Lowers Exam #3 Patellofemoral

Question 1

patellofemoral bone anatomy

-regions of the patella

Answer 1

lateral facet
medial facet
"odd" facet
-most medial
back side of patella is covered in hyaline cartilage

Question 2

patellofemoral articulation

Answer 2

at 0 degrees all facets are above groove
begin articulating at 10-20
45-90 is where patella is most stable
135 is where odd facet begins to articulate

Question 3

patellofemoral support

Answer 3

ligaments
-medial/lateral patellofemoral ligament
--allows superior/inferior movement
retinaculum
-medial/lateral patellar retinaculum
-inferior to ligaments
muscles
-quadriceps
-patellar tendon
-VMO

Question 4

compressive forces

Answer 4

a lot of forces run through the patella
separated patella
-pulled in half from force of patellar tendon

Question 5

patella function

Answer 5

lever
protection of anterior knee
-ACL would be palpable without patella

Question 6

ROM

Answer 6

0-135+?

Question 7

bursae

Answer 7

prepatellar bursa
-overlies anterior portion of patella
-allows patella to move freely beneath skin
suprapatellar (pouch) bursa
-extension of knee’s joint capsule
-allows free movement over the distal femur

Question 8

normal patellar alignment

Answer 8

normal

• inferior pole around joint line
• closer to medial femoral condyles
• midline of tibial plateaus

Question 9

patella alta (camel’s sign)

Answer 9

high patella (no shift)
causes
-tight quads
-long patellar tendon
consequences
-direct trauma to the knee
-increased likelihood of subluxations/patellar instability
-decreased quad strength

Question 10

patella baja

Answer 10

low patella
causes
-short patellar tendon
consequences
-fairly stable
-affects quad strength

Question 11

squinting patellae

Answer 11

high and medial
cause
-bony alignment
consequences
-predisposed to medial subluxation

Question 12

frog-eyed patellae

Answer 12

high and lateral
cause
-bony alignment
consequences
-predisposed to lateral subluxation
results
-medial ligament and retinaculum are loose

Question 13

medial/lateral patella glide

Answer 13

split patella into 4 quadrants
straight glide across
-normal patellar glide - 1 quadrant

Question 14

patella rotation

Answer 14

very minimal

Question 15

anterior/posterior patella tilt

• procedure
• ROM
• implications

Answer 15

elevate lateral border and depress medial border
normal ROM
-0-15
-more is hypermobile lateral tilt
-less is hypomobile lateral tilt
tilt of more than 15 may predispose to anterior knee pain

Question 16

inspection part of exam

Answer 16

patellar alignment
patellar orientation
posture of lower extremity
patellar tendon
tubercle sulcus angle
leg length difference
foot posture
skin
-scars
-calluses

Question 17

posture of lower extremity

Answer 17

genu varum
-pulls patella medial
genu valgum
-pulls patella lateral
genu recurvatum
-sits off of knee
Q angle
-men - 13 degrees or less
-women - 18 degrees or less

Question 18

joint and muscle function assessment

Answer 18

J sign with AROM
-lateral patellar deviaiton during knee extension
MMT thigh
PROM
-tilt - 15

Question 19

joint stability and special tests

Answer 19

• patellar glide
• patellar tilt
• apprehension test
• Clarke’s sign
• plica tests

Question 20

apprehension test

Answer 20

test for subluxation
attempt to move patella while watching patient
+
-person guards or looks apprehensive

Question 21

Clarke’s sign

Answer 21

one hand proximal to superior patellar pole, applying a gentle downward pressure
patient contracts quadriceps
+
-patient experiences patellofemoral pain and the inability to hold the contraction
-grinding
implications
-possible chondromalacia patella

Question 22

plica tests

Answer 22

medial synovial plica test

stutter test

Question 23

medial synovial plica

Answer 23

patient supine with knee flexed
with knee flexed and tibia internally rotated, passively move patella medially while palpating anteromedial capsule
knee is then extended and flexed from 90 to 0 while tibia is interally rotated
+
-reproduction of Sx
-pain or snapping at site of plica

Question 24

stutter test

Answer 24

sit with knee flexed over end of table
lightly cup one hand over patella while not compressing the articular surfaces
procedure
-patient slowly extends the knee
\+
-irregular motion or stuttering between 40 and 60 as the plica passes over the medial condyle
implication
-medial synovial plica

Question 25

arteries at patellofemoral

Answer 25

popliteal

Question 26

nerves at patellofemoral

Answer 26

common fibular

tibial

Question 27

referred pain from Legg-Calve-Perthes disease, or slipped capital femoral epiphysis (hip)

Answer 27

this happens

Question 28

patellofemoral stress syndrome

• recognition
• management

Answer 28

garbage can term (several symptoms categorized together)
recognition
-anterior knee pain
-decreased strength
-negative tests - ITBFS
management
-fix biomechanics
-VMO strengthening
--quarter squats
--most active in last 30 degrees of extension

Question 29

patellar tendinitis

• recognition
• management

Answer 29

recognition
-pain in inferior patellar tendon
-pain w/ stairs
-signs of inflammation
management
-cho apd
--palliative treatment
-ultrasound
-stretch quads

Question 30

apophysitis

• Osgood-schlatter disease
• apophysis
• etiology
• recognition
• management

Answer 30

apophysis
-meeting of a tendon on a bone
etiology
-excessive traction force on the apophysis
--body lays down excess bone
--overuse during childhood
--stereotype: male who plays multiple sports who is going through a growth spurt and is inflexible
recognition
-local pain over tib tub
-pain w/ kneeling/putting weight on it
management
-decrease activity
-stretch
-talk to parents if minor

Question 31

Sinding-Larsen-Johansson

Answer 31

inflammation of apophysis at inferior pole of patella

Question 32

patellofemoral bursitis

• etiology
• recognition
• management

Answer 32

etiology
-rubbing, friction
--wrestling
-acute trauma
-infection
recognition
-pain and swelling over bursa
-if redness and no history of trauma - possible infection, refer
management
-knee pads

Question 33

knee plica

• anatomy
• etiology
• recognition
• management

Answer 33

anatomy
-normal folds in joint capsule that is thickened
-common
-does not normally get irritated
-plicas
--medial plica (ends near pes anserine)
--suprapatellar plica
--infrapatellar
--lateral
etiology
-trauma by direct blow can cause irritation
recognition
-pain in knee (usually insidious)
-general area
-rule-out pathology
-pseudo-locking
-stutter test
-medial plica test
management
-conservative
-modify activity
-surgery

Question 34

chondromalacia patella

• anatomy
• etiology
• recognition
• management

Answer 34

anatomy
-between patella and femur
-degeneration of the cartilage
etiology
-not always known
-abnormal patellar tracking
-history of dislocations/subluxations
-knee alignment
recognition
-pain with activities that increase patellar compression
-crepitus
-+ Clarke's sign
management
-if patellar maltraching - McConnell taping
-rest
-glucosamine chondroitin
-if it occurs via an acute event, immobilize

Question 35

patellar fracture

• anatomy
• etiology
• recognition
• management

Answer 35

anatomy
-separated medial to lateral
-separated top to bottom
etiology
-direct blow
-excessive tension force
--quad contraction
recognition
-painful
-swelling
-visual/palpable deformity
--"false knee"
-complete lack of extension
management
-splint IN EXTENSION

Question 36

patellar tendon rupture

• anatomy
• etiology
• recognition
• management

Answer 36

anatomy
-patellar tendon no longer connected to tibia
etiology
-easy to mistake with patellar Fx
-extreme quad contraction
--can be associated with tendon degeneration
recognition
-patella in abnormal location
-pain
management
-splint IN EXTENSION

Question 37

acute patellar subluxation or dislocation

• anatomy
• etiology
• recognition
• management

Answer 37

anatomy
-patellofemoral ligaments, retinacula, and VMO (for lateral dislocation) prevent dislocation
--lateral tracking increases likelihood
--high Q-angle
etiology
-traumatic
-plant, turn, and cut
-almost always lateral
recognition
-dislocation
--patella displacement
-subluxation
--swelling
--bruising
--apprehension
--sore on side where ligaments were stretched
--ROM: limited
management
-1st time sublux - refer
-after that use judgement
-RTP
--several weeks for healing (may be immobilized)
--strengthen
--knee brace with buttress on one side

Question 38

on-field eval key focuses

Answer 38

observation
-patellar location
tests
-willingness to move limb
--flexion/extension
-willingness to bear weight
--if able to flex and extend, allow athlete to bear weight
-removal from field
--assist athlete

Question 39

on-field management

Answer 39

patellar tendon rupture or fracture
-spling in extension
patellar dislocation
-spontaneous reduction
--splint in extension
-unreduced dislocation
--splint as found
--refer to physician - rule out fracture