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The Knee- 639

The knee

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 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
Created by: 1158150021
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