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MSK basics > knee 2 - injuries > Flashcards

knee 2 - injuries Flashcards

1
Q

most ACL injuries are what

A

(80%) non contact

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2
Q

what is the normal MOI of ACL

A

foot planted, valgus/rot load

low flexion angles

hyperext load (step in pot hole)

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3
Q

what are some examples of activties that lead to ACL injury

A
  • Cutting combined with deceleration
  • Landing from a jump in or near full extension
  • Pivoting with knee near full extension
  • Deceleration with knee internal rotation
  • “Dynamic Valgus”: Femoral adduction, Knee abduction, Ankle eversion
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4
Q

what does a contact ACL injury look like

A

Posteriorly directed blow to anterior femur

blow to the lateral knee when the foot is planted

(dashboard, hyperext)

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5
Q

what is the general presentation of a ACL injury

A

popping,

giving away, buckling
- episodes of giving way with ADLs

severe pain

Continued effusion

flexed knee gait

Limited range of motion

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6
Q

what is quad inhibition

A

process in which quadriceps activation failure is caused by neural inhibition, is common following knee injury or surgery

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7
Q

what are the DD for ACL injuries

A
  • Multiple ligament injuries –MCL, PCL
  • Meniscal involvement
  • Unhappy Triad (O’Donoghue)
  • MCL, medial men, ACL
  • Patella subluxation/dislocation
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8
Q

what is the PCL MOI

A

hyperflexion

Fall on a flexed knee with foot in plantarflexion

Hyperextension mechanisms
* Step in a pothole

Blow to anterior tibia (Dashboard)

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9
Q

what is the general presentation of a PCL MOI

A

posterior knee pain

less effusion compared to ACL

flexion beyond 90 may be painful

hard time descending stairs, squatting, running

less quad inhibition then ACL

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10
Q

what is the DD for PCL injury

A
  • Patellofemoral pain: Patients with chronic PCL insufficiency can develop PFPS
  • Need to rule out posterior lateral complex involvement
  • False + Anterior Drawer Test
  • Consider chondral lesions when MVA trauma is involved
  • Meniscal tears at the posterior horns with hyperflexion injuries
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11
Q

what are chondral lesions

A

caused through degradation of joint cartilage, in response to metabolic, genetic, vascular and traumatic stimul

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12
Q

are PCL injries normally large traumatic events

A

no

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13
Q

Posterolateral Corner Injuries MOI

A
  • Posterolateral-directed force to the anteromedial tibia
  • Knee hyperextension
  • Severe tibial external rotation with the knee is low angles of flexion
  • Varus forces to a flexed knee
  • Atraumatic may present as chronic laxity without a PCL component
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14
Q

what are the structures we find in the posterio-lateral corner

A

static: PCL, LCL, posterior horn of the lateral meniscus, PL capsule

dynamic: ITB, popliteus, biceps femoris

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15
Q

MCL MOI

A
  • Controlling excessive valgus forces
  • With the LCL responsible for preventing excessive Femoral IR and Tibial ER
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16
Q

is the MCL attached to anything else

A

yes - medial meniscus, and ACL

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17
Q

what does the MCL feel like

A

flat and broad

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18
Q

what is the main purpose of the MCL

A

controling knee valgus

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19
Q

what is the secondary purpose of the MCL

A

with the LCL preventing excessive femoral IR and tibial ER

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20
Q

what is the DD for MCL

A
  • Medial meniscal tear
  • ACL / PCL
  • Epiphyseal plate injury
  • Patella dislocation
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21
Q

is the LCL attached to anything

A

no - not like the mCL

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22
Q

what structure seperates the lateral menicus and the LCL

A

popliteus

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23
Q

what forces does the LCL prevent

A

resists varsus stresses

we do not get hit from the inside of the leg so this does not get injuried as often

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24
Q

what else does thee LCL prevent - movement-wise

A

lateral tibia rot

median femoral rotation

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25
Q

what are DD for the LCL

A
  • ACL/PCL injuries
  • Posterolateral corner
  • Lateral meniscus
  • ITB
  • Biceps Femoris strain
  • Popliteus strain
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26
Q

what are the signs and symptoms of collateral ligament injury

A

varus and valgus stress

local swelling and ecchymosis

Joint effusion if ACL or meniscal involvement

Quadriceps dysfunction

Tenderness to palpation of ligament

Difficulty with pivoting, cutting, etc.

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27
Q

what is ecchymosis

A

a bruise

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28
Q

when palating collateral ligament what part do we want to palpate

A

the insertions and then entire length of the ligament

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29
Q

if someone with a collateral ligament issue - what do they complain about with runinng

A

“I can run in a straight line, but my knee feels like it’s going to fall apart if I turn quickly”

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30
Q

what are risk factors for OA

A

age gender race

joint laxity

obesity

quad weakness

prior knee injury

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31
Q

what is the general presentation of knee OA

A

stiffness in the morning that resolves after “ moving around for a bit

stiffness after prolonged sitting

crepitus

occasional pain at night

joint line pain

quad weakness

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32
Q

what is the capsular pattern of the knee

A

flex > ext

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33
Q

what is crepitus

A

grinding, clicking, and popping in the joint

sand paper feeling

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34
Q

what is the the MOI mencius

A

twisting

sudden change in direction with the foot planted

hyperflexion

high impact compression load

ACL/MCL injury

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35
Q

what is the general presentation for men injury - acute

A

Twisting/tearing sensation at time of injury

Severe pain on injury, effusion developing 6-24 hours post injury
(less the ACL)

may have giving away

Reports of clicking, popping, catching or locking of knee

Location of pain varies

Sx worsens with deep squats and stair negotiation

ROM limited in end range

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36
Q

what has more effusion men of ACL

A

ACL

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37
Q

what is the general presentation of men injury - chronic

A
  • Older population – joint/cartilage degeneration
  • History of a previous knee injury
  • Twisting or giving way
  • clicking and locking
  • Intermittent bouts of effusion
  • “If I do too much standing, walking, squatting, bending, etc., it swells up on me”
  • Reports of sudden sharp pain that causes knee to give way
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38
Q

what are the DD for men injury

A
  • MCL/LCL
  • ACL
  • PFPS and other Anterior Knee Pain “options”
  • PCL and Posterolateral Corner
  • Articular cartilage defects
  • OA
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39
Q

what are some risk factors for men injury

A

older age

male

work related kneeling/squatting

climbing greater then 30 stairs a day

D1 sport

delayed ACLR

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40
Q

art cart

A

look at notes closer

41
Q

PFPS MOI

A

increase frequency and duration of patellofemoral loading with insufficient time for

42
Q

what is the general presentation of PFPS

A

Anterior, retro- or peripatellar knee pain

associated with increase in activity

crepitus, clicking, popping

complains of stiffness around the patellofemoral joint

43
Q

peripatellar meaning

A

around the pattell

44
Q

what kind pain do we see with PFPS

A
  • Diffuse
  • Insidious onset (most of the time)
45
Q

what are some DD for PFPS

A

men injury

patellar or quadrecieps tendinopathy

IT Band syndrome

lumbar spine or hip origin

46
Q

what are some medical red flags that can be DD for PFPS

A

tumor

dislocation

septic arthritis

DVT

neurovascular compromise

47
Q

what are some risk factors for PFPS

A

sports specialization

younger

decrease quad strength

decreased quad, hamstring, gastroc flexibility

48
Q

what is patella instability

A

acute or chronic lateral subluxation or the patella

temporary partial dislocation

49
Q

what is the MOI for patella instability

A

forceful quad contraction while rotating on a planted foot

valgus blow to the knee

50
Q

what is the general presentation of patella instability

A

felt a pop

giving away of the knee

antereior knee pain the is aggrevated by activity

TTP along the medial aspect of the patella/medial patella femoral ligament

excessive lateral patella mobility

51
Q

patellofemoral OA is most common where on the patella

A

the lateral facet

52
Q

patellofemoral OA - presentation

A

similar to PFPS

crepitus

stiffness and pseudo locking - morning and prolonged sitting

53
Q

PFPS pain gets worse with what activity

A

squatting

sitting/prolonged knee flexion

stair climbing

sports participation

54
Q

what is Iliotibial Band Friction Syndrome

A

irritation of the distal ITB and underlying structures

55
Q

what is the overall MOI of Iliotibial Band Friction Syndrome

A

overuse

56
Q

overuse compression - Iliotibial Band Friction Syndrome

A

constant tension of the IT band compresses unnderlying nerve, blood vessels and fat pads

57
Q

overuse repetitive - Iliotibial Band Friction Syndrome

A

the lateral fibers rub agaist the lateral femoral condyle during flex and ext

58
Q

what athleteic population is Iliotibial Band Friction Syndromeoften seen in

A

runners, associated with the breaking phase of early stance

59
Q

what is the general presentation of Iliotibial Band Friction Syndrome

A

gradual onset of lateral or anterolateral knee pain

aggravted by activity

TPP of the lateral femoral condyle or gerdy’s

localized swelling (not always present)

snapping and popping

60
Q

what part of running concontribute to Iliotibial Band Friction Syndrome

A

down hill

increase in training

leg length discrepancy

61
Q

is IT band tightness a risk faxctor for Iliotibial Band Friction Syndrome

A

no

62
Q

what is Osgood-Schlatters Disease (OSD)

A

Apophysitis of the tibial tuberosity

63
Q

what is Sinding-Larsen Johannsen (SLJ)

A

Apophysitis of the inferior pole of patella

64
Q

what is Apophysitis

A

an inflammation or stress injury to the areas on or around growth plates in children and adolescents.

65
Q

what population do we see Osgood-Schlatters Disease (OSD) /
Sinding-Larsen Johannsen (SLJ)
in

A
  • Males (12-14 y.o.) > Females (10-12 y.o.)
  • Early sport specialization = 4 fold inc risk
66
Q

what is the general presentation of Osgood-Schlatters Disease (OSD) /
Sinding-Larsen Johannsen (SLJ)

A

localized pain or swelling at the tibial tuberosity or the inferior pole

TTP of the tibial tuberosity

palpable/visible swelling

pain with resisted knee extension

67
Q

what are aggravating activities for Osgood-Schlatters Disease (OSD) /
Sinding-Larsen Johannsen (SLJ)

A

running

jumping

squatting

knee extension

68
Q

what is the treatment for OSD and SLJ

A

progressive glutes and quads strengthing

education on activity, loading, and injury

activity ladder

69
Q

what is fat pad impingement

A

inflammation –> hypertrophy and fiborsis of the fat pad

70
Q

what is the MOI for the fat pad impingment

A

blunt trauma

patella dislocation/sublexation

impingement

71
Q

what is the general presentation of a fat pad impingement

A

burning or aching deep to or on either side of the patella tendon

TTP of medial/lateral fat pad

swelling

sym seen with quad set

limited patellar mobility

72
Q

Plica Syndrome is it seen often

A

no

it is zebra

73
Q

Plica Syndrome - what is it

A

inflammatory process

74
Q

where is hoffa’s fat pad

A

under the petellar tendon

under the patella

75
Q

what position causes issues with pilica syndrome

A

knee flexion

76
Q

what is the treatment for fat pad impingement

A

activity modification - avoid deep flexion and hyperext

tactile cueing to prevent hyperext - taping

quad strengthing 20-120 (rnage of the least compression)

patella mobs

77
Q

what is the plica

A

band of thick, fibrotic tissue that extends from the synovial capsule of a joint

function to protect the knee

78
Q

what is the MOI for plica syndrome

A

blunt trauma

twisting injury

rep flex/ext

79
Q

what is the general presentation of plica syndrome

A

delayed onset of symptoms

intermittant knee pain of the ant or medial-ant knee

poping or snapping during knee flexion

palpable thickening of the pilica

80
Q

what is the MOI for Pre-Patellar Bursitis

A

blunt trauma or prolonged kneeling

81
Q

what is the general presentation of Pre-Patellar Bursitis

A

pain/swelling directly over the patella

Bursal warmth and redness

82
Q

what should do if the patient has a fever with Bursal warmth and redness

A

Refer if >37.7° C (99.9° F)

  • 50% of cases in immunocompromised
83
Q

hamstrings MOI

A

overlengthening or ballistic movement

high muscle tendon forces

high velocity movements

84
Q

when is the biceps femorsis more commonly injuried

A

high speed running

85
Q

when is the Semimembranosus normally injured

A

jumping , kicking, when the hamstring is mac lengthened

86
Q

what is the general presentation of hamstring injury - gait

A

stiff leg

the patient want to avoid both overstrethcing

87
Q

what is the general presentation of a hamstring injury

A

bruise

pain with - sitting and palpation (mm belly and tendon)

88
Q

hamstring injury - flexibility tests

A

tests are limited and symptomatic

SLR and popliteal angle

89
Q

strength with hamstring injuries

A

limited and painful

prone knee flexion
prone hip extension

90
Q

patellar tendinopathy - MOI

A

chronic overuse injury

not enough rest

91
Q

patellar tendinopathy - general presentation

A

focal pain at the patella

tendon stiffness sensation - morning or after prolonged sitting

warm up effect

92
Q

for patellar tendinopathy where is pain noramlly focalized

A

the inferior pole of the patella

93
Q

what are symptom triggers for patellar tendinopathy

A

squatting

jumping

sprinting

dec

hills

94
Q

what are sym modifiers for patella tendionopathy

A

rest

95
Q

what pop do we normally see patellar tendinopathy in

A

younger

athletic

jumping athletes

96
Q

what are the recommend treatments for PFPS

A

exercise therapy

patellar tapping (short term pain relief)

foot orthoses for pronated feet

gait retraining

patient education

97
Q

do braces help with PFPS

A

nope

98
Q

what exercise therapy do we want to include for people with PFPS

A

quad strengthing

strengthen hip abd/ext/ER

address other impairments up and down the chain

MSK basics (20 decks)

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