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57 Cards in this Set
- Front
- Back
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Osgood-Schlatter's Etiology
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-boys > girls; age 10-15 y.o
-osteochondrosis of tibial tubercle or avulsion -px with running/stopping, stairs and jumping |
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Osgood-Schlatter's Clinical Appearance
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pt c/o local pain aggravated by kneeling on tibial tuberosity, direct blows and running, stopping, jumping etc.
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Osgood-Schlatter's Examination Findings
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- palp tend +
- palp cond + - MSTT + str/px with knee EXT - radiograph - possible dec CPROM |
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Osgood-Schlatter's Rx
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PT-reduce px and swelling
-address flexibility issues -chopat support to reduce patellar ligament tension MD-restrict aggravating activity |
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Osgood-Schlatter's vs Patellar Tendonitis
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two dx very similar, only differentiation occurs with radiograph confirming O-S...
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Meniscal Tear Etiology
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-hyperflexion can be ground between the femoral condyles and tibia, post meniscal glide is restricted by capsule
-tibial rotation that occurs opposite the normal accessory motion during FL and EXT ex: ER+knee FL, IR+knee EXT most often affects athletes |
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Bucket Handle Tear Clinical Appearance
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-"locked knee"
-usually medial -dec CAROM EXT due to meniscus in intercondylar groove, springy rebound -effusion -quad atrophy |
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Ant/Post Horn Tears Clinical Appearance
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-"catching sensation", but no ROM restriction
-knee feels unstable, pt cannot localize px -intermittent effusion -quad atrophy -less often than bucket handle |
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LCL Tear Clinical Appearance
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-rare 2* strong muscular stabilization laterally
-AccPROM EF: laxity or swelling -varus stress test + -palp tend + -MSTT knee FL/IR negative -no effusion, extracapsular |
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MCL Tear Clinical Appearance
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-result of valgus stress in FL or EXT
-part of unhappy triad -valgus stress test + -AccPROM EF: laxity, effusion ->part of capsule! |
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Unhappy Triad Clinical Appearance
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ACL+MCL+med meniscus
-mechanism: valgus stress + knee FL + ant tibial translation -associated with athletes often -AccPROM P/A glide laxity - + Apley's Distraction and Compression for medial structures -valgus stress + laxity |
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Tibial Plateau Fx Clinical Appearance
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-usually 60 y.o.<, osteoporosis
-valgus force compressing femoral condyle and tibia -comminuted, intracapsular, complications: hemarthrosis, DJD, adhesions, popliteal artery dmg |
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Synovitis
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effusion, warmth, onset approx 1 hr +
caused by irritation to intracapsular structures AccPROM EF: effusion |
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Hemarthrosis
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blood in joint, immediate swelling and hot
capsular tear blood breaks down cartilage, introduces fibrinogen into capsule increasing adhesions AccPROM EF: effusion requires immediate MD referral |
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Grade I Ligament Sprain
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-mild sprain
-no laxity with AccPROM -no loss of ligament integrity Rx: treat pain, swelling |
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Grade II Ligament Sprain
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-moderate tear, partial integrity loss
-mild laxity with AccPROM Rx: reduce pain and swelling, TFM, strengthening |
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Grade III Ligament Sprain
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-severe tear or complete rupture
-significant laxity with AccPROM Rx: immob, possible surgery, PNF exercises, CKC exercises |
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ACL Injury Mechanisms
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-hyperextension
-deceleration in CKC with rotation -hyperflexion -forced ER of femur in CKC |
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ACL Clinical Appearance
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-presence of clicking
-pop heard during injury -knee px, diffuse px -ant tibial instability -fxnal limitation -unable to run -potential hemarthrosis |
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ACL Medical Rx
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-surgery often in active individuals requiring stability
-BonePatellarBone gold std surg. -other surgeries involve biological structures and synthetics |
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ACL PT Conservative Rx
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-reduce px and swelling
-quad/ham isometrics -limit initial therex 90-45 FL -isometric IR/ER tibia when 90 FL obtained -emphasize Ham for rotational tibial control -estim for muscle maintenance -knee brace for activity |
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ACL PT S/P ACL Repair Rx Acute
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Accelerated protocol:
-immediate motion, WBAT, -immediate full EXT -early CKC therex to maintain strength and NM control -aquatic therapy -PNF |
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ACL PT S/P ACL Repair Rx SubAcute/Settled/Chronic
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-continue CKC therex
-progress to ambulation, balance exercises -treadmill gait training for symmetrical gait -progress to running, plyometrics |
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PCL Injury Mechanisms
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-flexion with post translation
-varus force -blow to tibial tubercle -fall on flexed knee or plantar flexed foot -“dashboard injury” |
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PCL Clinical Appearance
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-generalized pain
-instability -functional limitation -knee gives way -hemarthrosis—positive “tap test” or emptying the suprapatellar pouch -inability to easily descend stairs, squat or run backward |
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PCL Medical Rx
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-may/not operate
-good prognosis w/out surgery if isolated PCL |
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PCL Injury Conservative Rx
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-eccentric quad exercise
-dynamic stabilization -balance/stabilization exercise -CKC therex |
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Rx S/P PCL Repair
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-no isolated ham exercise 6-8 wk
-CKC therex -no early motion -4-6 wks immob -focus quad exercises -strengthen gastroc if repositioned during surgery |
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Pes Anserine Tendonitis Injury Mechanism
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-overuse injury/repeat mvmts
-DJD -same side road running -"muscle imbalance" -rapid change to training intensity/duration/frequency |
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Pes Anserine Tendonitis Examination Findings
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-MSTT + str/px with FL/IR
-Palp Cond + warmth/swelling -Palp Tend + px over tendon -MLT px w/ stretch gives reactivity |
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Pes Anserine Tendonitis Rx
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-ice, rest, avoid aggravating activity
-TFM -nonthermal US |
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Popliteus Tendonitis vs. Semimembranosus Tendonitis
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-MSTT + str/px with FL/IR
->test hip to differentiate -palp tend + px over tendon -palp cond + warmth/swelling |
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3 Locations of Patellar Tendonitis
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-inferior pole
-tibial tubercle -suprapatellar ->use palp tenderness to differentiate |
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Patellar Tendonitis Injury Mechanism
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-kneel w/out padding
-osgood-schlatter's -muscle imbalance -patellar tracking -jt mobility -genu varus/valgus |
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Patellar Tendonitis Examination Findings
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-MSTT + str/px with knee EXT
-palp cond + warmth/swelling -palp tend + px over site -MLT px w/ knee FL |
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Popliteus Tendonitis Clinical Appearance
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-px over lateral insertion on femoral condyle
-usually associated with long distance running -may see excessive foot pronation |
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IT Band Friction Syndrome Examination Findings
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- Ober's Test + ITBand tight
- Noble's Compression + - palp tend + px over lat condy. - palp cond + warmth/swelling - MSTT + Hip FL and EXT |
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IT Band Friction Syndrome
Clinical Appearance |
-lateral knee pain
-px w/ squatting (max 30deg FL) -lat condyle tenderness -may be crepitus with AROM FL/EXT -may occur after drastically changing a training regimen |
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Spencer et al
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=> VMO is not selectively inhibited by effusion
-20 mL effusion enough to inhibit VMO, rec fem, VL, 60 mL MORAL = strength ex may not be effective until effusion has diminished |
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Anouchi et al
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-TKA had greater effect on pts with very limited motion Preop, less limitation preop pts had less improvement
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Define Q Angle
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-angle between the pull of the quads and the patellar ligament
-ASIS to mid patella; mid patella to tibial tubercle -norms approx 12-18 deg |
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3 symptoms of PF Syndrome
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-anterior knee px
-px w/ squatting, kneeling -px after sitting "movie-goers" |
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Structural Contributions to PF Syndrome
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genu valgus, femoral anteversion, external tibial torsion, excessive hindfoot pronation (IR tibia inc. valgus stress), leg length discrepancy
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Define Chondromalacia Patellae
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Chondromalacia is softening (malacia), fissuring and fibrillation of the articular cartilage on the posterior surface of the patella
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Distinguish PF Syndrome from Chondromalacia Patellae
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-CP is softening of articular cartilage of patella, can ONLY be confirmed by imaging
-present similarly clinically, insidious onset, ant. knee px =>avoid CP dx, we have no tools to verify |
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Causes of Anterior Knee Pain
Tissues |
-contractile: quads, hams
-ligament: hypermob laterally -capsule: laxity or tightness -osseous: smaller lat. condyle -cartilage: DJD -edema/effusion -fat pad: highly nociceptive |
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Other Causes of Anterior Knee Pain
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-direct trauma
-indirect trauma -pathology: RA -referred px: L2/3; S2 -Ergonomics -Neural Elements |
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Patellar Dislocation vs. Subluxation
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dislocate: tear present
sublux:edema/effusion, dec muscle control |
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Plica
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-thickened, fluid filled folds of the synovium that may require surgery
-FL problem -palp t, palp c, and stutter test to confirm |
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Plica Rx
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Pa - heat/ice
Pr - US or massage Co - TFM Su - self TFM, avoid FL postures |
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Dr. Kao S/P PCL Arthroscopy Phase 1
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-3 weeks locked EXT
-NWB gait training w/ ax crutches |
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Dr. Kao S/P PCL Arthroscopy Phase 2
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-90 deg FL over 2-3 mo post op.
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Dr. Kao S/P PCL Arthroscopy Phase 3
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-quad strengthening to include:
SLR, SAQ, Quad sets |
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Dr. Kao S/P PCL Arthroscopy Phase 4
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-3-4 mo add Hamstring curls
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Dr. Kao S/P PCL Arthroscopy Phase 5
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-at 80% strength begin running and agility exercise
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Dr. Kao S/P PCL Arthroscopy Phase 6
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-9 to 12 mo post op may return to sports
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Indications for ACL Surgery
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-ACL deficiency
-young, active person -fxnal instability during change of direction activity |
