantation
which anatomic structure needs protection during rehab after a meniscectomy? none need protection; can proceed aggresively
what are the goals during phase 1 (acute) for meniscectomy rehab? diminish inflamm and swelling, restore ROM, and reestablish quad muscle activity
after meniscal repairs, is WB limited during rehab? WB is as tolerated
study that tested quad strength on pts with a partial meniscevtomy w/in 4 years, found what? concluded quad strength was still reduced
continued pain in what compartments is a post-operative warning sign of meniscal repair? continued pain in medial or lateral tibiofemoral compartment
the knee feeling "loose" or clicking is a warning sign post-op, T or F? true
T or F, failure to meet ROM goals is a post op warning sign? decreased patellar mobility? persistent inflamm? all are warning signs
what is articular cartilage composed of? viscoelastic material - chondrocytes, water and ECM
characteristics of type 1 cartilage injury? superficial, microscopic damage to cells
cartilage type 2 injury characteristics? partial thickness, microscopic surface disrupt; does not provoke inflamm response b/c it doesn't penetrate subchondral bone
type 3 cartilage injury? full thickness, penetration to subchondral bone, significant inflamm
for prognosis to be good for cartilage lesions, what tx is necessary? surgery with rehab programs. palliative care unsuccessful, avascular tissue=doesn't heal well
most common force type for chondral injuries? rotational force in direct trauma, shearing injuries
define osteochondritis dissecans? fragment of bone or cartilage that is loose and floats within knee joint
osteochondritis dissecans is most commonly distributed to what area? medial femoral condyle, then lateral femoral condyle, then trochlea
after osteochondritis dissecans treatment, what is and is not encouraged? WB necessary for cartilage integrity to be maintained, certain ROM avoided to engage lesion, goal of full ext in 1 week, full flex 3-5 weeks - closed chain exercise avoided 4-6 weeks
percentage of people over 55 with OA? 70-85%, 8th worldwide disability cause
what is OA? fissures/cracks/thinning of cartilage; bone damage; synovial inflamm; cartilage hypertroph; progressive erosion
most noteable complaint for OA? morning stiffness
cause of primary OA? no known cause; possibly due to excess load or previously injured joint
secondary OA is what? OA as a result of articular injury
osteoporosis vs osteomalacia? malacia= softening; porosis=holey
some risk factors for OA? previous joint injury, obesity, heredity, malalignment, instability, weak quads, occupation
medically related risk factors for OA? bleeding disordes, lack of proper bld supply, other arthritis
which OA test has a higher k value, palpation of medial tibiofemoral tenderness, or lateral tenderness? medial tibialfemoral tenderness is .94, with lateral being.85
some recommended treatments for knee OA? reduce body weight by 5% if BMI>25, low impact aerobic fitness, strengthen quads!!, nsaids, corticosteroid injections, arthroscopy if there are loose bodies or tears, patellar taping
treatments that are NOT recommended for knee OA? needle lavage, hydrochloride, custom foot orthotics, arthroscopy with no loose bodies or tears
for mild OA symptoms, which PT activities are good? modalities prn, knee sleeve, AROM, joint mobs, conditioning (low impact), isomentrics
moderate to sever OA symptom PT treatments? stretching, unloaded aerobic conditioning, strength exs
treatments not recommended for or against OA treatment? acupuncture, bracing, hyaluronic acid with mild OA symptoms
which factors are contraindications to TKA for OA treatment? peripheral vascular disease, history of infection, and morbid obesity
basics of acute management (1-5 days post op) for TKA? CPM, therapeutic exc, PROM, transfers, gait training w WB per MD orders
TKR survival rate appx? 10-15 years
Created by: berglands
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