Knee Flashcards
(96 cards)
1
Q
what type of joint is the knee
A
modified hinge joint
2
Q
largest joint in the body
–> very exposed and at high risk of injury
A
the knee
3
Q
bony stability is sacrificed for?
it is highly dependent on?
A
mobility
capsule, & surrounding muscles and ligaments
4
Q
2 important functions of the patella
A
protects the femur &
increases effective power of the quadriceps
5
Q
2 primary joints of the knee and there type
A
- tibiofemoral (modified hinge joint)
- patellofemoral (planar joint)
6
Q
what joint is capable of rotation at end range extension
A
tibiofemoral
7
Q
4 ligaments of the knee
A
- anterior and posterior cruciate
- medial and lateral collateral
8
Q
4 functions of the meniscus
A
1) Stabilize joint by deepening the articulation
2) Shock absorption
3) Provide lubrication and nourishment
4) Improve weight distribution
9
Q
Fibrocartilaginous discs attached to tibial plateaus
- relatively poor blood supply
A
meniscus
10
Q
movements of the knee require?
A
flexion
extension
rotation
arthokinematic motions of rolling and gliding
11
Q
the “screw home mechanism” refers to?
A
the rotational components of the knee
–> As the knee extends it externally rotates because the medial femoral condyle is larger than the lateral
12
Q
the rotational component of the knee provides increased?
A
stability
13
Q
what “unlocks” the knee allowing it to flex
A
popliteus
14
Q
capsular ligaments are tight when? and relaxed when?
-this allows what to occure?
A
in extension, in flexion
- rotation
15
Q
deeper capsule ligaments remain ? to keep ? in check
A
tight, rotation
16
Q
prevents excessive internal rotation, limits anterior translation and posterior translation when tibia is fixed and non-weight bearing, respectively
A
Posterior cruciate ligament
17
Q
tops excessive internal rotation, stabilizes the knee in full extension and prevents hyperextension
A
anterior cruciate ligament
18
Q
the primary mover of flexion is ? (1) assisted by? (4)
A
- hamstrings
- popliteus, gastrocs, gracilis, sartorius
19
Q
the primary mover of extension is?
A
-quads
20
Q
what joint is involved in flexion and extension
A
tibiofemoral
21
Q
what joint is involved in compression during walking (50% of body weight–increases with stair climbing)
A
patellofemoral
22
Q
4 techniques to prevent knee injuries
A
1) physical conditioning
- -> strength
- –> balance between quads and hamies
- –>
2) footwear
3) appropriate equipment; prophylactic bracing
4) decreasing the risk of ACL injury
23
Q
techniques to prevent ACL injury
A
- focus on strength, neuromuscular control, balance
- Series of different programs which address balance board training, landing strategies, plyometric training, and single leg performance
24
Q
common acute knee injuries (6)
A
- Ligamentous sprains
- Muscular strains
- Contusions
- Meniscal tears
- Patellar dislocation
- Fractures
25
common chronic knee conditions (3)
* Patello-femoral pain syndrome (PFPS)
* Bursitis Patellar tendonitis
* Osgood Schlatter’s disease
26
-No tearing; no laxity; mild stretching
- Minimal swelling; few limitations.
(what grade of sprain? )
grade 1
27
management of grade 1 sprain
- Rest from sport 7-10 days
- RICE
- Therapeutic modalities
- ROM & strengthening exercises
- Balance and proprioception exercises
- Maintain cardiorespiratory fitness
- Tape for support
28
-Moderate damage with partial tearing
- Some joint laxity present, but solid endfeel noted
- Slight swelling and increased pain
- Moderate to severe joint tightness;
- decreased ROM
(what grade of sprain)
grade 2
29
management of grade 2 sprain (5)
- RICE 48-72 hours; crutch use during acute phase
- Rest from sport 2-4 weeks
- May brace prior to initiation of ROM exercises
- Gradual progression from isometric exercises to CKC & functional progression activities.
- Maintain/regain CV conditioning/balance
30
-Complete tear of supporting ligaments
-Complete loss of stability during motion
-Loss of motion due to effusion & guarding
- Immediate pain that builds as swelling increases
- No ligamentous end feel at passive end range
(what grade of sprain)
grade 3
31
management of grade 3 sprain (5)
- RICE
- Conservative vs. surgical approach
- Limited immobilization with a brace
- Progressive weight bearing and increase ROM over 4-6 wks
- Progress as per 1st and 2nd degree sprains
32
Result of blow from lateral side causing tension on medial knee (valgus force)
Medial collateral ligament sprain
33
Swelling & pain dependent on severity and Pain on medial aspect of knee
Medial collateral ligament sprain
34
Result of a varus force, generally w/ the tibia internally rotated
lateral collateral ligament sprain
35
if a LCL sprain is severe enough damage can also occur to the(3) ? producing ?
cruciate ligaments, ITB and meniscus
| -bony fragments
36
- Pain, tenderness & swelling lateral joint line over LCL
- May cause irritation of peroneal nerve
lateral colateral ligament sprain
37
LCL sprain can cause irritation to what nerve?
peroneal nerve
38
- varus force is coming from what side?
| - valgus in coming from what side?
- hits medial going lateral
| - hits lateral going medial
39
% of ACL sprains that are a result of non contact
80%
40
MOI of an ACL a sprain (6)
1) deceleration
2) hyperextension
3) unhappy triad
4) anterior force to the tibia with knee flexed to 90 degrees
5) internal rotation of leg with body in external rotation
6) leg external roation with valgus force (cutting)
41
females are 3-5 times more likely to suffer a ?
| -reasons? (3)
ACL injury
- hormonal influences (estrogen makes ligament elastic)
- anatomical (women generally have a slightly smaller ACL and intercondylar notch)
- neuromuscular risk factors (core stability, strength, proprioception or intermuscular coordination and rate of firing)
42
- Experience pop w/ severe pain and disability
- Sudden ‘giving way’ and inability to WB
- Positive special tests (anterior drawer and Lachman’s)
- Rapid swelling at the joint line peaking 24-48hrs after
ACL sprain
43
most at risk for a PCL sprain at what angle?
90 degrees
44
- Fall on bent knee/AP force is most common mechanism -Can also be damaged as a result of a rotational force
- Sometimes referred to as a “dashboard injury”
PCL sprain
45
what is sometimes referred to as a dashboard injury??
PCL sprain
46
differences signs and symptoms of PCL sprain than ACL sprain
swelling is less and there is generally very little instability it he most cases
47
Posterior drawer test for the Knee is positive.
| - “Sag sign” is generally present
PCL sprain
48
management of PCL sprain (2)
-Quad strengthening -Surgical vs. non operative (no surgery for this one)
49
what menisci is more commonly injured?
| -why?
medial
- MCL attachment ("triad")
- Decreased mobility
50
most common MOI for meniscal injury?
rotary force with knee flexed or extended
51
4 types of meniscus tears?
1) longitudinal (bucket handle, edges lift up)
2) oblique
3) transverse
4) triad
52
the triad includes
MCL, ACL, medial menisci
53
two signs of a menisci tear:
- the joint gets stuck in a position
| - giving way sensation
54
- Effusion developing over 48-72 hour period
- Joint line pain and loss of motion (due to tear and swelling)
- Intermittent locking and giving way
- Pain w/ squatting
- Portions may become detached causing locking, giving way or catching w/in the joint
- If chronic, recurrent swelling or muscle atrophy may occur
meniscal injury (tear)
55
management of meniscal injury (2)
-RICE
- protect- splint crutches
(If the knee is not locked, but indications of a tear are present further diagnostic testing may be required)
56
If locking occurs, ? may be necessary to unlock the joint w/ possible arthroscopic surgery follow-up
anesthesia
57
- Deceleration w/ simultaneous cutting in opposite direction (valgus force at knee)
- Direct blow to patella when knee is flexed and planted
- quad pulls the patella out of alignment
patellar dislocation
58
some individuals are predisposed to patellar dislocation because?
have an increased Q angle
59
- Repetitive subluxation will stress medial restraints
- Women more prone
- Usually dislocates laterally
patellar dislocation
60
the patella usually dislocates which direction?
laterally
61
- Pain and swelling, restricted ROM, palpable tenderness over adductor tubercle
- Results in total loss of function
patellar dislocation
62
management of patellar dislocation (3)
- Immobilize, RICE, immediate medical attention (leave it alone, yourself)
- Immobilization 4-6 weeks with crutches
- Muscular strengthening
63
- Direct or indirect trauma (severe pull of tendon)
| - Semi-flexed position with forcible contraction (falling, jumping or running
patellar fracture
64
- Hemorrhaging and joint effusion w/ generalized swelling
- Pain, disability, & potential deformity
- Indirect fractures may cause capsular tearing, separation of bone fragments and possible quadriceps tendon tearing
patella fracture
65
Indirect fractures of the patella may cause? (3)
- capsular tearing,
- separation of bone fragments
- possible quadriceps tendon tearing
66
management of patellar fracture
- X-ray necessary for confirmation of findings
- RICE and splinting if fracture suspected
- Refer and immobilize for 2-3 months
67
- An apophysitis occurring at the tibial tubercle
| - Traction injury; repetitive stress from quad contractions associated with bony immaturity
Osgoode-Schlatter’s Disease
68
Osgoode-Schlatter’s Disease usually occurs in what population?
teenagers
69
- Swelling, point tender at tuberosity, enlarged & deformed tuberosity
- Pain w/ kneeling, jumping and running
Osgoode-Schlatter’s Disease
70
management of Osgoode-Schlatter’s Disease (2)
- Rice, activity modification, Cho-Pat brace
| - Isometrics for quadriceps and hamstrings
71
Larsen Johansson Syndrome is an adolescent apophysis injury that involves the ? at the attachment on the ?
- patellar tendon
| - inferior pole of the patella
72
- Joint aggravation on underside of patella or femoral condyles due to flexion/extension stresses
- Patella isnt sitting properly within the condyles
- Result of lateral deviation of patella while tracking in femoral groove
Patellofemoral Pain Syndrome
73
4 causes of Patellofemoral Pain Syndrome
1) tight structures
2) pronation
3) increased Q angle
4) insufficient medial musculature
74
- Tenderness of medial facet during running, jumping, squatting, stairs
- Dull ache in center of knee
- Patellar compression will elicit pain and crepitus/grinding
- ‘Movie goer’s sign’
- Overpronation
patellofemoral pain syndrome
75
management of patellofemoral pain syndrome (4)
- RICE
- Activity modification
- Wearing patellar brace or McConnell tape job
- Correct biomechanical issues/strength/flexibility
76
Jumper’s knee ( Not the patellar tuberosity that’s mad but the tendon in between)
patellar tendonitis
77
patellar tendonitis results in pain in one or more of the following:
a) The inferior pole of the patella
b) The mid tendon region
c) The insertion at the tibial tuberosity
78
4 causes of patellar tendonitis
1) Jumping or kicking
2) Over-pronation
3) Running on hard surfaces; rapid increase in running
4) Sudden or repetitive extension
79
where is the pain located in patellar tendonitis
inferior pole of the patella
80
3 phased of signs and symptoms of patellar tendonitis
1) pain after activity,
| 2) pain during and after, 3)pain during and after (possibly prolonged) and may become constant
81
management of patellar tendonitis (7)
- RICE
- Therapeutic modalities; heat
- Exercise
- Patellar tendon bracing
- Transverse friction massage
- Eccentric strengthening
- Stop & drops
82
Etiology:
- caused by repetitive/overuse conditions
- structural mal-alignment
- structural asymmetries
- training errors
iliotibial band friction syndrome
83
- Leg length discrepency
- Genu varum
- Over pronation
- sudden change in training surface, equipment, distance
- tight TLF/glute max
- hip weakness
Etiology for?
iliotibial band friction syndrome
84
iliotibial band friction syndrome caused by compressive and friction forces to ?
lateral femoral condyle
85
When the knee flexes, the ITB moves posteriorly along the lateral femoral epicondyle.
- Contact against the condyle is highest between ? degrees
20-30 degrees
86
the IT band rubs more vigorously when it is ?
excessively tight or stressed
87
Pain after running; going up or down stairs; point tenderness at Gerdy’s tubercle
iliotibial band friction syndrome
88
management of iliotibial band friction syndrome (6)
- RICE,
- correction of mal-alignment,
- proper warm-up & stretching; -activity modification,
- stretching,
- orthotics
89
Acute, chronic or recurrent swelling of the knee
bursitis
90
- prepatellar bursitis is from ?
| - infrapatellar bursitis is from?
- continued kneeling
| - overuse of patellar tendon
91
Injury occurs as the result of a single contusion force or when there is repeated compression and shearing forces together
bursitis
92
pes anserine bursitis is caused from? (5)
- Overuse: as in breaststroke kicking, or kicking a ball repeatedly; running with one leg higher than other (i.e. crowned road)
- Repeatedly pivoting from a deep knee bend
- A direct blow to the area
- Biomechanical features such as genu valgum or external tibial rotation. (running on a slant --> switch up route)
- Bursa sits below the 3 tendons
93
what 3 tendons does the bursa sit below in pes anserine bursitis ?
sartorious, semitendinosis, gracilis
94
-Prepatellar ? may be localized swelling above knee that is ballotable
bursitis
95
swelling in popliteal fossa may indicate?
bakers cyst
96
management of bursitis
RICE, activity modification & protective foam donut pad Aspiration and steroid injection if chronic
