Final Exam Flashcards
(49 cards)
Overall - 4 Mechanisms of General Knee Injuries
- Contact or Non-contact (more common)
- Deceleration
- Plant & Pivot (axial + rotation)
- Multi-planar stress (rotation & valgus/varus stress)
History of Knee
T or F: patients will always sense/hear a “pop” with knee injuries
T or F: it is obvious if there’s ever a tear of ACL/PCL
Why is there variable magnitudes and locations of pain with knee injuries?
Why is WB status variable?
Describe the Locking Knee. Is it common? Why is it a good and bad thing?
- not all injuries are 3rd degree….injury can happen with or without pop
- large x-sectional - would be obvious
- due to the varying # of nociceptors in the different structures of the knee
Status can change throughout the healing process
Locking knee: knee gets caught somewhere in the ROM; bad - there is something jamming the joint (loose ligament, meniscus); good - gets you high priority, straight into surgery
Recognition - 4 signs of a knee injury?
Swelling - where and when? (immediate=bleeding/ligament; slow - 24 hrs=syn fluid from syn membrane/meniscus)
Discoloration - if external (no discoloration with ACL/PCL)
Local muscular responses (muscle spasm, atrophy, limited ROM)
Change in WB status
MCL
Position of vulnerability
Pain location
Painful movements
Other damage?
Dynamic stabilitizers
multi-planar - valgus + knee FL
medial femoral condyle, tibial plateau (medial, anterior aspect)
EX, EX ROT (tibia out or femur in)
medial meniscus tear (connected), ACL (if force goes deep)
Pes anserine = 3 saviours of MCL - gracilis, sartorius, semitendinosus
LCL
Position of vulnerability
Rarely damaged because…
3 other potential structures that could be damaged
What might happen to the lateral chain?
varus stress (force running med-lat)
unnatural/uncommon force
PCL, biceps femoris (dynamic stabilizers), popliteus (avulsion)
tight lateral chain - as a response effect
ACL
2 mechanisms or situations where you’d get an ACL tear
3 non-contact positions/motions that could tear ACL?
quick change of direction, one leg landings
near full EX/slightly FL
hyper EX
IN AND EX ROT
T or F: in hyper-EX position, ACL and PCL can be taken out without rotational forces
T
ACL
Special tests?
Pain location
T or F: ACL rarely tears in isolation
lachman’s + others
deep knee pain, anterior tibia, medial joint line (medial to patellar tendon)
PCL
Common MOI(s)
Special test
- dashboard knee (tibia translated posterior); tripping over another player/branch
- HYPER EX (with ACL)
-posterior drawer test
Menisci
Mechanism of injury
ROM that would tear medial/lateral meniscus
Mobility
Joint line pain (M or L) - in what position is it palpable? what are the two theories for meniscus pain, even though they have few nociceptors?
FL + axial load + shear = plant & pivot
medial = EX ROT lateral = IN ROT
palpable = knee FL, sitting on the table
small coronary LIGAMENT (anchors circumbference), articular cartilage (BONE)
Menisci (cont.)
1 good and 2 bad things about the meniscus
Special test
Size and location of the tear influences (ie. bucket-handle tear)
bad - if they don’t feel pain…can cause unnoticed damage,low blood supply - slow metabolic rate; good - meniscus senses little pain, so if it does sense pain it can keep patient off their knee and let it heal
special test - mcmurray
tears can happen anywhere but size/location of the tear can affect its effects or lack of effects on the joint; bucket-handle tear -anterior horn, body of the meniscus (depending on the size/location) it can flap back and forth with knee movement
2 other DDx with knee injury
bone bruising and articular cartilage damage
Potential for surgery
Priority (3 - high to low)
How about MCL?
Policy for surgery - do you always need surgery?
What happens over time if problem is not fixed?
ACL, PCL, unstable meniscus
MCL - if in isolation - heals by itself
athlete vs. normal person
arthritic change
Care for the menisci and ligaments
Acute Care (2) - WB status?
Surgical interventions
Exercise goals (4 focus areas)
Long term challenges
PWB - crutches, brace
remove loose meniscal fragments; full ACL = reconstruction
strengthen and increase control for hip, core, knee, ankle (mostly hip cause it dictates the rest)
long term: post injury = increase shear forces = degradation of cartilage
PFS
Pain locations
4 signs?
Inflammation?
Mechanical or acute damage problem?
4 factors (or rather Side FXs)
LOCALIZED behind patella (at its articulation area with femur)
axial load of BW (running, jumping)
PROLONGED low level fatigue = BUCKLING
theater sign = stiffness of knee after prolonged sitting, knee does not want to flex
/- crepitus (usually normal) - sense of something creaking/grinding
low inflammation
MECHANICAL - weight distribution, imbalance @ knee
hip control - impaired ABDs and EX ROTs (glutes) causing more VALGUS
arch control - OVER-PRO = medial shift of BW = VALGUS
quadriceps weakness - tight/weak RF, pulls on patella and quadriceps tendon to add pressure of it onto femur
restricted lateral chain - weak glutes med; tight ITB (blends into patella) = further pull on patella
Patellar Tendinopathy - “Jumper’s Knee”
Pain location
What action would cause ECC loading of the patellar tendon?
Recall: at what point does tedinopathy occur? What other feature of tendons furthers the problem?
Testing ROM + Resisted testing (pain)
Special test
Direction of patella movement/shift
Care/Supports (4) - identify it’s for PTS or PT
apex of the patella
SHOCK ABSORPTION/LANDING - passive knee FL + ECC load
tedinopathy = rate of damage > rate of repair; tendons usually have a lower blood supply and are often constantly used = overall SLOW HEAL
- = active/passive knee FL, resisted knee EX
thomas, ober’s, step-down*
laterally
PTS: taping to pull patella medially IF QUADS ARE “LOOSE” (if tight, then you’d be further increasing grinding)
PTS: arch support - limit OVER-PRO/Valgus - orthotics, change of shoes, taping,
PTS: knee brace - C-shaped plastic to hold patella medial (can be used if they’re allergic to tape)
PT: patella tendon strap - counter pressure - compression of tendon for distribution of tensile load
Patellar Tendinopathy - “Jumper’s Knee” (cont.)
Mobility for? (3)
Resisted exercises for? (3)
What about exercises for the patellar tendon?
PTS: hip, knee, and tight lateral chain
PTS: ABDs, EX ROTs, knee EXs; more so PFS
PT: patellar tendon responds favourably to ECC training - but be careful because with tedinopathy…this is the MOI in the first place = single/double leg squat on a decline
Why do 1-2 leg squats on a decline? Which intensity level should this be at?
shift of work from ankles to knees as you go ECC down; mildly painful/uncomfortable
T or F: AC joint deals with a lot of rotation forces
F = mostly planar, little movement
Differentiate a shoulder dislocation and a separation
dislocation - completely out - GH joint
separation = structure holding AC joint together is SPRAINED (+/- supporting ligaments, syn. capsule)
AC joint sprain is equiv to?
separated shoulder
T or F: a lot of the ligaments of the AC joint do not cross its joint
T - ie. coracoid process to clavicle
AC joint sprain/”Separated shoulder”
MOI
Patient presentation (name 4)
Aggravating motions (8) - high to low - any problems with rotations?
Other conditions to consider (2)
Rockwood classifications: Type I, Type II or III
-how is classified?
DIRECT LOAD onto ACROMION process due to falls
step deformity
LOW GRADE shoulder dislocation
bruising
discolouration
X-FL, X-EX, FL, ABD, EX, ADD, EX ROT, IN ROT
clavicle fx, impaired traps because the muscle blends into AC
grade or severity
OVERALL: KEEP AC JOINT IMMOBILIZE/CLOSED TO ALLOW HEALING vs. reducing pain
Type I: sling for days - little damage - support dropping of arm from gravity
Type II or II: sling up to 6 weeks - a bit more damage - longer time because more fibres are damaged
Anterior GH Dislocation
Would you grade this?
Common MOI
Patient presentation (3)
Symptoms (3)
Nope, it’s 100% out
APPREHENSION POSITION (ABD, EX ROT, a little X-EX + posterior force) = pops out anterior
humeral head @ arm pit
gap @ acromion process
cradling arm
bruising
swelling
damage at anterior aspect of capsule
