Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
92 Cards in this Set
- Front
- Back
HS/QUAD RATIO |
2/3 |
|
normally ----- are stonger than HS |
quads |
|
Lachman's has both good ----- & ------- |
-sensitivity -specificity |
|
Is tibial torsion the same as tibial rotation? |
yes |
|
Lateral Tibial Deviation |
-pronation & tibial IR (for corrected motions) |
|
-sharp pain in the knee -swelling & local tenderness -pain increases w/ knee motion Best intervention? |
-elevate above the heart to decrease edema & increase venous return -rest -compression dressing applied distal to prox to decrease edema -do not heat until 24-48 hrs after injury -avoid WB in acute stages |
|
Fractured tibia -after pain is localized, what is the best tx to decrease pain secondary to a fractured tibia |
-isometric contractions by wiggling the toes to decrease edema & increase venous return -change of position to relieve pressure -elevate extremity -analgesics |
|
TKA -instructions to use a pick up walker w/ 4 solid prongs |
-grip the top of the walker with both hands & walk into it -step off the injured leg & complete the step with the good leg -when turning take smaller steps |
|
Meniscal Tear in avascular area -best type of surgery |
partial meniscectomy |
|
Lachman's -amt. of flex |
20-30 degrees |
|
Ext lag of the knee -what is it |
-greater passive ext. than active ext -difference is used to quantify the amt. of the lag |
|
Causes of ext lag of the knee |
-muscle weakness: inability to produce adequate force for active motion -inhibition by pain: makes it impossible for the muscle to generate amt. of force to actively extend -pt. apprehension |
|
Which ligs control passive screw home mechanism |
ACL PCL |
|
TKA -exercises to do in the recovery room |
-QUAD SETS -SLR -knee straightening -knee flex w/ support (these exercises decrease post-op pain & increase recovery) -walk short distances -assisted knee bend after pt regains independence with short distances |
|
HS-MMT |
PRONE -flex knee to 50-70 degrees with slight lateral rotation of thigh -resistance prox to ankle jt GRAVITY MINIMIZED -sidelying -test leg on frictionless surface |
|
Posterior Sag |
-PCL injury (sprain or rupture) TEST POSTION -supine -knee flex to 90 degrees -hip flex to 45-90 degrees -PT can hold pts foot -positive: posterior position of tibia in relation to femur |
|
Genu varus more common in |
males |
|
Genu valgus more common in |
Females -associated with wider pelvic structure -can influence alignment and extend to ankle & foot, which is more likely to deviate to pronation |
|
Unilateral leg press post op ACL reconstruction |
-closed chain exercise -not as good as mini squat bc it's unilateral & pt would not have the benefit of using uninvolved LE to assist -mini squat implies limited range and unilateral leg press doesn't |
|
Active knee ext in short sit after post op ACL reconstruction |
-open chain exercise that places a significant amt. of force on ant surface of the knee and in particular the patella tendon donor area -DO NOT PERFORM |
|
Isokinetics at 30 degrees per sec 8 days post ACL surgery |
-can jeopardize integrity of the graft |
|
s/p ACL reconstruction w/ patellar tendon autograft -best exercise? |
-mini squat -closed chain exercise performed in standing that allows pt to vary the force through involved extremity by shifting their weight -limits amt. of knee flex and doesn't place a lot of stress through reconstructed knee -during squat knee should not move ant. to toes as hip descends |
|
ACL reconstruction w/ patellar graft -why should knees not come in front of feet |
-it increases the shear force of the tibia and can stress the graft |
|
Anterolateral/medial knee instability -special tests |
-slocum test |
|
Knee swelling -special tests |
-brush test -patellar tap test |
|
Medial Plica Damage -special test |
hughston's plica test |
|
Knee Anteromedial Rotary instability -special test |
slocums |
|
Knee anterolateral instability -special tests |
-slocums -lateral pivot shift -active pivot shift |
|
knee posterolateral rotary instability -special tests |
-reverse pivot shift |
|
knee ITB friction syndrome -special tests |
-noble compression test |
|
lateral pivot shift test |
ACL -anterolateral instability -medially rotated tibia + valgus force to knee |
|
bounce home test |
meniscal lesion |
|
patellofemoral pain syndrome -signs |
-AKA: chondromalacia patella -discomfort in anterior knee -excessive foot pronation -increased Q angle: patella tracks laterally -muscle tightness & imbalance -knee hyperext -weak vastus medialis can't balance lateral pull of lateralis |
|
patello femoral pain syndrome d/t |
-repetitive overuse disorder from increased force at patellofemoral jt |
|
tibial apophysitis AKA |
osgood schlatter |
|
what would restrict both PROM & AROM of knee ext |
-tight HS -capsular restriction -bony obstruction |
|
what causes lateral tracking of patella in WB & non WB |
retinacular tightness |
|
contracted HS or weak quads result in |
-decreased knee ext during stance and an unstable knee |
|
what inserts on pes anserine |
-semitendinosus -gracilis -sartorius |
|
HS -origin |
ischial tuberosity |
|
Clarkes sign tests for |
-patellofemoral dysfunction |
|
Clarkes sign -test |
-supine -knees extended -PT slight pressure distally with web space over superior pole of patella -contract quad -positve: pain with contraction |
|
Tripod Sign test for |
-evaluates HS length |
|
Tripod Sign -test procedure |
-sitting -knees flexed to 90 degrees over table -PT passively extends one knee -positive: tightness in HS OR ext of trunk to limit effect of tight HS |
|
Why avoid ER of the hip after TKA |
-it may cause slight knee flex and increase the risk of a knee flex contracture |
|
correct position of the knee post op TKA |
-supine -pillow under calf w/ knee ext -helps to decrease edema and regain knee ext |
|
post op TKA - position to avoid |
-supine with pillow under the knee -this increases risk of flex contracture -be careful bc pts like this position bc it's open packed position and less painful |
|
tight HS's does what to AROM & PROM |
-limits both AROM & PROM -does not cause ext lag (PROM> AROM) |
|
extension lag |
-inability to actively extend knee through full ROM (PROM>AROM) -diff. btwn. AROM & PROM used to determine magitude of ext lag |
|
reasons for ext lag |
-inhibition of quads d/t pain is common reason (if knee is passively moved into ext. there is no pain) -weak quads also reason for ext lag -bony obstruction |
|
IT Band Syndrome -what is it |
-irritation of IT Band where it passes over the lateral femoral condyle -often caused by tight TFL of glute max -aggravated by repetitive flex & ext of the knee |
|
IT Band Syndrome -Tx |
-LE flex program -once sx's have decreased cycling may be more desirable than running (if running increases sx's) |
|
Tibial plateau fx d/t |
-usually from traumatic injury, not overuse |
|
tibial plateau fx -signs |
lateral knee pain |
|
patellofemoral (chondromalacia patella) -anatomically what's happening? -causes pain where? |
-softening of cartilage on underside of patella -results in ant knee pain |
|
IT band syndrome -common injury in |
runners |
|
IT band syndrome -often d/t? |
tight IT band |
|
IT band -insertion |
-lateral knee, can cause pain there |
|
IT band syndrome -tests |
-ober -modified thomas |
|
straight leg raises -strengthen |
-knee extensors (mostly rectus femoris) |
|
heel slides strengthen |
-knee flexors & extensors |
|
ACL sprain grade III -management |
-strengthening -proprioceptive exercises -bracing to maintain stability until surgery (muscles & ligs can't fully compensate for laxity from grade III sprain) |
|
Why doesn't ACL heal on it's own |
-poor vascular supply -approximation -typically repaired with grafting rather than re-approximation of the damaged lig |
|
Why pursue conservative management for grade II ACL tear & not surgery for and 11 yo |
-ACL reconstruction often deferred in adolescence until tibia epiphysis closes & pt reaches skeletal maturity -risk of growth plate disruption is a big factor -conservative management may carry increased risk of injury to adjacent structures (MCL, meniscus) in the short term, growth plate disruption can lead to lifelong orthopedic deficits |
|
Why do females experience more ACL injuries than males |
2-8 x greater -bony alignment -hormonal difference -pelvis width -joint laxity -structurally smaller lig -larger Q angle increases lateral pull of quads on patella & leads to increased risk for ACL injury -narrow intercondylar notch |
|
patellar tap test |
indicates jt. effusion |
|
noble compression test |
indicates IT band syndrome |
|
damage to which other structures is associated with MCL sprain |
-ACL -medial meniscus -posteromedial jt capsule -tibial plateau |
|
steinman test |
-pt seated -knee flex 90 degrees -PT IR & ER tibia |
|
McMurray |
-knee ext + tibia IR + varus -knee ext + tibia ER + valgus (IR the toe points to the medial side and you stress the opposite side the toe points to, so do a varus stress test) |
|
Apley |
-prone -90 degree knee flex -PT applies axial load to lower leg & ER's & IR's the tibia |
|
Hughston's Plica Test |
-supine -PT flex knee & IR tibia -PT presses patella medially with the other hand and palpates the medial femoral condyle |
|
most sensitive test for acute ACL rupture |
lachmans |
|
ACL tear -signs |
-acute pain -popping in knee during landing from a jump |
|
pivot test |
-used to detect ACL injury -valgus force to knee as ER the foot & passively straighten the knee (during valgus the foot wants to ER) (piVot = Valgus) |
|
sag test assesses |
PCL injury |
|
test for meniscus injury |
mcmurray apley -create compression or shearing forces on torn meniscus |
|
ACL tear -signs |
-acute painin knee -hemarthrosis -inablity to complete knee ext audible pop when changing direction at a game and it tears -absence of endpoint when tibia displaced forward from femur
-positive lachman: no endpoint |
|
positive mccurray indicates |
MCL injury medial meniscus tear |
|
Grade III medial meniscal repair surgery -how long to return to normal activity after surgery |
0-6 weeks: protect area, immobilize, allow tissues to heal 6-12 weeks: PROM progress to AROM 12-18 weeks: AROM progress to resisted activity -knee brace & locked in full ext for 1st 6 weeks -full motion when not WB -arthroscopic repair may have shorter recovery time |
|
ACL injury -MOI |
-audible pop in the knee after suddenly changing direction |
|
PCL tear -MOI |
-force to the anterior aspect of the prox tibia when the knee is flexed |
|
valgus force applied to partially flexed knee -triad of injury involves which structures |
-ACL -medial meniscus -MCL (pain & stiffness in medial knee) |
|
a meniscus repair may compress which nerve |
saphenous |
|
meniscus repair -3 phases |
PHASE I -regain balance & coordination -isometric quads & SLR's in sitting or supine PHASE II -regain full knee motion & strength -stationary bike -SAQ PHASE III -return to normal physical activity |
|
MCL injury -valgus stress test w/ laxity of 7 mm Treatment |
-laxity of 7 mm = Grade II MCL injury -Grade III tear: initially non WB Tx for grade II -ambulate with WB as tolerated |
|
Genu Valgum |
GAIT -each leg swings outward to avoid striking limb with ground when taking a step -knees touch in standing -ankles apart in standing -usually seen in kids 2-6 yo |
|
If meniscal repair involves greater than 50% of meniscal thickness -best procedure |
meniscus repair -recommended for tears greater than 50% of meniscal thickness -if tear is in vascular region -unstable to arthroscopic probing - greater than 1 cm in length |
|
ACL injury -best type of surgery |
intra-articular reconstruction |
|
LCL lig injury -MOI |
-inwardly directed force applied from the knee to the outside |
|
MCL injury -MOI |
-outwardly directed force applied to a partially flexed knee from the inside |
|
strongest lig in the knee |
PCL (tensile strength of 200 N) -twice as strong as ACL -MCL is stronger than LCL |