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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