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78 Cards in this Set
- Front
- Back
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Approximately how much of the adult population has knee complaints?
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10-15%
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Knee complaints account for __-__% of all visits to a physician
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3-5
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Approximately __% are sports injuries from football, baseball, basketball, soccer, skiing, etc.
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75
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What is a common way an athlete experiences a knee injury?
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When wearing cleats that get stuck in artificial turf
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What is the ratio of knee injuries between females and males?
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3:1 ... knee injuries more common in females
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What bones make up the knee joint?
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patella, femur, tibia
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What's the function of the ligaments in the knee?
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To provide the knee with STABILITY
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What are the 5 knee ligaments?
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Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL), Lateral Collateral Ligament (LCL), and the Meniscal Ligament
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What is the function of the PCL?
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Limits anterior to posterior motion of tibia in relation to the femur
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What is the function of the ACL?
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Limits posterior to anterior motion of tibia in relation to the femur
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Describe an ACL injury and some common examples.
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- Foot planted, hyper-extension, twisting motion
- often with valgus stress - Occurs with clipping in football; lateral hit |
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Describe a PCL injury and some common examples.
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- Impact to the anterior shin with knee flexed
- Car accident (knee pushed against the dash) or falling on distal lower extremity |
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Describe LCL and MCL injuries.
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Rotation with an extended or slightly flexed knee position
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Compare swelling of ACL and Meniscal tears.
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1. ACL tear - immediate swelling/effusion
2. Meniscal tear - delayed onset of swelling/effusion |
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Describe Clinical Manifestations (CMs) of the following ligaments: ACL?
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When injured, feels like it BUCKLES (give out or gives away) when walking regularly
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PCL?
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Knee buckles when walking DOWNSTAIRS.
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MCL?
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pain along the MEDIAL aspect of knee joint; with VALGUS stress
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LCL?
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pain along the LATERAL aspect of knee joint; with VARUS stress
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What is the difference between varus and valgus stress?
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-VALGUS = medial (when closing knees)
-VARUS = lateral (when opening knees; like when you bend over) |
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What is the main function of the menisci?
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CUSHION
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What does bone rubbing on bone signify?
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The menisci are not there; can lead to arthritis
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Which of the two menisci is more attached to the tibia?
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MEDIAL MENISCUS
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Which of the two menisci is larger?
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LATERAL MENISCUS
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Which menisci has some mobility and which is immobile?
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The MEDIAL meniscus is IMMOBILE.
The LATERAL meniscus does have SOME MOBILITY. |
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What is the primary range of age for knee replacements?
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60-65
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What are articular surfaces?
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Surfaces where the femor and the tibia meet
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What is the technical term for the surfaces where the tibia and femur meet?
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Articular surfaces
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What are the 4 functions of menisci?
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1. Lubricates
2. Shock absorber 3. Provides increased STABILITY of the knee joint 4. Distributes weight across the knee |
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What is the Mechanism Of Injury (MOI) of the Medial Meniscus? Explain. (There are 2)
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1. Sports injuries - occurs with excessive rotational force of the femur on the tibia
2. Degenerative - wear and tear |
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Which menisci is most commonly injured? Why?
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Medial meniscus, because it is not as mobile
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True or False: Medial menisci injuries only occur WITH ligament tears.
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FALSE
- They may occur with or without ligament tears |
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Name 3 of the 9 Clinical Manifestations of Meniscus tears.
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1. Heard a popping sound
2. Clicking 3. Locking (inability to fully extend; usually medial meniscus because it isn't as mobile) 4. Catching 5. Buckling (giving out or giving in) 6. Swelling - delayed onset (abrupt onset with a ligament tear) 7. Pain (+/- with meniscus damage - menisci are without pain fibers) 8. Pain/difficulty walking up and down stairs and squatting 9. Joint line tenderness on the side of the injury |
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What are the 5 primary things you look for during inspection?
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- Gait = antalgic (limp while walking)
- Position = flexed, hanging - Effusion = loss of peripatellar grooves - Bony Deformities, ecchymosis, muscle atrophy (loss of muscle mass) - posterior sagging or leg distal to patella |
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What parts of the knee do you palpate?
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- ACL, LCL, MCL, Lateral Epicondyle of the femur, Medial Epicondyle of the femur, Tibial plateau (margins of the tibial plateau), tibial tuberosity, popliteal space (at the back of the knee), and inner and outer sides of knee.
- WILL NEED TO LABEL DIAGRAM FOR EXAM |
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If a meniscal tear is present would a patient present pain during palpation?
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YES; moderate pain
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How do you test ROM?
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Flexion (bringing knee back) and extension
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How do you test strength?
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With RESISTANCE to flexion and extension
- +5/5 and equal bilat = normal |
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Example of how to test strength in knee?
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put pressure on shin area (bilaterally) and ask them to push and pull
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How do you test Neuro?
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Sensation & reflexes;
- Sensation: start DISTAL, move proximal if abnormal - Reflexes: quadriceps reflex |
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How do you test vascular?
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REFLEXES
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What are the three pulses to find in the vascular portion of the physical exam?
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- Dorsalis pedis
- Posterior tibialis - Popliteal (most difficult to find; at the back of the knee) |
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What are the two most used types of knee effusion?
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1. Bulge test/Fluid wave
2. Ballottement test |
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What is the most sensitive test for ACL instability?
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LACHMAN'S TEST
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What is a positive test in the Lachman's test?
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if increased anterior subluxation of tibia in relation to the femur
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What is sensitivity?
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% false negatives
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What is the most commonly done test for ACL instability?
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Anterior drawer test
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What is a positive finding of the Anterior Drawer test?
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if increased anterior subluxation of tibia in relation to the femur
---(SAME AS Lachman's) |
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What is a positive finding of the Posterior Drawer test?
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if increased posterior subluxation of tibia in relation to the femur
--- (opposite of anterior drawer test) |
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How is the posterior drawer test done?
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By pushing the tibia AWAY FROM you
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What test is used on the MCL?
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Varus stress test
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What test is used on the LCL
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Valgus stress test
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What ligament is McMurray's test for?
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Distinguishes between meniscus and ligament problems
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What is a positive result of McMurray's test?
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pain; popping/clicking with flexion to extension of knee and hip with internal and external rotation of tibia while valgus stress is applied
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What is Apley's compression test for?
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meniscus
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What is a positive result of Apley's compression test?
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increased pain
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What effect does "pulling up" have on the knee?
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opens space around meniscus and stretches the muscles
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What effect does "pushing down" have on the knee?
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closes space
- WILL hurt if meniscus damage is present; will NOT hurt if ligament problem is present |
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What are the purposes of Apley's compression and distraction tests?
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Distinguishes between meniscus and ligament damage
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What does a positive compression test signify?
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meniscus injury
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What does a positive compression test signify?
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ligament injury
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__% of ACL tears are associated with a meniscal tear
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50
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True or false: Meniscus injuries heal slowly.
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TRUE
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Why do meniscus injuries heal slowly?
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Because of the lack flow to the middle of the menisci
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________ injuries are typically medial meniscus and MCL.
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Acute
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Acute injuries are typicall ______ ________ and ___.
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Medial meniscus; MCL
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What is the terrible triad in relation to sports injuries?
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Injury of the MCL, ACL, and medial meniscus
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True or False: The meniscus lacks pain receptors.
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TRUE
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True or False: X-rays will be positive for ligament and menisci damage.
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FALSE; X-rays are negative for ligament and menisci damage because they involve soft tissue
- (used to r/o fractures) |
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What is the best non-evasive way to confirm ligament or meniscus damage?
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MRI
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What is considered "Conservative Treatment" in terms of knee injury? (4 things)
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- limit activity
- anti-inflammatory medication - quadriceps strengthening exercises - Time (8-12 weeks) |
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What is the best method of determining if a knee injury is an ACL tear?
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GO IN AND LOOK! (scope or othoscopy)
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True or False: Prescription dosage is usually 2 times the dose on the box.
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TRUE
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What is the risk of letting a meniscal tear go?
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Could cause articular carilage damage
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What should you do if conservative treatment (tx) is not working or if locking, clicking, catching, giving away, significant loss of ROM, or obvious deformity occurs/is present?
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REFER TO ORTHOPEDICS
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True or False: All meniscus tears are very painful
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FALSE; some menisccus tears are NOT painful
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What is arthrocentesis used for? (2 things)
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To drain fluid as a treatment (relieves pain) or to acquire the fluids for diagnostic testing
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What is the purpose of fluid analysis?
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Could help give you cause of swelling
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What is arthroscopy used for?
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to r/o a meniscus tear; also cleans up meniscus
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