Knee Flashcards
(158 cards)
1
Q
What type of joint is the Tibiofemoral joint?
A
The Tibiofemoral joint is a modified hinge joint (synovial) that allows primarily biaxial movement in one plane, including flexion, extension, and internal/external rotation.
2
Q
What bones form the Tibiofemoral joint?
A
The Tibiofemoral joint is formed by the distal femur and proximal tibia.
3
Q
Describe the static stabilizers of the Tibiofemoral joint.
A
• Joint capsule
• Menisci: Increases articular congruency, absorbs shock; the medial meniscus is attached to the medial joint capsule, MCL, and ACL.
• Patellar ligaments
• ACL/PCL: Provides anteroposterior stability.
• MCL/LCL: Provides mediolateral stability.
• ITB
4
Q
What are the dynamic stabilizers of the Tibiofemoral joint?
A
• Pes anserinus (medial)
• Biceps femoris and semimembranosus (posterior)
• Gastrocnemius (posterior)
• Popliteus (posterior)
• Quadriceps and extensor retinaculum (anterior)
5
Q
What type of joint is the Patellofemoral joint?
A
The Patellofemoral joint is a plane (synovial) joint that allows gliding between the femur and patella.
6
Q
What bones form the Patellofemoral joint?
A
The Patellofemoral joint is formed by the distal femur and the patella.
7
Q
What is unique about the patella in terms of bone classification?
A
The patella is the largest sesamoid bone in the body.
8
Q
How does the patella increase the biomechanical advantage of the quadriceps?
A
The patella enhances the quadriceps’ biomechanical advantage during the last 30 degrees of knee extension and redirects forces exerted by the quads.
9
Q
How does the patella track during knee movement?
A
The patella tracks laterally during extension, following the line of pull of the quadriceps.
10
Q
What is the normal range of motion (ROM) for knee flexion?
A
Flexion = 135 degrees.
11
Q
What is the normal range of motion (ROM) for knee extension?
A
Extension = 0 degrees.
12
Q
What is the normal range of motion (ROM) for knee internal rotation?
A
Internal Rotation = 30-40 degrees.
13
Q
What is the normal range of motion (ROM) for knee external rotation?
A
External Rotation = 20-30 degrees.
14
Q
Why do we need a balance of stability and mobility in the human body?
A
To achieve mechanical efficiency in movement.
15
Q
What determines the primary need of a joint (stability vs. mobility)?
A
Available movement at the joint, articulation, amount of static and muscular stabilizers, etc.
16
Q
Do two joints with the same primary need (stability or mobility) usually appear in tandem?
A
No, typically two joints with the same primary need are not found in tandem.
17
Q
What happens if a joint lacks stability or mobility?
A
Another joint will compensate, leading to mechanical inefficiency and potential injury.
18
Q
What is the primary functional need of the knee?
A
Stability, due to its sagittal plane movement, poor articulation, and vulnerable static stabilizers.
19
Q
What planes of motion must be controlled for efficient knee movement in the sagittal plane?
A
Rotation and abduction/adduction must be controlled.
20
Q
How does knee instability manifest?
A
As unwanted movement in the transverse and/or coronal planes while trying to move in the sagittal plane.
21
Q
What are the knee’s menisci and ligaments sensitive to?
A
Varus/valgus forces and shear stress, making stability important to prevent injury.
22
Q
What can cause excessive rotation or adduction/abduction in the knee?
A
Issues at neighboring joints, such as excessive pronation/supination at the subtalar joint or lack of pelvic stability.
23
Q
How does excessive pronation at the subtalar joint affect the knee?
A
It can lead to compensatory movement in the knee, increasing stress and instability.
24
Q
What effect does pelvic instability have on the knee?
A
It may cause compensatory adduction or internal rotation in the knee, leading to valgus stress.
25
During single limb stance in gait, which directions does gravity pull the hip/pelvis?
Into adduction and internal rotation.
26
Which muscles control adduction and internal rotation at the hip during single limb stance?
The deep lateral rotators (control internal rotation) and hip abductors (gluteus medius controls adduction).
27
What are possible consequences of weakness in gluteus medius or deep lateral hip rotators?
Valgus at the knee and overpronation at the subtalar joint due to increased adduction/internal rotation.
28
How does overpronation (pes planus) of the ankle affect the lower extremity and knee?
Causes internal rotation of the lower extremity, dysfunctional patellar tracking, and valgus at the knee.
29
What are the effects of oversupination (pes cavus) of the ankle on the lower extremity and knee?
Leads to external rotation of the lower extremity, strain on lateral structures, potential varus at the knee, and hyperextension with excessive tibial external rotation.
30
How do weak hip lateral rotators and abductors impact the lower extremity?
They cause internal rotation in the lower extremity, which may lead to overpronation of the foot.
31
What effect does femoral anteversion have on the knee?
It can increase the Q angle and cause lateral patellar tracking issues.
32
How does an increased Q angle impact patellar movement?
It may lead to patellar tracking issues, especially laterally.
33
What are the key ankle and foot observations for a quick postural assessment related to knee pain?
Look for pes planus (overpronation), pes cavus (oversupination), and toe-out/in positioning.
34
What are the implications of pes planus in a postural assessment?
Overpronation can cause medial tibial rotation, valgus at the knee, patellar tracking issues, and inefficient force distribution up the kinetic chain.
35
How does pes cavus affect the lower extremity during weight-bearing?
It leads to lateral tibial rotation, possible patellar tracking issues, and fails to dissipate forces effectively.
36
What does a toe-in or toe-out position indicate in a knee pain assessment?
It may suggest tibial or femoral rotation.
37
What are important knee observations in a postural assessment for knee pain?
Check for tibial rotation, patellar height, varus/valgus alignment, and hyperextension.
38
What are the implications of medial and lateral tibial rotation on knee function?
Medial rotation often accompanies overpronation, and lateral rotation accompanies oversupination, both affecting patellar tracking.
39
How does varus or valgus alignment impact the knee?
It stresses the collateral ligaments and joint capsule.
40
What is the implication of hyperextension at the knee?
Hyperextension places stress on the ACL.
41
What hip observations are critical in a knee pain assessment?
Observe for innominate rotation, increased Q angle, and femoral retroversion or anteversion.
42
How does innominate rotation or a leg length discrepancy affect the knee?
The longer leg may overpronate to compensate, leading to tibial rotation and valgus stress at the knee.
43
What is the impact of an increased Q angle on the knee?
It increases the bowstring effect on the quadriceps, causing more lateral patellar tracking.
44
What are the implications of femoral anteversion in knee assessments?
Femoral anteversion can increase the Q angle and may indicate muscular imbalances at the hip.
45
What is the Q angle?
The Q angle is the angle formed by two intersecting lines: one from the ASIS to the midpoint of the patella, and the other from the tibial tuberosity to the midpoint of the patella.
46
What do the two lines of the Q angle represent?
They represent the bowstring effect on the patella from the pull of the quadriceps femoris muscle and the patellar tendon.
47
What is considered a normal Q angle?
A normal Q angle is 10-15 degrees, typically greater in females than in males.
48
Where does the patella typically stay and track with a normal Q angle?
The patella stays and tracks within the intercondylar groove.
49
What factors help maintain a normal alignment of the patella?
1. Balanced pull of the vastus medialis (VMO) and vastus lateralis
2. The lateral condyle of the femur projecting more anteriorly
3. Medial and lateral patellofemoral ligaments
50
What factors can increase the Q angle?
• A wide pelvis
• Changes in the orientation of the femur and tibia relative to each other
• Genu valgus
51
What are the impacts of an increased Q angle on the knee?
• Increased lateral tracking of the patella
• Increased patellofemoral pressure, especially the • lateral facet against the lateral femoral condyle during flexion and weight-bearing
52
What is neuromuscular inhibition?
Neuromuscular inhibition occurs when muscles do not function optimally and may test weak due to neurological inhibition.
53
What are common causes of neuromuscular inhibition?
• Pain
• Inflammation
• Trigger points
• Myofascial restrictions
• Joint effusion
• Joint laxity
• Reciprocal inhibition (short antagonist)
• Nerve impingement or damage
• Disuse or deconditioning
54
How does the CNS respond to tissue damage or joint issues?
The CNS may inhibit muscle function via motor nerves to protect tissue from further injury.
55
How can a short or overused muscle affect its antagonist?
A short or overused (hyper-facilitated) muscle can inhibit its antagonist, a process known as reciprocal inhibition.
56
What is reciprocal inhibition?
Reciprocal inhibition is when a hyper-facilitated muscle causes inhibition in its opposing muscle (antagonist).
57
How does injury impact muscle balance?
An inhibited muscle after injury may leave its antagonist unopposed, potentially causing hyper-facilitation in the antagonist.
58
Why is rehabilitation important after injury in relation to muscle control?
Rehabilitation is necessary to restore proper muscular control and synergy, allowing both agonist and antagonist muscles to function correctly.
59
What is meant by "flexion dominance" in human biology?
Humans are biologically flexion dominant; our primary spinal curve is kyphotic, and we develop secondary curves (lordosis) through muscular effort to achieve an erect posture.
60
What is the function of the popliteus muscle?
The popliteus muscle:
• Unlocks the knee from an extended position via tibiofemoral rotation to allow knee flexion
• Stabilizes the posterior knee
• Protects the knee from excessive flexion, anterior femoral translation, and posterior tibial translation
61
What are the attachments of the popliteus muscle?
The popliteus attaches from the lateral femoral condyle to the medial aspect of the proximal tibia, with additional connections to the fibular head, PCL, and lateral meniscus (with some variation between individuals).
62
How does the popliteus muscle compare to knee ligaments in its stabilizing function?
Similar to certain knee ligaments, the popliteus muscle stabilizes the posterior knee and protects it from excessive flexion and anterior femoral translation.
63
What is the "screw home mechanism"?
The screw home mechanism is a process where the tibiofemoral joint locks in extension, which:
• Reduces the workload on the quadriceps
• Provides maximal stability for an upright posture
64
How does the popliteus muscle participate in the screw home mechanism?
The popliteus muscle unlocks the knee from its fully extended position by causing slight rotation to initiate knee flexion.
65
Describe the actions of the popliteus in different positions for knee flexion.
• Proximal attachment fixed: Popliteus rotates the tibia medially on the femur to flex the knee.
• Distal attachment fixed (standing): Popliteus rotates the femur laterally on the tibia to initiate knee flexion.
66
What are the three main presentations of patellofemoral dysfunction?
1. Instability
2. Poor patellar tracking (biomechanical)
3. Chondromalacia patella
67
What are common signs and symptoms (S/S) of patellofemoral dysfunction?
• Pain or crepitus ‘deep’ in the anterior knee
• Worsens with descending stairs or eccentric loads
• Often felt with overuse or prolonged static positions
68
Describe instability in patellofemoral dysfunction.
Instability may involve subluxation or dislocation of the patella in single or recurrent episodes, often in a lateral direction.
69
What happens with poor patellar tracking?
Excessive lateral tracking of the patella causes compression of the lateral facet on the lateral femoral condyle, which can chronically irritate the underlying cartilage.
70
What is chondromalacia patella, and how can it occur?
Chondromalacia patella is the softening or breakdown of articular cartilage, secondary to patellofemoral dysfunction or from prolonged immobilization.
71
What are five main categories of causes for patellofemoral dysfunction?
1. Increased Q angle
2. Muscle weakness/Fascial laxity
3. Muscle/Fascial tightness
4. Structural factors
5. Other factors
72
What factors can contribute to an increased Q angle, potentially leading to patellofemoral dysfunction?
• Wide pelvis
• Changes in femur and tibia orientation
• Femoral anteversion
• Genu valgus
• Overpronation
73
How does muscle weakness or fascial laxity contribute to patellofemoral dysfunction?
• Laxity in the medial patellar retinaculum
• Weak or inhibited vastus medialis obliquus (VMO) or poor coordination between VMO and vastus lateralis
• Hip abductor weakness
• Weakness in deep lateral rotators
74
What muscle or fascial tightness can lead to patellofemoral dysfunction?
• Tightness in the iliotibial (IT) band
• Tightness in the lateral patellar retinaculum
75
What structural factors can contribute to patellofemoral dysfunction?
• Leg length discrepancy (which can cause overpronation and internal tibial rotation)
• Shallow trochlear groove or high-sitting patella
• Femoral anteversion
76
How can improper training contribute to patellofemoral dysfunction?
• Aggressive increase in training volume
• Lack of stretching or self-care
• Uneven training surfaces
77
What assessments should be conducted for patellofemoral dysfunction?
• Postural and palpation assessment: Patellar facets, quadriceps/patellar tendons, subpatellar cartilage
• Range of motion (ROM) assessment
• Muscle length and strength tests
• OBER’s test
• NOBLE’s test
• Functional assessments: Squat, lunge, step-down test
78
What techniques can be used in the treatment of patellofemoral dysfunction?
• Myofascial release to the lateral retinaculum
• Decreasing muscle reactivity (MRT) and trigger points (TRP) in lateral structures (e.g., petrissage, trigger point techniques)
• Tapotement or electroacupuncture for vastus medialis obliquus (VMO) facilitation
• Kinesiology taping for support or VMO proprioceptive feedback
Therapeutic exercise:
• Stretching lateral structures
• Strengthening medial structures, especially VMO and deep lateral rotators/hip abductors
79
When should a referral be considered in treating patellofemoral dysfunction?
Consider referring out for possible orthotics for:
• Structural pes planus or pes cavus
• Structural leg length discrepancy
80
What is Fat Pad Syndrome (Hoffa's Syndrome) and what are its causes?
Fat Pad Syndrome is caused by:
• Forceful direct impact to the kneecap
• Overuse or excessive load to quadriceps and patellar tendons
81
What are the signs and symptoms (S/S) of Fat Pad Syndrome?
• Impingement of the fat pad between the distal femoral condyle and the patella
• Anterior pain located on either side of the lower kneecap
• Pain worsens with knee extension
• Extremely painful, as the fat pad is the most sensitive structure in the knee
82
What is the difference between tendinitis and tendinosis?
• Tendinitis: Acute or chronic irritation with inflammation of the tendon, commonly occurs in the quadriceps or patellar tendons.
• Tendinosis: Chronic irritation without inflammation, leading to degeneration of the tendon, loss of organized structure, and development of microscopic tears.
83
What is the mechanism of injury (MOI) for quadriceps and patellar tendonitis (Jumper's Knee)?
Often results from repetitive jumping or squatting activities.
84
What is the MOI for popliteus tendonitis?
• Common at the femoral attachment
• Often linked to downhill running and overuse during squatting
• Popliteus checks anterior displacement of the femur during knee flexion.
85
How can improper foot mechanics contribute to tendinopathy?
Improper foot mechanics can fail to absorb and distribute forces, allowing them to travel up the kinetic chain, contributing to knee and tendon issues.
86
What types of knee mal-alignment can contribute to inefficiency in the quadriceps?
• Varus and valgus alignment
• Femoral and tibial rotation
87
How does internal rotation of the lower extremity affect the hip and knee?
• It can stretch the glutes and deep lateral rotators, creating inhibition and weakness.
• It may hyper-facilitate the hip flexors, including the rectus femoris, increasing strain on the patellar tendon.
88
What are the treatment considerations during the acute phase of injury management?
Manage inflammatory pain:
• Lymph drainage
• Superficial fluid techniques
• Hydrotherapy
• Positioning for optimal drainage
• Low grade joint play
• K taping
Manage spasm pain:
• Muscle approximation and GTO techniques (depending on lesion site)
Maintain ROM:
• Active free (AF) pain-free ROM
• Self-care: RICE, AF ROM, no passive stretching
89
What techniques can be used for lymph drainage in the acute phase?
• Superficial fluid techniques
• Hydrotherapy
• Positioning for optimal drainage
• Low grade joint play
• K taping
90
How should spasm pain be managed in the acute phase?
Use muscle approximation and GTO techniques, depending on the lesion site.
91
What is the goal for maintaining range of motion (ROM) in the acute phase?
To maintain active free (AF) pain-free ROM.
92
What are self-care recommendations for the acute phase of injury management?
• RICE (Rest, Ice, Compression, Elevation)
• Active free (AF) ROM exercises
• Avoid passive stretching
93
What are the treatment considerations during the subacute phase of injury management?
Eliminate residual swelling:
• Contrast hydrotherapy
Normalize ROM:
• Apply all spasm techniques
• Decrease increased MRT/TRP’s with petrissage and TRP techniques
• Decrease fascial adhesions with heat, myofascial techniques, stretching, and high grade joint play
Encourage healthy scar formation:
• Stretching, myofascial techniques, frictions (subacute)
Self-care:
• Contrast hydrotherapy
• Passive stretching
• Introduction of isometric exercises (muscle setting)
94
What techniques can be used to eliminate residual swelling in the subacute phase?
Contrast hydrotherapy.
95
How can ROM be normalized in the subacute phase?
• Apply all spasm techniques
• Use petrissage and TRP techniques to decrease increased MRT/TRP’s
• Apply heat, myofascial techniques, stretching, and high grade joint play to decrease fascial adhesions.
96
What self-care practices are recommended in the subacute phase?
• Contrast hydrotherapy
• Passive stretching
• Introduction of isometric exercises (muscle setting)
97
What are the treatment goals during the chronic phase of injury management?
• Improve function
• Eliminate lingering trigger points (TRPs)
• Increase muscle resting tone (MRT)
• Manage healthy scar formation
• Normalize strength using isotonic exercises and electroacupuncture
• Incorporate proprioception exercises
• Treat compensatory structures and potential issues above and below contributing to tendonitis
98
What are bursae, and what is their function?
Bursae are fluid-filled sacs formed by inflections in the joint capsule. They reduce friction at tendinous or ligamentous attachments.
99
Name the bursae surrounding the knee and their common names.
• Suprapatellar Bursa
• Deep Infrapatellar Bursa: "Carpet layer’s knee"
• Prepatellar Bursa: "Housemaid's knee"
• Pes Anserine Bursa: "Swimmer’s/Athlete’s knee"
• Semimembranosus Bursa: "Baker’s cyst," located between MCL and semimembranosus tendon, lateral to medial head of gastrocnemius.
100
What condition is commonly associated with bursitis?
Bursitis is commonly associated with tendonitis.
101
What is rebound pain in the context of bursitis?
Rebound pain refers to a spike of pain upon the release of contraction, which occurs due to deformation of the bursa.
102
How can you differentiate between bursitis and tendonitis during assessment?
• With tendonitis: Pain would be consistent throughout the range of motion.
• With bursitis: Pain would occur upon release of the contraction.
103
What are the treatment considerations for managing soft tissue injuries?
• Reduce inflammation using hydrotherapy, compression, K-taping, and lymph drainage.
• Reduce muscle resting tone (MRT) and trigger points (TRPs) in associated muscles.
• Reduce myofascial restrictions (MFR) in associated fascia, tendons, ligaments, and capsules that have restrictions.
104
What is Osgood-Schlatter's disease, and what is its etiology?
Osgood-Schlatter's disease is a traction epiphysis condition caused by excessive force placed on the patellar tendon, leading to traction and microdamage to the bone, as well as excessive growth of the tibial tuberosity.
105
Who is most commonly affected by Osgood-Schlatter's disease?
It is common in adolescents and more prevalent in young boys.
106
What is the mechanism of injury (MOI) for Osgood-Schlatter's disease?
The MOI includes repetitive irritation through the patellar tendon or repetitive trauma, with pain worsening during jumping or repetitive activities.
107
What are the treatment considerations for Osgood-Schlatter's disease?
• If using ice, apply it in a comfortable lengthened position.
• Perform manual lengthening of the quadriceps (avoid stretching when painful).
108
What is IT Band friction syndrome?
IT Band friction syndrome is the irritation of the iliotibial band (ITB) as it passes over the lateral femoral condyle/epicondyle.
109
What are the mechanisms of injury (MOI) for IT Band friction syndrome?
ITB Tightness:
• Early postural imbalances of the pelvis/leg (hip abductor/external rotator weakness, VMO weakness, glute weakness).
• Activities of daily living (ADLs) such as habitual movements: running, cycling, prolonged sitting, and lack of movement.
• Post-surgical recovery, where compensatory mechanisms may develop due to muscle atrophy.
ITB Contracture:
• Inflammation post-local injury leading to connective tissue contracture.
• Sedentary lifestyle or disuse.
• Postural imbalances in the lower extremity.
110
What are the signs and symptoms (S/S) of IT Band friction syndrome?
• Pain/crepitus over the lateral distal femur or lateral tuberosity of the tibia.
• Symptoms worsen with eccentric loading of the lower limb.
• Typically worse at around 30 degrees of knee flexion.
• Often felt at a specific time or distance into a run.
• Local adhesions may develop.
• Bursitis may develop under the ITB.
• Inflammation possible immediately post-activity.
111
What are the assessment considerations for IT Band friction syndrome?
• Palpation and observation of the affected area.
• Postural assessment.
• Strength assessment of glute medius and deep lateral rotators (hip).
• Strength assessment of glute max and hamstrings.
• Functional assessments such as squat and lunge.
• NOBLE’s and OBER’s tests.
• Range of motion (ROM) assessment at the knee and hip.
112
What are the treatment considerations for IT Band friction syndrome?
• Decrease muscle resting tone (MRT) and myofascial restrictions.
• Decrease trigger points (TRPs).
• Hydrotherapy, depending on the presence of inflammation.
• K-taping for support.
• Self-care strategies: stretch tight structures and strengthen weak muscles.
113
What is the vascularity and innervation status of the meniscus?
The meniscus has minimal innervation and is avascular except for the outer one-third, leading to minimal pain with meniscal injury unless the coronary ligaments are also torn.
114
Which meniscus is less prone to injury and why?
The lateral meniscus is less prone to injury because it is not as firmly attached to the tibia as the medial meniscus.
115
Why is the lateral meniscus generally not torn with lateral collateral ligament (LCL) injuries?
The lateral meniscus is not attached to the LCL, so it is generally not torn when the LCL is injured.
116
What are the mechanisms of injury (MOI) for meniscal injuries?
• Hyperextension
• Sudden twist in a flexed position
• Valgus force with rotation
117
What are the signs and symptoms (S/S) of a meniscal injury?
• A 'pop' sound at the time of injury
• Giving way or instability of the knee
• Pain along the joint line
• Quadriceps atrophy
118
What is the function of the anterior cruciate ligament (ACL)?
The ACL prevents anterior translation of the tibia and posterior translation of the femur, stabilizes the knee during directional changes, and checks knee hyperextension.
119
What are the mechanisms of injury (MOI) for ACL sprains?
Hyperextension, valgus force with or without rotation (severe injury). Severe injuries can also involve the posteromedial joint capsule and the medial meniscus, known as the "Unhappy Triad."
120
What is the role of the posterior cruciate ligament (PCL)?
The PCL prevents anterior displacement of the femur and posterior displacement of the tibia and checks excessive knee flexion.
121
What are the mechanisms of injury (MOI) for PCL sprains?
A force applied to a flexed knee that pushes the tibia posteriorly, such as in a dashboard injury during a motor vehicle accident.
122
What is the most commonly injured ligament in the knee?
The medial collateral ligament (MCL).
123
What does the MCL check and how is it commonly injured?
The MCL checks valgus stress at the knee and is frequently torn in conjunction with the medial meniscus due to valgus force with or without rotation.
124
How common are lateral collateral ligament (LCL) injuries?
LCL injuries are not common.
125
What does edema developing over several hours indicate?
This indicates extracapsular interstitial edema, suggesting inflammation of injured structures outside the joint, such as the medial collateral ligament.
126
What does locking with stops/starts during changes in direction indicate?
This suggests a loose body in the joint or scar tissue within the joint capsule.
127
What does instability with stops/starts during changes in direction indicate?
This indicates a torn cruciate ligament.
128
What is osteoarthritis and its common characteristics?
Osteoarthritis is the most common disease affecting weight-bearing joints, characterized by the degradation of articular cartilage, increased friction at the joint, and reduced shock absorption and distribution.
129
What percentage of individuals over the age of 65 will have some degree of osteoarthritis?
Approximately one-third of individuals over the age of 65 will have some degree of degeneration.
130
What symptoms and functional impacts are associated with osteoarthritis?
Symptoms include pain, muscle weakness, joint limitations affecting function, and leading to instability.
131
What postural deformity commonly develops in osteoarthritis of the knee?
Genu varum commonly develops in osteoarthritis of the knee.
132
What are some contributing factors to osteoarthritis?
Contributing factors include excess weight, joint trauma, developmental deformities, weak quadriceps, and increased repetitive microtrauma.
133
What is post-trauma osteoarthritis?
Post-trauma OA occurs in response to any injury affecting structures within the joint, particularly following acute ligament and meniscal tears.
134
How does rheumatoid arthritis typically manifest?
Rheumatoid arthritis usually manifests in the hands and feet first and can progress to affect the knees.
135
What are common symptoms of rheumatoid arthritis?
Symptoms include warm, swollen joints, limited motion, and a typical disease progression with flare-ups and remission periods.
136
What postural deformity commonly develops in rheumatoid arthritis?
Genu valgum commonly develops in rheumatoid arthritis.
137
What are the treatment considerations for arthritis?
Treatment considerations include symptom management (reducing myofascial restrictions, muscle tension, and trigger points), maintaining or increasing joint play and range of motion, improving joint stability through muscle strength, and emphasizing movement.
138
What are contraindications (CIs) for joint mobilizations in arthritis?
Contraindications include bony end feel, bony deformation, and pain on mobilization (which could indicate osteophytes).
139
What types of activities are best for improving joint stability in arthritis?
Swimming and walking are considered the best activities for improving joint stability.
140
What are some referral options for arthritis management?
Referral options include the Arthritis Society, nutritional consultation, and weight loss programs.
141
Where do the nerves controlling the muscles of the lower extremity originate?
The nerves controlling the muscles of the lower extremity originate in the spine.
142
How can lower extremity nerve irritation manifest in relation to knee pain?
Lower extremity nerve irritation can manifest as knee pain or pain in the surrounding musculature.
143
What is an interesting example of nerve dysfunction related to knee pain?
The obturator nerve passes behind the ovaries; during puberty, growing ovaries can compress the obturator nerve, leading to knee pain.
144
How can pain and abnormal mechanics affect sensory feedback and motor signals?
Pain and aberrant joint or muscular mechanics can alter sensory feedback transmitted to the brain, changing the motor signals sent to the musculature, which can result in muscle inhibition.
145
What impact does obturator nerve compression have on the knee?
Obturator nerve compression can cause abnormal sensory information to be transmitted to the brain, affecting motor signals to the muscles surrounding the knee, including the VMO involved in patellar tracking and stability.
146
What additional muscles does the obturator nerve supply?
The obturator nerve also supplies the adductor muscles.
147
What neurological phenomenon occurs with the co-activation of the adductor group and VMO?
Studies have shown that VMO EMG activity increases with the co-activation of the adductor group due to neurological overlap.
148
What is a potential effect of obturator nerve compression on the adductor muscles?
With obturator nerve compression, innervation to the adductor muscles is likely affected.
149
What is the relationship between puberty and patellofemoral issues in girls?
There is a high rate of patellofemoral issues, including subluxation, in girls around puberty, which research has linked to ovarian growth during this time.
150
Why is it important to consider more than just the musculoskeletal system when assessing knee pain?
It's important to consider factors beyond the musculoskeletal system and mechanical pain to form a comprehensive clinical impression, as other systems (like neurological) can influence knee pain.
151
What does the Local approach in the Local-Regional-Spinal Segmental approach focus on?
Treating tissue impairments local to the knee depending on condition/presentation.
152
What specific tissue impairments might be addressed in the Local approach?
• Trigger points
• Myofascial release (MFR)
• Scar tissue
• Adhesions
• Increased muscle tone (MRT)
• Muscle spasms
• Inflammation
• Inhibited muscles
• Local nerves
153
What does the Regional approach focus on in the Local-Regional-Spinal Segmental approach?
Treating impairments at the hip and ankle/foot.
154
What impairments are addressed in the Regional approach?
• Same impairments as in the Local approach (trigger points, MFR, etc.)
• Compensatory structures
• Mobility/stability issues
• Peripheral nerve pathways
155
What is the focus of the Spinal Segmental approach?
Treating the spine.
156
Which spinal nerve distribution is associated with muscles crossing the knee?
T12-S3 spinal nerve distribution.
157
What are the key nerves involved in the Spinal Segmental approach related to the knee?
• Femoral
• Obturator
• Sciatic
• Tibial
• Common peroneal
158
What vascular sympathetic innervation is involved in the Spinal Segmental approach?
T10-S3 vascular sympathetic innervation, which supplies the lower extremity arterial supply.
