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msk: menis rehab
| Question | Answer |
|---|---|
| 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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