lecture 6: continued Flashcards by sophia carrasco

what is altmans criteria for KNEE OA

Knee pain and:
 Age >50 yrs
 Knee crepitus
 Palpable bony enlargement
 Bony tenderness to
palpation
 Morning stiffness <30 minutes
 No palpable warmth

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what are teh CPG recommendations for KNEE OA that has STRONG evidence

exercise
-NSAIDS (when not contraindicated)
self management
pt education

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what are the CPG recommendations for KNEE OA that has MODERATE evidence

 Unloading (cane, bracing)
 Neuro Re-ed (balance, coordination, agility)
 Weight loss
 Intra-articular corticosteroid injection (for short term relief)

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what are the CPG recommendations for KNEE OA that has LIMITED evidence

 Oral dietary supplements (turmeric, glucosamine, etc)
 Manual therapy, massage, laser, acupuncture, TENS
 PRP
 High tibial osteotomy

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what are the CPG recommendations for KNEE OA that has NOT RECOMMENDED evidence

 Lateral wedge insoles
 Oral narcotics, including tramadol
 Hyaluronic acid injections
 Arthroscopy with lavage and/or debridement

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what are 5 indications of a TKA

severe joint pain w WB that compromises function
desdstruction of articular cartilage of the knee secondary to arthritis
deformity of the knee (genu varum or valgum)
gross instability or limitation of motion
failure of non operative things

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where is the pain from patellofemoral pain syndrome (PFPS) and what is it possibly causes by

anterior knee pain

possibly causes by direct trauma , over use , faulty patellar tracking or degeneration

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what will someone have pain doing with patellofemroal pain syndrome (PFPS)

squatting
getting up from chair
kneeling
-stairs
prolonged sitting
jumping
walking
running

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how will the foot and hip present with patellofemoral pain syndrome

foot ER
hip adduction and IR

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what hip motions will be weak w PFPS

hip abd/ ER

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if a pateint is 23 active female that complains of anterior knee pain and she explains she is a runner and has been ever since she was little and she has pain w squatting , kneeling , stairs and running what u see her foot is ER and her hip is add and IR what syndrome can we suspect

Patellofemoral Pain
Syndrome (PFPS)

can sound like OA but AGE is a huge factor in this**

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what are ACUTE phase treatment from Patellofemoral Pain Syndrome (PFPS)

modalities
reset
gentle ROM
isometrics

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what are some OKC beginning level exercises fro PFPS

 Quad sets
 Quad set + SLR
 Resisted isometrics
 Short arc quads for terminal knee extension (TKE

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what are some CKC beginning level exercises fro PFPS

 Begin with partial WB if full WB is painful
 Retrain mechanics and knee control
 Standing TKE
 Mini squats
 Leg press, total gym
 Use caution when squatting past 60°

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what is the hallmark features of patellar tendinopathy

pain localized to the inferior pole of the patella
load related pain that increases w the demand ont he knee extensors

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for patellar tendinopathy

 Rarely have pain at ____
 Sometimes better with ___ ___
 Increased pain day after ___ ___ activities
 May see stiff knee jump landing strategy

rest
warming up
energy storage

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what is the rehabilitation stages and progression criteria for patellar tendinopathy

isometric training
isotonic loading
energy storage loading
return to sport

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what are the CPGs for meniscus clinical finding

twisting injury
tearing sensation at time of injury
delayed effusion (6-24hrs)
history of “catching” or “locking”
pain with forced hyperextension
pain w maximum passive knee flexion
pain or audible click w McMurray maneuver
joint line tenderness
positive thessaly test

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what is the clinical finding for the articular cartilage CPG

acute trauma w hemarthrosis (0-2 hrs)
insidious onset aggravated by repetitive impact
intermittent pan and swelling
history of “catching” or “locking”
joint line tenderness

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when can ppl w articular cartilage damage begin to full weight bear

6-8 weeks

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if a pt has a valgus force as their MOI what ligament is injured

MCL

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a valgus force MOI is also accompanied by injury to what other 3 things and what is this called

medial meniscus
aCL
and posteromedial capsule

un happy triad (ACL , MCL and medial meniscus)

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if a pt has a MOI of hyperextension what is injuried and what is it accompanied by

injury to ACL and accompanied by injury to the meniscus

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if a pt has a MOI of flexion w posterior tranlastion what is injuried and this is a classic what

injury to PCL

classic dashbaord injury

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if a pt has a injury to the LCL and it is accompanied by injury to the posterolateral capsule and PCL what kind of MOI/force is it

varus

what special test will be positive for an ACL injury

lachman anterior drawer pivot shift

what will pts be guarding with if they have an ACL injury and what is that guarding preventing

guarding by hamstrings to prevent anterior tibial translation

if someone has an ACL injury how fast does it swell

0-2 hours post injury

what is considered the unhappy triad

ACL medial meniscus sMCL (superficial)

what is the MOI of the unhappy triad

sudden valgus impact with ER or IR there is immediate swelling

what will the exam look like for someone w a unhappy triad

may report a snapping/ click noise positive lachman test , pivot shift test , anterior drawer test , valgus test , menicual testing tenderness over sMCL

what is the goals for the first 1-4 weeks after a ligament injury (ACL)

- keep the knee calm - achieve full ROM (especially EXTENSION) - quad activation - appropriate single leg strengthening - normal gait

what is the criteria for the acute/ protective phase from ACL tear

 Minimal swelling and pain  Full ROM  Straight Leg Raise with no lag  Normal gait with no AD or brace

if someone has cortical inhibiton what are the 4 indicated treatments you can do

1. forced use intervention 2. cortical drive (biofeedback) 3. mechanical and metabolic stess 4. open chain knee extension

if someone has arthogenic mm inhibiton what are the 3 indicated treatments you can do

1. disinhibitory interventions 2. forces used (NMES) 3. open chain knee extension

how many weeks is the strengthening phase for ACL tear

4-8 weeks

what is the goals for the strengthening phase from ACL

 Full ROM  Normal gait, improve distance  Progress strengthening  Start Single Leg strengthening (usually around week 6

what are phase 2 exercise ideas for the quads after an ACL tear

• Step Up • Step Down • Leg Press • Single Leg Sit to Stand • Front squats • Lunges • Split squats

what are phase 2 exercise ideas for the glutes after an ACL tear

• SL Bridge/Thruster • Side-Step with band • Side Plank • Back Squats

what are phase 2 exercise ideas for the hammy after an ACL

• SL RDL • Ham Curl Machine • Slide Board Ham Curls • Physioball Ham Curls

what are phase 2 exercise ideas for the core after an ACL

•Planks •Dead Bugs •Paloff Press

when during ROM is there the most strain on the ACL

40°-0°

what reduces anterior tibiofemoral shear and thus less strain on the ACL

co contraction of quads and hamstrings

when are OKC knee extensions exercises safe to do after a ALC injury

when performed at low load from 90to 40° of knee flexion ROM

how many weeks is the functional phase after a ALC injury

8-16 weeks

what are the goals during the functional phase (8-16 weeks) for an ACL injury (lig injiry)

start running (straight line) start double leg jumping improve single leg strength get back not gym

what is the criteria for the functional phase after a ACL sx

run normal on treadmill w/o pain normla double leg landing normla single leg squat

what is the criteria from the return to running after an ACL injury

- 95% of knee flexion - full extension ROM - no swelling - limb symmetry index >80% from quad strength - limb symmetry index > 80& eccentric impulse during counter movement lump - pain free jogging and alter G running - pain free repeated single leg hopping

what are examples of phase 3 exercises (functional phase) after an ACL injury

- pre jogging (jump rob , alter g , single leg squats for speed) - strengthening - landing mechanics - running

what is the timeline for return to sport for post ACL

16 weeks to 6 months

when during ACL recovery can u being light single leg hops ? being cutting/chang of direction ?

16 weeks 20 weeks

at 24 weeks after an ACL sx what shoudl be at least 90% of contralateral limb , and what else shoudl be normla

single leg hopping change of direction should be normla

what is the criteria to return to sport phase for ACL

- Y balance within 4cm of contra - single leg hop test 90% of contra - LESS is good - 5-10-5 is normla - strength testing of quads/hammy writhing 90% of contra

what is the complex for Anteromedial Rotatory Instability

ACL + medial/posterior medial knee ligament complex

what is the complex for posteromedial Rotatory Instability

PCL + medial/posterior medial knee ligament complex

what is the instability for the anterolateral rotatory instability

ACL alone ACL and posterolateral corner

what is the instability for the posterolateral rotatory instability

- PCL and posterolateral corner - posterolateal corner alone

what is included int he posterolateral corner

- LCL -popliteus tendon - poplitofibular ligament ( arcuate lig , fabello-fibular ligament , biceps femoris long head , ITB)

what are teh 6 attachments of the IT band

-1. ITB tract 2. Lateral intermuscular septum 3. Kaplan fibers (femoral) 4. Patellar insertion 5. Tibial insertion (Gerdy’s) 6. Lateral femorotibial ligament

what are teh ITB syndrome factors (5)

 Excessive foot pronation  Excessive internal torsion  Genu varum  Deep hip rotator/abductor weakness  Innominate positioning

what is a traction injury to the cartilage/bony attachment of tendons in children and adolescents

apophysitis

what is the **MAIN** difference between Osgood- Schlatter syndrome and Sinding- Larsen Johansson syndrome

Osgood : pain at the tibial tub Sinding : pain at the inferior pole of the patella

if a pt is 12 y/o boy and has pain at the anterior tibial tibuerle w kneeling and activity what do we think it is

Osgood-Schlatter syndrome

if a pt is 12 y/o boy and has pain at the anterior tibial tibuerle w kneeling and activity what do we think it is

Osgood-Schlatter syndrome