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MSK II - EXAM 3 KNEEEEEEE > Knee- Patellar Dislocation thru Functional Testing > Flashcards

Knee- Patellar Dislocation thru Functional Testing Flashcards

(84 cards)

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1
Q

What is the worse case of PFPS?

A

Patellar dislocation

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2
Q

What is the incidence of patellar dislocation?

A

rare

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3
Q

What are risk factors for patellar dislocation?

A
  • pre-existing patellar hypermobility
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4
Q

What makes patellar dislocation more common?

A
  • shallow sulcus angle
  • congruence angle lateral to zero line or laterally located patella
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5
Q

What is the etiology of patellar dislocation?

A
  • trauma with lateral patella displacement
  • may be more likely with pre-existing patellar hypermobility
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6
Q

What are the structures involved with patellar dislocation?

A
  • patella
  • med retinaculum and other medial tissues
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7
Q

What are S&S of patellar dislocation?

A
  • worse case of PFPS hypermobility
  • patellar apprehension likely to be positive
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8
Q

What is the PT rx for patellar dislocation?

A
  • non- WB to PWB up to 3 weeks
  • immobilizer
  • POLICED
  • MET
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9
Q

What do we need the immobilizer for with patellar dislocations? (DONT MEMORIZE RN, REFERENCE)

A
  • possibly allowing up to 60 degrees flexion for 3 weeks
  • flexion progressed to 90 degrees until 6 weeks
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10
Q

When should we have full ROM with patellar dislocation?

A
  • full ROM after 6 weeks
  • < 6 weeks leads to higher dislocation rates
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11
Q

What can taping do for patellar dislocation?

A
  • protection
  • allowed 30-40 degrees flexion for 5-6 weeks
  • apply after 1 week immobilization
  • better outcomes than complete immobilization
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12
Q

When should muscular control be used with patellar dislocation?

A

at least up to 6 weeks

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13
Q

What can we use a brace for with patellar dislocation?

A

patellar control

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14
Q

What kind of exercises should we start with for MET?

A

CKC exercises prior to OCK

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15
Q

What should we do for the quads with MET for patellar dislocation?

A
  • isometrics and isotonics
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16
Q

What structures should we work on extensibility and elasticity with?

A
  • postlat structures
  • hams
  • IT band
  • Gastroc
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17
Q

What is the prognosis with patellar dislocation?

A
  • up to a 44% re-dislocation rate
  • higher without sx
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18
Q

What is IT band syndrome?

A
  • basically a tendinopathy of the distal IT band
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19
Q

What is the prevalence of IT band syndrome?

A
  • 5-14% of runners
  • 2nd leading cause of knee pain in runner
  • biological males are 50-81% of cases
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20
Q

What are risk factors for IT band syndrome?

A
  • running
  • training errors
  • weak hip ERs and Abd
  • excessive pronation
  • increased hip add and IR
  • trunk lean in U stance
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21
Q

What is IT band syndrome associated with? (other conditions)

A
  • GTPS
  • PFPS
  • recognize common contribution
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22
Q

What is the etiology of IT band syndrome?

A
  • little is known that leads to abnormal mechanical loading
  • consider lumber hypermobiity/instability with impaired LE control and excessive recruitment of TFL as a hip flexor
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23
Q

What are the structures involved with IT band syndrome?

A

-TFL/IT band
- Lateral femoral epicondyle, Gerdy’s tubercle (insertion) and associated bursae and fat pad

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24
Q

What are the pathomechanics of IT band syndrome?

A
  • tendinopathy origins
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25
What are the symtoms of IT band syndrome?
- gradual onset of lateral knee pain - worse with activities involving repetitive knee motion, hills, and dynamic U stance such as running
26
What will we observe with IT band syndrome?
- impaired LE control - possibly thickened tendon
27
What will we find with ROM with IT band syndrome?
pain likely with hip adduction and knee fleixon
28
What will we find with resisted testing/MMT withIT band syndrome?
- possible hip ER weakness - possible hip abd weakness with pain, particularly in a lengthened position - possible pain and weakness with knee ext
29
What will we find with special tests with IT band syndrome?
- possible positive Ober's
30
What will we find with palpation with IT band syndrome?
- TTP over lateral femoral condyle and Gerdy's tubercle
31
What can we educate the patient on with IT band syndrome?
- soreness rule (MILD pain okay 24-48 hours out) - load management (active rest, rest days) - movement cues for LE mechanics
32
What are some PT rx for IT band syndrome?
- POLICED - Pt. ed - address impairments - MET
33
What is the primary purpose of MET for IT band syndrome?
- tendon proliferation and stabilization (hip and lumbar)
34
What kind of MET should we be doing with IT band syndrome?
- Tendonosis prescription (2-3 sets of 10-15 with heavy load) - isometric loading without compression from lengthening - Isotonic loading without compression from lengthening - isotonic loading WITH compression from lengthening - Isometric loading in weight bearing (CC hip abd, er, and ext) - plyometric loading
35
What is patellar tendinopathy?
- aka jumper's knee or ant knee pain
36
What is the incidence and risk factors for patellar tendinopathy?
- up to 50% of athletes - biological males > females - more common in jumping sports
37
What are the structures involved with patellar tendinopathy?
- patellar tendon - infra patellar bursae and fat pad
38
What bursae are involved with patellar tendinopathy? where?
- superficial infrapatellar: between skin and patellar tendon - deep infrapatellar: between patellar tendon and tibia
39
What is the etiology of patellar tendinopathy?
- abnormal mechanical loading
40
What are the pathomechanics of patellar tendinopathy?
tendinopathy origins
41
What are the symptoms of patellar tendinopathy?
- overuse or gradual onset of pain - increased with activity, jumping, lunging and squatting
42
What will we observe with patellar tendinopathy?
- possible thickened tendon (due to scar tissue?) - impaired LE control, particularly knee anterior to toes
43
What will we find with ROM with patellar tendinopathy?
- possible pain and limitation with end range flexion, especially if hip extended
44
What will we find with resisted/MMT with patellar tendinopathy?
- possible pain with knee ext, esp in a lengthened position; may be weak
45
What will we find with accessory motion testing with patellar tendinopathy?
- possible impaired patellar motion (such as limited inferior glide)
46
What special tests can we do for patellar tendinopathy?
- possible positive Thomas Test for shortened rectus femoris
47
What will we find with palpation with patellar tendinopathy?
- localized TTP - possible patella alta positioning
48
What is the PT rx for patellar tendinopathy?
- pt ed - POLICED - Modalities - Orthotics
49
What should we know about PT rx for patellar tendinopathy?
- lack of high quality evidence
50
What can we educate the patient on with patellar tendinopathy?
- soreness rule - load management - movement cues for LE mechanics, increased trunk flexion with landing limits tendon stresses - Address previously mentioned impairements - MET
51
How does increased trunk flexion upon landing decrease tendon stresses?
Decreases stress by preventing "knees over toes" position which would lengthen the patellar tendon. With trunk flexion, knees are less likely to go over the toes.
52
What modalities can we use with patellar tendinopathy?
- extracorporeal shockwave therapy
53
What should we know about extracorporeal shockwave therapy for patellar tendinopathy?
- no additional benefit when added to MET
54
What orthotics are helpful with patellar tendinopathy?
- tendon strap may help; why might it cause more pain
55
What are the primary purposes of MET for patellar tendinopathy?
- tendon proliferation and stabilization (hip and lumbar)
56
What is the prescription for MET for patellar tendinopathy?
- Tendinosis prescription - Isometric loading without compression from lengthening- e.g., ? - Isotonic loading without compression from lengthening- e.g.? - Isotonic loading with compression from lengthening- e.g., ? - (Isometric loading in weight bearing)- CC hip abd, ER, and ext - Plyometric loading
57
What is the MD rx for patellar tendinopathy?
- platelet rich plasma injections: minimal benefit - cortisone (should NOT be used)
58
What is the prognosis of patellar tendinopathy?
- 50-70% improvement at 3-6 months with MET.
59
What is another name for tibial tubercle apophysitis?
Osgood Shalatter's disease
60
What is the prevalence of tibial tubercle apophysitis?
- MOST common cause of anterior knee pain in children
61
When does tibial tubercle apophysitis peak? (age)
at 12-15 years of age
62
What are the structures involved with tibial tubercle apophysitis?
- tibial tuberosity apophysis or epiphyseal plate
63
What are risk factors for tibial tubercle apophysitis?
- growth spurt - high activity - shortened quads and hamstrings - weak quads - high BMI - reduced core stability
64
What is the etiology of tibial tubercle apophysitis?
- overuse
65
What are the pathomechanics of tibial tubercle apophysitis?
- bone growth exceeds quadriceps lengthening - increased tendon tension - most often inflammation
66
What is the weak spot in children? Adults?
- growth plate is the weak spot in children as opposed to tendons in adults
67
What are complications with tibial tubercle apophysitis?
- avulsion and/or premature closure
68
What are symptoms of tibial tubercle apophysitis?
- gradual onset of anterior knee pain with overuse - a "pop" may indicate an avulsion - possible loss of vertical jump
69
What are some signs we could observe with tibial tubercle apophysitis?
- impaired LE control - possibly enlarged tibial tuberosity
70
What will we find with ROM with tibial tubercle apophysitis?
- possible pain with end-range flexion, esp if hip is extended
71
What will we find with resisted/MMT with tibial tubercle apophysitis?
- likely pain with extension, especially in lengthened position; possible weakness
72
What will we find with accessory motion with tibial tubercle apophysitis?
- possible patellar hypo mobility (ie limited inferior glide)
73
What will we find in special tests with tibial tubercle apophysitis?
- maybe positive Thomas test for rectus femoris shortening
74
What will we find with palpation with tibial tubercle apophysitis?
- TTP over tibial tuberosity, and possibly tendon - possible patella alta positioning
75
What is the PT rx for tibial tubercle apophysitis?
- pt ed - POLICED - JMs - orthotics - MET
76
What can we educate the patient on with tibial tubercle apophysitis?
- soreness rule - load management - movement cues for LE mechanics
77
What can we do JMs on with tibial tubercle apophysitis?
- PF glides, likely to increase inferior glide
78
Why should we be careful with stretching with tibial tubercle apophysitis?
- be careful with stretching quads if pain occurs at epiphyseal plate
79
What kind of orthotics can be useful with tibial tubercle apophysitis?
- sleeve but may cause compression pain - strap on tendon but may cause traction pain - arch support to control LE
80
What is MET for with tibial tubercle apophysitis?
- possibly for trunk and hip stabilization
81
When should we use caution with MET for tibial tubercle apophysitis?
- caution with muscle/tendon attached to growth plate to avoid greater overuse
82
What is the prognosis with tibial tubercle apophysitis?
- PT 90% successful - can become a recurrent/persistent problem
83
What are Ottawa Knee rules?
x ray if any are present after trauma for fx - ≥ 55 years of age - fibular head tenderness - isolated patellar tenderness - inability to flex knee > 90 degrees - inability to bear weight immediately and take 4 steps in ER - Do NOT use if > 7 days from injury
84
What is PT rx for fracture?
- primarily treating consequences of immobilization with other tissues

MSK II - EXAM 3 KNEEEEEEE (6 decks)

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