Knee Flashcards
(25 cards)
What type of joint is the knee? Why is it vulnerable?
Modified hinge joint-the largest joint in the body
bony stability is sacrificed for stability & it is very exposed
What are the two primary joints?
tibiofemoral and patellofemoral
What are the ligaments?
Medial and lateral collateral ligaments & the anterior and posterior cruciate ligaments
where do the menisci sit?
atop the tibial plateau
How do we assess the knee?
History, Observation, Assessment?
History= any sounds, giving way? Obs = Structure (eg-tibial tuberosity), Gait (walking and running) Assessment= flexion and extension
How do we prevent risk of knee injuries?
Physical conditioning (strength- balance between quads and hamstrings & flexibilty)
Footwear
Appropriate equipment: prophylactic bracing
How do we decrease risk for ACL injury specifically?
focus on strenght, NMC and balance….balance boards, single leg training, landing strategies
What are the common acute knee injuries? (6)
Ligamentous sprains Muscle strains Contusions Meniscal tears Patellar dislocation fractures
What are common chronic knee conditions? (5)
Patello-femoral pain syndrome
Bursitis
Patellar tendonitis
Osgood Schlatter’s Disease
What defines a first degree ligamentous sprain?
How do we manage it?
No tearing and no laxity: mild stretching
Minimal swelling and few limitations
Rest from sport 7-10 days, RICE, therapeutic modalities, ROM and strengthening exercises, balance and prop, maintain CR fitness, Tape for support
What defines a second degree ligamentous sprian?
Management?
Moderate damage with partial tearing: some joint laxity but notable end point, slight swelling and increased pain
Moderate to severe joint tightness ( decreased ROM)
RICE 48-72 hours and use crutch 2-4 week rest from sport Brace before ROM exercises, isometric->closed kinetic chain--> functional progression activities mantain CV fitness and balance
What defines a third degree ligamentous sprain?
management?
Complete tear of supporting ligaments
loss of stability during motion and loss of motion due to effusion and muscle guarding
Immediate pain the builds as swelling increases
no ligamentous end feel at passive end range
RICE—
can be conservatively or surgically dealt with
immobalize w a brace
Progressive WB and ROM over 4-6 weeks….see 1st and 2nd degree sprain treatment plans
Medial Collateral Ligament Sprain:
ET?
S&S?
Result from a valgus force: a blow from the lateral side causing tension on medial knee
swelling and pain dependent on severity (pain is on medial side of knee)
Lateral collateral ligament sprain:
et?
s/s?
results from a varus force—usually caused when the tibia is internally rotated
Pain, tenderness and swelling over the lateral joint line
may cause irritation of the peroneal nerve
Anterior Cruciate Ligament:
ET? (6 MOI)
S/S?
Caused by both a direct contact and non contact mechanism (80% are non contact)
MOIs: Deceleration, Hyperextension, Unhappy Triad (ACL, MCL and med meniscus are sprained bc of a lateral force), Anterior force to tibia w knee at 90, Internal rotation of the leg while the body is externally rotated, the leg is externally rotated and a valgus force is applied (ie-cutting)
S&S= experience a “pop” w severe pain and disability
sudden giving way and inability to WB
positive special tests
rapid swelling at the joint line, peaking 24-48 hrs after
Why are female athletes more likely to suffer an isolated ACL injury than males? (3 reasons)
Hormonal influence: estrogen….our ligaments are more elastic at certain stages of our cycles
Anatomical: women have smaller ACLs and smaller intercondylar notch
Neuromuscular risk factors: core stability, strength, proprioception, intermuscular coordination
Posterior Cruciate Ligament sprain
ET
S&S
Most at risk of this during 90 degrees of flexion, or a fall on a bent knee (anterior/posterior forces are the culprits)
“dashboard injury”
Symptoms are similar to an ACL but swelling is less and there is very little instability in most cases
We will see the “sag sign”
(main management is quad strengthening)
Meniscal injuries:
ET
S/S
Management
Medical meniscus is most commonly injured bc of : MCL attachment…the triad & it has decreased mobility relative to lateral meniscus
MOI: rotary force while knee is extended or flexed
the type of tear depends on MOI.
Effusion (water in the knee) 48-72 hours after
joint pain and loss of motion
intermittent locking and giving way
Pain w squatting
RICE & protect with spint/crutches
Patellar Dislocation
ET
SS
Man
Deceleration w simultaneous cutting in opposite direction creating a valgus force on the knee
Firect blow to patella when knee is flexed and planted
Quad pulls the patella our of alignment
Predisposition (^Q angle)
Pain and swelling
restricted ROM
Immobilize, RICE, immediate medical attn
4-6 weeks on crutches
muscular strengthening
*repetitive subluxation will stress medial constraints
Patellar Fracture
Et
SS
M
direct trauma
indirect trauma (pull on tendon)
Semi-flexed position with forcible contraction (falling, jumping or running)
Generalized joint swelling
Pain, disabiliy, deformity
Xray to confirm
RICE & splint
Osgoode-Schlatter’s Disease
ET
SS
Man
It’s a traction injury—repetitive stress on immature tibial tuberosity from quad contractions
Swelling
Point tender at tuberosity
enlarged and bony deformation
Pain w kneeling, jumping and running
RICE, modify activity, Cho-Pat brace
Isometrics for quads and hammies
Patellofemoral Pain Syndrome
ET
SS
Managm
The underside of the patella and the femoral condyle rub during flexion and extension
caused by lateral deviation of the patella while tracking in the femoral groove because of:
tight structures, high Q angle, insufficient medial musculature.
Tenderness on medial facet during running, jumping, squatting, stairs
dull ache in center of knee,
pateller compression creates pain and grinding
overpronation
movie goers sign
RICE, modify activity, wear patellar prace, correct biomechanical issues (strength, flexability)
Patellar Tendonitis
ET
SS
Man
Jumpers knee! Caused by: Jumping/kicking Over pronation Running on hard surfaces, rapid increase in running sudden or repetitive extension
Creates pain in one or more of the following:
- Inferior pole of the patella- we see grades: pain after, pain during and after, pain during and after and constant (chronic)
- The mid tendon region
- Insertion of tibial tuberosity
RICE
Therapeutic modalities; heat, massage, PRP
Exercise
Brace-give tendon new point of pull
Transverse friction massage
Eccentric strengthening (stops and drops)
Illiotibial Band Friction Syndrome
ET
SS
Man
Caused by:
Repetitive/overuse injuries
structural mal alignment/asymmetries (leg length..born with or hips are poorly aligned, tight butt, hip weakness)
Training errors (sudden change in surface)
Being bow legged, over pronation
MOI– compressive and friction forces to lateral femoral condyle
SS- pain after running, going up/down stairs; point tenderness at gerdy’s tubercle
RICE, correct mal-alignment, proper warm up, stretching, modify activity, orthotics
