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57 Cards in this Set

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