Flashcards in 04 MCL Deck (37):
1
MCL sprains: MOI
- traumatic valgus force
- twisting injury associated with an ACL injury
2
MCL sprains: clusters of s/s (symptoms)
- patient describes MOI
- may describe a "tearing" sensation
- pain
- pain with palpation over MCL
3
Where on the MCL will there be pain for a sprain?
- most common at joint line
- 2˚ at proximal attachment
4
MCL sprains: clusters of s/s (signs)
- localized swelling (extra-articular)
- effusion (if injury also affects the meniscus or ACL)
- increased c/o pain with valgus stress testing
- laxity testing
5
severity of sprains and laxity testing
depends on severity whether there's instability
6
sprain
involves noncontractile tissue
7
strain
involves contractile tissue
8
primary medial restraint for the knee
MCL
9
primary lateral restraint for the knee
LCL
10
medial restraints: %
MCL at 0˚
57%
11
medial restraints: %
MCL at 30˚
78%
12
lateral restraints: %
LCL at 0˚
55%
13
lateral restraints: %
LCL at 30˚
69%
14
What is the significance of the percentages of lateral and medial restraints of the knee?
it's the scientific reasoning (evidence) of why you test the knee at 0˚ and 30˚
15
grade I sprain
- mild sprain
- interstitial injury to MCL
- pain, but no laxity on valgus stress testing
16
grade II sprain
- moderate sprain
- partial tear of MCL
17
subdivisions of a grade II sprain
1+
2+
18
grade II 1+ sprain
1-5 mm more laxity than uninvolved side
19
grade II 2+ sprain
6-10 mm more laxity than uninvolved side
20
grade III sprain
- severe sprain
- total rupture
21
subdivision of a grade III sprain
3+
22
grade III 3+ sprain
≥10 mm more laxity than uninvolved side
23
MCL valgus stress testing: closing the joint
- first move toward varus to approximate the femur to the tibia
- done so you can palpate the joint line and kinesthetically feel the amount of motion
24
MCL valgus stress testing: what should you consider if it's a younger person?
- Think femoral epiphyseal plate injury
- ligament is stronger than the physes in younger patients
25
What is also possible with an MCL valgus stress injury? (PF)
PF subluxation is a potential additional injury and comorbidity
26
What treatments are common to all grades of MCL sprains?
- treat the symptoms
- MCL double upright brace
- dynamic stability exercises
- neuromuscular reactive training exercises
- functional (specificity) exercises
27
In addition to the treatments done for all sprains, what must be avoided with Grades II and III sprains in particular?
avoid valgus stresses in rehab
28
For a Grade III MCL sprain, what must be used immediately post injury?
drop lock brace
29
Drop lock brace for grade III sprain
Week 1: (0˚) 30-90˚
Week 2: 20-100˚
Week 3: 10-110˚
Week 4: 0-120˚
30
Grade I MCL sprain: return to activity
- back to sports 1-3 weeks
- avg 2 weeks
- with MCL double upright brace
31
Grade II MCL sprain: return to activity
- back to sports in 3-5 weeks
- avg 4 weeks
- with MCL double upright
32
Grade II 1+ return to sports
3 weeks
33
Grade II 2+ return to sports
4-5 weeks
34
Grade III MCL sprain: return to activity
- back to sports 9-12 weeks
- avg 8-10 weeks
- with MCL double upright brace
35
MCL surgical repair
very few GIII MCL sprains have a primary repair
36
When would a MCL primary repair be indicated?
- only for high performance patient with functional instability
- multiple plane injuries
37