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The Knee- 639
The knee
| Question | Answer |
|---|---|
| Which aspect of the tibeofemoral joint is larger? | medial! |
| C shaped cartilage? | medial meniscus |
| O shaped cartilage? | lateral meniscus |
| How are the ACL and PCL angled? | oblique |
| True or false: Pressure in the joint capsule may interfere with normal arthrokinematics | true! need to find out what is causing the fluid! |
| How is the knee cap most easily dislocated? | full extension |
| how can you replace a dislocated knee cap? | place it back into extension |
| What can we fix if the pt has an excessive Q angle? | work on the hip abductors |
| how is the patella pulled laterally into the condyle? | by a tight IT band. |
| patellofemoral pain is typically from? | IT band, kinetic chain problems |
| Tight IT band + patella? | 'frog eye look', patella goes lateral |
| dislocation of the patella is caused by? | medial p-f ligament rupture, potential for success: lig intact= good, not intact=bad=surgery |
| Osgood Schlatters | bad hip, bad foot/ankle, if in pronation/lock all the time= quads are CONSTANTLY used |
| What happens to the quads in osgood schlatters? | the quads are always used bc all else is weak! |
| WB at the time of injury is how sensitive for meniscus? | 85% SN....NOT WB at the time of injury= NOT meniscus |
| cut, pivot, or twist injuries may be indicative for? | men. or instability |
| stairs may be painful for who? | patellofemoral patients, places higher compression on the patella |
| Acceleration and deceleration may cause: | ACL/PCL through instability |
| LPP for the patella? | full extension |
| 20* flexion for the patella? | tibfem= LPP |
| why is pain worse in full ext? | tibfem= closed pack |
| when is patellofemoral pain worse? | AT 30*!!! less than 30=fine, over 30= fine |
| Why/when does the knee give way? | all muscles relax= the knee gives out |
| which joint sounds at the knee are okay, which are not? | patella= okay, tibiofemoral= more concerning |
| Swelling in the knee is how SN and for what? | 80% SN for MCL and Meniscal.. DO NOT HAVE! |
| True or false: if you have swelling you want to rule OUT MCL/MENIS: | TRUE! |
| True or false: if you dont have swelling you do not have a menis. or mcl injury: | TRUE! |
| With what type of knee injury will you typically see swelling and why? | ACL tear= has vascular structure with it |
| how soon after an ACL tear will swelling occur? | 1 hour, fluid containing blood begins to accumulate |
| What is the Fick angle? | angle feet are at when standing or walking |
| What does ER do to the knee? | places more MEDIAL force on the patella |
| What does IR do to the knee? | places more LATERAL force on the patella...PIGEON TOED= MANY more probs! |
| What are the two different types of patellar position? | patella alta, patella baja |
| What happens if you rupture your quad or hammys? | lots of blood, wasting =weaker and weaker |
| what is the patella position in a 'frog eye' position? | laterally displaced |
| What do we need to consider in the screw home mechanism? | why it wont screw home aka, go into full extension |
| dif. reasons why it wont 'screw home' | lig(wont make it tight), excessive fluid, tib. wont ER at end range |
| what does a pronated foot cause? | ^ valgus at knee, navicular drop, talus IR, tibia= into flexion, |
| is the knee more stable or less stable when the foot is pronated? | LESS stable |
| What may be the cause of a backward knee appearance? | LAX ACL |
| What is the position of the tibia when the ACL is more lax? | the tibia is placed more forward, more likely to rupture ACL |
| What happens in Patella baja? | bone does not function as a pulley, more patellofemoral, more compressive force |
| What happens in patella alta? | patella= out of groove= no bone stability, lig. check in, GREATER likelihood to dislocate |
| is the ACL taut or lax in flexion and extension? | Taut! |
| what is the position of the knee in the stance phase? | knee is flexed |
| what should the position of the knee be in swing phase? | flexed |
| if the knee is not flexed in swing what may this be indicative of? | stiffness=pain |
| What limits knee flexion? | tissue approx. from the gastroc:hams. |
| what is normal ROM for flex/ext? | 0 to 135* (AROM) |
| normal end feel for knee extension, medial rotation, lateral rotation, patella? | tissue stretch |
| what happens during econcentric actions? | one= concentric(shorten), the other= eccentric(lengthen) |
| What LE muscle groups need to perform ecc and conc? | quads/hammys |
| true or false: isokinetic training is very controlled motion with 3 dimensions? | true! |
| is isokinetic testing without speed very functional to the knee? | no, it is not essential that is done rapidly, therefore it does not affect the knee function to a great extent |
| true or false: isokinetic testing is nice to test as an individual part, but it needs to be integrated as a whole? | true! |
| what do the machines that perform isokinetic testing control? | speed |
| what happens when our muscles fatigue out? | decrease mechanics=increase for injury |
| How is avg torque for isokinetics figured? | left/right, quads/hams/ body weight (2:1 ratio [smaller frame vs larger frame] |
| what is total work? | how much done in a given time |
| when does peak torque occur? | it is generated at its max amount at approx. the middle of range. |
| what is the definition of the time to peak? | 0-->60= how long to contract to full force...training is very important! |
| what is cutting? | abrupt change in direction (think meniscal tears) |
| what type of special test does walking down hill function similarly to? | anterior drawer (ACL) |
| functional tests are completed how? | in order of progressive difficulty: walking, stairs, squatting, running(straight, curves, cutting, stopping), then jumping |
| what is a jump considered? | 2 feet to 2 feet |
| what is a hop considered? | 1 foot--> land on the same foot |
| what is a bound considered? | start one foot--> land on opposite foot |
| what is the point of the 3 hop test? refer to 12.37- Magee? | compare how much distance is covered in 3 hops |
| the crossover test can be examined how? refer to 12.37 | over distance or over time |
| what does covering more distance in a shorter amount of time indicate? refer to 12.37 | better function! |
| Agility hops are performed how? refer to 12.37 | one-then other- one- then other |
| Mini hurdles are completed how? refer to 12.37 | side-> side up->down ...height matters! |
| The MOST USEFUL patellofemoral tests include: | step down test waldron test |
| how is the step down test so useful? | control step down= slow touch heel, bend knee, control eccentric load down |
| how is the waldron test so useful? | patellafemoral (lig?), controlled squat, look for patellofemoral pain |
| What are Metric tests for the knee? | cincinnati knee rating system, knee outcome survey, knee society, knee score, lysholm |
| Medial ligaments: Valgus Test SN | 91% SN with laxity.... NOT lax= NO MCL tear, pain doesnt always indicate tear |
| Lateral ligaments are tested how? | varus test |
| Lachmans test: SN and SP | does not ALWAYS indicate an ACL tear, SN= 85%, SP= 94%, negative means NEGATIVE! |
| Anterior drawer test: SN and SP | positive means positive, low SN= 55%, HIGH SP=92% |
| Sag Sign: | weight of tibia can cause tibia to go back on femur "sag on femur" |
| Posterior Drawer Test SN: | 100% SN- no laxity= no laxity/tear in PCL |
| Pivot Shift Tests SN and SP: | not good to rule out: SN= 24%, SP= 98%....positive test= you know something is wrong! |
| Findings for a pivot shift test may be a result of: | tightness, need to look for rotary instabilities |
| What is the KT 2000? | it measures lachmans test in mm, how far back the tibia glides on femur. It is used for studies because it is valid, reliable, and quantifiable |
| McMurrays test SN and SP: | SN= 55-71%, SP= 71-77%, a POSITIVE means positive a little more. NEGATIVE does not always mean a negative! |
| Apley's test SN and SP: | distration:ligaments, compression:meniscus..... SN=22 to 61%...SP= 70-88% |
| Thessalys test SN and SP: | SN= 90%, SP= 98% |
| what is Thessalys test? | test for meniscus, look for lock or catch in knee, drive knee medially...this is a FUNCTIONAL test! |
| brush test: | pt is sitting: tap on one side, other side will bulge from the fluid |
| bakers cyst: | palpate and feel a hole- swollen in front= 10 cc fluid, bulging in jt capsule |
| Patellofemoral tests: | Clarkes sign, Patellar Apprehension, Q-Angle |
| Patellar Apprehension SN and SP: | SN= 100%, SP= 88%....SN= NO APPREHENSION= DONT have it(-)....(+)= good indicator that pt does have it, this is where we then look for dislocation |
| which order should be check for dislocation? | run through range, then try to dislocate |
| Knee OA: mobilize how? | 4 directions in 1 session |
| how do knee OA patients respond to mobilization? | MODERATELY better 2 days later |
| how do we 'attack' knee OA? | the hip attacks the knee with limitations |
| Patellofemoral pain | Tx: OTC foot orthotics |
| how do patellofemoral patients respond to tx? | 50% decrease in pain with orthotics |
| how does the foot influence patellofemoral pain? | 2* or more forefoot valgus, 78*/90* 1st MTP ext |
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