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MSK II > Knee 3: Patellar Dislocation-End > Flashcards

Knee 3: Patellar Dislocation-End Flashcards

1
Q

risk factors for patellar dislocation

A

pre-extisting hypermobility

more common with shallow sulcus angle or trochlear groove

more common with large positive congruence angle or laterally located patella

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2
Q

etiology of patellar dislocation

A

trauma iwht lateral patellar displacement

can be more likely with prior instability

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3
Q

structures involved in patellar dislocation

A

patella

medial retinaculum

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4
Q

S&S of patellar dislocation

A

traumatic/worse case of PFPS

+ patellar apprehension

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5
Q

PT Rx for patellar dislocation

A

non-WBing to PWB up tot 3 weeks

immobilizer
-can allow 60 flex for 3 weeks
-90 til 6 weeks
-full ROM after 6 weeks

taping after 1 week of immobilization for protection and muscular control

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6
Q

MET for PFPS

A

CC prior to OC extercises

quads - isometrics then isotonics

extensibility/elasticity of postlat structures (hams, IT band, and gastroc)

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7
Q

re-dislocation rate of patellar dislocation

A

44%

higher w/o sx

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8
Q

what is IT Band syndrome

A

tendinopathy of distal IT band

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9
Q

prevalence of IT Band syndrome

A

5-14% runners

2nd leading cause of knee pain in runners

males = 50-80% of cases

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10
Q

risk factors for IT band syndrome

A

running
training erros
weak hip ERs and ABDs
excessive pronation
increased hip add and IR
trunk lean in U stance
associated with GTPS and PFPS

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11
Q

etiology of IT band syndrome

A

not entirely well understood

abnormal mechanical loading

consider lumbar hypermobility/instability with impaired LE control and excessive recruitment of TFL

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12
Q

structures involved with IT band syndrome

A

TFL/IT band

lateral femoral epicondyle

gerdys tubercle insertion (lateral)

associated bursae and fat pad

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13
Q

symptoms of ITB syndrome

A

gradual onset lateral knee pain

worse with activities involving repetitive knee motion, grades, and dynamic U stance (i.e. running)

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14
Q

signs of ITB syndrome

A

impaired LE control

pain with hip add likely (stretch)

general ROM is not consistent; could be pain with both bending and straightening due to multi function of TFL

possibly weak hip ER

weak hip ABD with pain (especially in a lengthened position)

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15
Q

signs for ITB syndrome

A

possible + obers

TTP over lateral femoral condyle and gerdy’s tubercle

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16
Q

PT Rx for ITB syndrome

A

other associated impairments

tendon proliferation and stabilization = primary purpose

tendinosis Rx

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17
Q

what is patella tendinopathy

A

jumpers knee or anterior knee pain

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18
Q

incidence/risk factors for patellar tendinopathy

A

up to 50% athletes

males > females

more common in jumping sports

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19
Q

structures involved in patellar tendinopathy

A

patellar tendin

infrapatellar bursae and fat pad

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20
Q

what are the bursae involved with patellar tendinopathy/where are they

A

superficial infrapatellar = between skin and patellar tendon

deep = between patellar tendon and tibia

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21
Q

etiology of patellar tendinopathy

A

abnormal mechanical loading

22
Q

symptoms of patellar tendinopathy

A

overuse and gradual onset of pain

increased with activity, jumping, lunging, and squatting

23
Q

signs of patellar tendinopathy

A

observation = possibly thickened tendon and impaired LE control (knees past toes)

ROM = possible pain and limits with end range flexion, especially if hip is extended

MMT = pain with knee ext, especially from lengthened

AM = impaired patellar motion

special tests = possible + thomas test for rectus femoris

palpation = TTP localized; patella alta adds tendon tension/compression

24
Q

PT Rx for patellar tendinopathy

A

pt edu on soreness rule, load management, and movement cues

POLICED

JMs

25
effectiveness of exracorporeal shockwave therapy
no additional benefit when added to MET
26
MET for patellar tendinopathy
purpose = tendon proliferation and stabilization tendinosis Rx increased trunk flexion with landing/jumping/squat/lung takes tension off of tendon
27
MD Rx fro patellar tendinopathy
platlet rich plasma injections = minimal benfit cortisone = should not be used
28
prognosis for patellar tendinopathy
50-70% improvement at 3-6 months with MET
29
what is tibial tubercle apophysitis
aka Osgood schlatter's disease
30
prevalence of osgood schlatters disease
most common cause of anterior knee pain in kids peaks at 12-15 years
31
structures involved with osgood schlatters disease
tibial tuberosity apophysitis or epiphyseal plate patellar tendon
32
risk factors for osgood schlatters
growth spurt high activoty shortened quads and hamstrings weak quads high BMI reduced core stability
33
etiology of osgood schlatters disease
overuse
34
pathomechanics of osgood schlatters
bone growth exceeds quad lengthening increased tendon tension growth plate is the weal spot as opposed to tendon in the adult most often inflammaiton complications = avulsion or premature closure
35
symptoms of osgood schlatters
gradual onset knee pain with overuse pop may indicate avulsion possible loss of vertical jump
36
signs of osgood schlatters
impaired LE control enlarged tibial tuberosity ROM = possibly pain with end range flexion especially with hip ext MMT = pain with ext; especially lengthened AM = possible patellar hypo special tests = + thomas test for RF shortening TTP over tibial tuberosity possible patella alta
37
Rx for osgood schlatters
pt edu on soreness rule, load management, and movement cues POLICED JMs (PF glides, likely for inf glide) careful with stretching quads if pain occurs stretch of hams/gastroc
38
effectiveness of orthotics for osgoods schlatters
sleeve may cause compression strap on tendon may cause traction pain foor orthotics can help control LE
39
MET for osgood schlatters
possibly trunk and hip stabilization caution with muscle/tendon attached to growth plate to avod overuse
40
prognosis for osgood schlatters
PT 90% successful can become recurrent/persistent
41
characteristics of skeletal muscle
transmits mechanical forces striated voluntary contractile tissue actin and myosin myofilaments make up sarcomere hypervascular enveloped by fascia
42
characteristics of fascia
continuous loose connective tissue throughout body minimal contractile properties vs muscle surrounds/permeates all tissues and organs can scar and harden following injury
43
prevalence of quad/hamstring strain
quads = less common hams = more common
44
risk factors for strains
abnromal ham/quad ratio may be a predisposition to injury (may use ACL criteria) lack of warm up
45
etiology/pathomechanics of strains
can be injured directly or indirectly (external vs internal) can be functional (i.e. fatigue/neurogenic dysfunction without structural changes) = majority (70%) of strains in professional soccer can be structural = structural changes; overestimayed in professional soccer (30%)
46
symptoms of strains
localized pain sudden onset with forceful activity possible limited motion and WBing
47
signs of a strain
obs = asymmetrical gait/possible ecchymosis ROM = likely pain with lengthening MMT = pain and weakness for mid range (grade I) and lengthened range (grade II) special tests = shortened muscle length TTP over muscle
48
return to play timeline for strains
functional or grade I = about 1-2 weeks structureal = 5-6 weeks for grade 2 and over 8 weeks for grade 3
49
distinct Rx for strains
pt edu on soreness rule and load management compression wrapping to help muscle action
50
MET for strains
focus = tissue integrity and muscle characteristics including progressing to agility and power activities max contractions held until 8 weeks with structural change of grade II and III strains
51
what are the ottawa knee rules
get an x-ray if any of the following things present after trauma: over 55 fibular head tenderness isolated patellar tenderness inability to flex knee past 90 inability to bear weight immediately and take 4 steps ** DO NOT USE if over 7 days from injury
52
PT Rx for fractires
treating consequences of immobilization with other tissues

MSK II (18 decks)

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