final Flashcards
(83 cards)
1
Q
In the modified hinge joint of the knee what movements are involved
A
Flexion/ Extension
Rotation of the tibia
2
Q
The knee joint is the connection of 2 long bones and it is the _____ stable joint in the lower extremity
A
Least
3
Q
When the foot is in contact with the ground surface it sin ____ kinetic position
A
closed
4
Q
How do you measure the Q angle?
A
measured from ASIS to center of the patella and the tibial tuberosity to the center of the patella
5
Q
What are the normal ranges for the Q angle in both male and females
A
males 10
6
Q
what is considered an unstable Q angle
A
> 20
7
Q
Chondromalacia Patella AKA
A
Patella- Femoral Syndrome
8
Q
What is the most common injury for Chondromalacia Patella
A
Due to non- trauma in the knee…. overuse, degenerative issue
9
Q
Chondromalacia Patella causes damage to what area?
A
the retropatellar articular cartilage (Hyline)
10
Q
Causes for a chondromalacia patella ?
A
cumulative biomechanics micro/macro trauma to cartilage
11
Q
What can chondromalacia lead to?
A
problems with tracking of the patella in the trochlear groove of the femur, OA
12
Q
What is the presentation of Chondromalacia Patellae
A
- Knee pain increases with sustained knee flexion (movie sitting sign)
- retro- patellar crepitus
- decrease joint space on x-ray
- Abnormal Patellar Tracking
13
Q
What is movie sitting sign?
A
Knee pain is increased with sustained knee flexion
14
Q
What is the better way to evaluate the knee
A
have patient do a squat and looking for the patella to go superior to inferior the last 15-20 degrees of knee extension
15
Q
What is the recommendation for management for Chondromalacia Patella
A
increase water glucosamine sulfate 500mg/50ibs CHO-Pat support orthotics adjust spine/knee/lower extremity
16
Q
What are the diff dx for chondromalacia patella
A
- jumper’s knee ( pain above the patella)
- oshgood schlauer(pain below the patella)
- Bursitis
- the 3 C’s (collaterals, cruciate, meniscus)
17
Q
where are the most common bursae located
A
- pre patellar
- infra patellar
- pes anserine
18
Q
What sign is to confirm a PCL tear
A
Godfrey test aka sag sign
19
Q
How do you perform Godfrey test
A
bent knee in air - flex knee and flex hip - push down on tibia
Torn cruciate= sags
Intact cruciate= straight
20
Q
pain increased on medial knee behind knee cap going up steps/hills this indicates what .. and what is this called
A
weak vastus lateralis
medial patellar tracking syndrome / patellar femoral arthralgia
21
Q
______ test and weakness of the ____ muscle are indicators pf the post. tibia that may stimulate meniscus involvement and inability to fully extend the knee
A
- Bounce Home
- Popliteus
22
Q
What are the new terms for anterior / posterior shin splints
A
- medial and lateral tibial stress syndrome
23
Q
Irritation of the _______ is due to shin splints
A
periosteum of tibia
24
Q
What are some causes of medial/lateral tibial stress syndrome
A
- Talo-tibial dysfunction leading to lateral stress on the fibula stressing the interosseous leg. insertion site of the tibia
- Imbalance b/w dorsiflexors and plantar flexes
- Gait- hyperpronation
- over-training
- running surface- camber of road
25
when pain on the lateral side of tibia, what should you rehab
- tip. anterior/ext. hallux longs/ ext. digitorum longus
26
when pain on the medial side of tibia , what should you rehab
- tip. post./ flexor hallux/ flexor digitorum longus
27
what should the management protocol be for shin splints
1. exercise dorsiflexors = heel walk, rocker board
2. exercise plantarflexors= toe walk/ rocker board
3. adjust spine
4. alter activity
5. alter footwear
6. wrapping /ice
28
What should the Diff Dx should be for shin splints
1. stress fx
2. compartment syndrome
3. tendonitis
29
Hip pain is ___ in nature from ____ ____ or ____ ___ , hypertonicity which may also cause ____ knee pain along with _____ snapping hip sound
- trochanteric
- piriformis syndrome
- IT band
- lateral
- external
30
_______ is a lateral stabilizer of the knee
ITB
31
____ may affect hip and create an internal snapping hip condition
Psoas
32
____ ___ is the time interval or sequence of motions occurring between 2 consecutive initial contacts of the same foot
Gait Cycle
33
_____ phase = 60 to 65% of walking cycle
| _____ phase= 35 to 40% of walking cycle
stance
| swing
34
as velocity _____ the cycle length or stride length ____ -
- increases
| - decreases
35
jogging gait cycle =____ of walking
| Running gait cycle= ____ of walking
70%
| 60%
36
wha is involved in stance phase
- foot on ground and bearing weight
- allows lower leg to support weight of body
acts as shock absorber
- acts as shock absorber
- allows for advancement of body over supporting limb
- 60% of gait cycle
37
Subphase 1 of stance phase includes:
- weight loading of stance leg
- AKA double support of double leg stance
- 10% of gait cycle
both feet in contact with floor = toe of one leg and heel of other
38
Sub phases 2 and 3 includes:
- load response and mid stance of single support
- AKA single -lg stance
- 40% of gait cycle
- one leg carries weight and other leg swings through swing phase
39
Subphase 4 and 5 includes:
- Terminal stance and pre- swing instants
- AKA weight unloading period
- 10% of gait cycle
- During period= stance leg unloading body weight to opposite leg
40
Swing Phase Includes
occurs when non weight- bearing
- 40% of gait cycle
- 3 sub phases
41
the 3 sub phases of swing phase
- initial swing= acceleration ( foot lifted off floor, knee flexion and ankle dorsiflexion, occurs to allow swing limb to accelerate forward
- Mid Swing= Swing leg beside weight- bearing leg in mid stance
- Terminal swing= deceleration ( more injuries occur, during running stance phase decreases, Float phase=double unsupported phase)
42
Double leg stance occurs when both feet on ground and occurs ___ of cycle
25%
43
Single- leg stance when only leg occurs and occurs twice during normal gait cycle and is ___ of total cycle
30%
44
List the alterations of gait cycle
- rearfoot varus
- forfeit varus
- forefoot valgus
- Equines syndrome
- Hallux limitus/rigidus
- Plantar flexed 1st ray
tibia vacuum
tibial torsion
- narrow base gait
- angle of gait toe out
- Q- angle
leg length inequality
45
Neutral Gait :
- Zero rear foot and zero forefoot
46
Normal forefoot is considered to be what
4 to 6 varus angle
47
normal rear foot is considered to be what
0 degrees
48
Under - Pronation Gait AKA
supination
49
under pronation gait occurs when
- with a forefoot deformity
- less than 10% have it
- not enough pronation to allow for adequate shock absorption and foot adaption to surface which leads to limit proper rotation of lower extremity , stress on lateral tibial plateau and squeaky know that leads to TFL problems
50
Posterior tibia modified drawer
```
DS= at the foot of the table soft tissue stabilizes over patient foot
P.P= supine with involved leg flexed, foot on table
SCP= posterior proximal tibia and fibula
CP= palm of dominant hand interlocked fingers with opposite fingers and hand
LOC= take the joint to tension from AP and gently pulse P-A
```
51
Post. tibia pump or wedge
```
DS= side of involved knee
PP= supine with involved leg in flexion and foot in the air
SCP= posterior proximal tibia and fibula with hands and the anterior distal tibia with elbow
CP= palms and interlocked fingers on proximal end tibia/fibula and forearm across the distal tibia
LOC= take the joint to tension by pushing anterior to posterior with the elbow
```
52
Posterior tibia prone
```
DS= same side of affected knee , stabilizing anterior tibia with shoulder
Pt= prone with knee flexed and foot in the air
SCP= posterior proximal tibia and fibula
CP= interlocked fingers and hands , elbows tucked in body
LOC= take the joint out of tension and impulse P-A
```
53
____ is used to reset the joint and the muscles surrounding the joint can test for a medial or a lateral plateau
wobble
54
LOD for wobble
impulse into direction of restriction with thenar pads, stabilize pts. slightly flexed leg with doctors knee
55
Fibular- checking motion side of involvement
| what is the fibular head criteria
symtoms, decreased motion, chronic knee, foot or ankle problems
Check ROM
56
Fibular head visualization
look and palpate from the tibial tubercle to anterior aspect of the fibula- check the measurement from side to side
Short Side= anterior
Long side= posterior
57
what is the criteria for a fibular head fingertip pull
- symptoms
- decreased motion
- chronic knee
- foot problems
58
_____ creates internal snapping hip
iliopsoas
59
____ creates external snapping hip
ITB
60
____ creates a figure 8 type motion through complete gait cycle
ITB
61
what is the management of the external hip
- adjust
2. stretch
correct gait
give advice for possible associated trochanteric bursaae
62
Management for internal hip
- adjust spine
- stretch posts
- correct gait
63
what is the result of cane use
- decrease compressive forces into the hip
interaction of gluteus medium on pelvic leveling
support side opposite problem
64
cane use for foot or knee problems is ____ side of injury
same side
65
Anterior talus:
- alters function of arch
- increases internal rotation
- affects tibial alignment, patellar tracking, knee stability
- reflects to ITB
- progresses to SI joint
- impacts lumbosacral relationship
66
initial injury to 2 weeks for Grade 1 (knee flow chart)
- pain with no instability
- adjust knee and spine
- heal=> 2 weeks
- taping/ mild support
- avoid position of pain
- no crutches
- ice 15 2x per day
- ROM=> weight bearing
- keep upper body active
67
initial injury to 2 weeks for a Grade 2 (knee flow chart)
- pain with moderate instability
-adjust knee and spine
- Heal 2-6 weeks
- bracing with activity
- avoid position of pain
- crutches= 2 days per week, wean off 1 to 2 weeks
- ice 15 min 4 X per day
ROM = weight as tolerated in water
- keep upper body active
68
initial injury to 2 weeks for a Grade 3 (knee flow chart)
- pain with severe instability
- adjust knee and spine
- heal => 36 weeks
- full-time brace
- avoid position of pain
- Crutches => 2 weeks
- ice 15 minutes 6X per day
- ROM => without weight 2 weeks in water tub/pool
- Keep upper body active
69
2 weeks to 4 weeks for a grade 1 (knee flow chart)
- full activity
| - taping maybe
70
2 to 4 weeks for a grade 2 knee flow chart
- moderate to full activity
| - wear brace
71
2 to 4 weeks for a grade 3 knee flow chart
- weight bearing walking with support
| - wear brace to avoid pain exercise non- weight unless in pool with chest at water level
72
4 to 8 weeks for a grade 1 knee flow chart
should be normal
73
4 to 8 weeks for a grade 2 knee flow chart
- brace during activity
- no crutches
- full strength workouts
74
4 to 8 weeks for a grade 3 knee flow chart
brace when weight bearing ]
- no crutches
- gradually increase non weight bearing exercise
75
8 to 12 weeks for a grade 1
should be normal
76
8 to 12 weeks for a grade 2
should be normal
77
8 to 12 weeks for a grade 3
- brace when weight bearing
- start weight bearing exercises
- non- painful ROM=> cycling, run in water chest level, mild to moderate weights
78
after 12 weeks for a grade 3
- recheck orthopedic tests
- do gentle adhesive releases in knee flexion to restore complete complete knee flexion and extension
- start stretching regimen
- work up to full strength weight bearing exercises
79
The _____ reflects A to P at the greater trochanter and lateral femoral condyle, creating a figure"8" type motion through the complete gait cycle.
ITB
80
The _____ may also affect the hip and create an 'internal snapping hip' condition when the tight psoas pulls over the lesser trochanter.
iliospoas
81
The Tibia must accomplish up to ___ degrees of relative external rotation from internal rotation in order to accomplished closed pack/ full knee extension.
20
82
_______________-pain behind knee cap lateral side while walking or running down hills or down steps. Usually associated with a weak Vastus Medialis. (VMO)
excessive lateral patellar syndrome
83
______________pain behind knee cap medial side while walking or running up hill or up steps usually associated with a weak Vastus Lateralis.
medial patellar tracking syndrome ( patellar femoral arthralgia)
