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PTY EXAM > PTY1011 Knee + ankle > Flashcards

PTY1011 Knee + ankle Flashcards

(106 cards)

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1
Q

What deficit might encourage use of ZKS?

A

Quads lag post op

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2
Q

What is a test used for knee joint effusion?

A

Brush and swipe test/sweep test

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3
Q

How is the brush and sweep test done?

A

Patient supine w/ knee E
Brush up w/ hand over medial aspect of knee to supra patellar pouch 3x
then brush down once over lateral aspect
+ve sign show bulge or wave on medial side

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4
Q

What other tests may be perform in physical examination and show pain for suspected PFPS?

A

Observation-patella position, (eg tilt or lateralised), femoral position, muscle bulk, especially gluteals, quads and calves. Presence of effusion

ROM, especially loss of extension.

Muscle length-Modified Thomas test to assess hip flexors, quads and add in adduction for TFL. Gastroc/soleus, glute max insertion into ITB (Hip F + add)

Functional: squat, heel raise, gait, hop

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5
Q

How to perform patellar apprehension test? What is a positive sign?

A

Knee E, apply pressure to medial patella to move laterally while bending pt’s knee to 90 flexion
Pos: if pt pushes examiners hand away, worried of dislocation

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6
Q

Patellar dislocation treatment

A

Reduction + RICE
appropriate rest, appropriate hip and thigh muscle strengthening, and perhaps the use of a patellar buttress brace

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7
Q

What is the ober’s test?

A

Tests for tightness of Tensor Fasciae Latae (TFL) (responsible for tight Iliotibial band (ITB))
-Bend both legs in sidelying, bring top leg into hip extension w/ knee flexed 90, then gently drop.
-+ve if leg stays in air and does not drop.

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8
Q

What is the modified ober’s test?

A

same as ober’s test but Knee is fully E and not 90 deg flexed.

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9
Q

What test can be used to assess if hip is the source of patients pain? What shows it is positive?

A

Hip quadrant test. Moving from hip flexion + adduction to hip flexion + abduction through 70-140 deg
Reproduction of pain or clunking

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10
Q

What might a positive hip quadrant test indicate?

A

arthritis,
avascular necrosis
joint capsule tightness and/or an acetabular labrum defect

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11
Q

What tests look at meniscal damage? (4)

A

McMurrays Test
Apley’s grind test
Thessaly Test

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12
Q

How is the Mcmurray conducted? which way rotation tests which side of meniscus? What is +ve?

A

Supine
Flex knee to 90
Medial meniscus: ER and bring knee into Ext.
Lateral meniscus: IR and bring knee into Ext.

+ve: pain, clicking or locking

MUST COMPARE TO OTHER SIDE!

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13
Q

How is the Apley’s grind test conducted? Which part confirm ligamentous lesions vs meniscal lesions?

A

Prone
Flex knee to 90
Ligamentous: distract knee and IR + ER just above ankle joint - +ve if painful + increased rotation vs other side
Meniscal: compress knee from heel of foot and IR + ER
+ve- painful + decreased rotation

MUST COMPARE TO OTHER SIDE!

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14
Q

How is the Thessaly test conducted?

A

Have pt stand on SL w/ knee flexed 5 then 20
Instruct to IR and ER body while holding therapist arms for support

+ve: pain in joint line during rotations

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15
Q

What test look at the collateral ligaments of the knee?

A

Varus stress test: lateral lig
Valgus stress test: medial lig

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16
Q

How to conduct varus test?

A

Supine, one hand at ankle, another on medial side of femur
ER + apply force w/ hand on femur to put stress on LCL

Repeat in 20-30deg flexion (cause use fulcrum)

+ve: pain + excessive gapping

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17
Q

How to conduct valgus test?

A

Supine, one hand at medial ankle, another on lateral side of femur
Slight ER + apply force to stress MCL

Repeat in 20-30deg flexion (cause use fulcrum)

+ve: pain + excessive gapping

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18
Q

Interventions for PFPS

A

-Education re: rest + gradual increase in exercises + monitoring pain levels
-Medial patellar taping
-Strengthening quadriceps, calf and gluteal muscles, avoid knee agg (no more than 2-3/10 VAS)
-stretching calf + ITB

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19
Q

Outcomes for for PFPS

A

Patellofemoral Pain and Osteoarthritis Subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-PF)

Lower extremity functional scale

VAS

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20
Q

What is an overuse injury of the shin area?

A

Medial tibial stress syndrome (MTSS)

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21
Q

Differential diagnoses w/ medial tibial stress syndrome

A

Anterior tibial stress syndrome- pain along anterolateral tibia
Tibial/fibular stress fracture: Pain with running, point tenderness over fracture site, “dreaded black line” on lateral x-ray

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22
Q

What is MTSS?

A

Vague, diffuse pain along middle-distal tibia, worse at beginning of exercise, that decreases during training

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23
Q

Intervention for MTSS

A

Ice + Rest
Edu: re gradual return, Shock-absorber shoes (replace every 500-800km)
Tape foot to counter pronation
Softer surface running
Calf stretch + strengthen
If tape works- anti-pronating shoe inserts (for biomechanic abnormalities)
Maintain training instead of sudden increase in load,
Strengthen supinators
Hydrotherapy

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24
Q

How to differentiate between stress fracture and MTSS

A

one-leg hop test
#- wont be able to hope without severe pain
MTSS: can hope up to 10x

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25
Common Hx for patients with MTSS (3)
-Pain in medial tibial border in the middle and lower third -Pain persists for hours or days after cessation of activity -Pain decreases with running (early stage) (Differentiate from exertional compartment syndrome, for which pain increases with running) -Earlier onset of pain with more frequent training (later stages)
26
Common physical exam with MTSS (5)
- tenderness of the involved medial tibial border, more than 5 cm - Pes planus (flat feet) - Tight Achilles tendon - "one-leg hop test" - Provocative test: pain on resisted plantar flexion
27
Imaging for MTSS
Most sensitive: MRI- periosteal fluid and marrow oedema Scinctography: 3-phase isotope longitudinal uptake on the delayed images (stress fracture shows earlier)
28
Tests for ACL injury
Lachman's Test Anterior drawer Pivot-Shift
29
how does ACL injury commonly occur?
participate in sports activities associated with a jump, pivoting, twisting, and direct impact to the front of the tibia - 70% by doing a wrong movement.
30
How to do Lachman's test and what is +ve result?
Supine, knee F to 20-30 + slight ER PT places one hand on thigh and the other behind tibia (w/ thumb on tibial tuberosity) Pull tibia anteriorly +ve: soft/mushy end-feel (should be firm if -ve)
30
How to do Lachman's test and what is +ve result?
Supine, knee F to 20-30 + slight ER PT places one hand on thigh and the other behind tibia (w/ thumb on tibial tuberosity) Pull tibia anteriorly +ve: soft/mushy end-feel (should be firm if -ve)
31
Sensitiviy vs specificity
Sensitivity: ability to rule IN Specificity: test's abililty to rule OUT
32
How to do anterior draw test and what is +ve result?
Supine, hip F 45 + knee 90, PT sits on toes PT hands below tibiofemoral joint line + pull tibia anteriorly +ve: lack of end-feel/excessive ant. translation (>6mm) COMPARED TO OTHER SIDE XX
33
How to do pivot-shift test and what is positive result?
Supine leg relaxed PT list leg by grasping heel and other hand lateral of prox. fibular applying valgus force W/ heel, move leg from E to 30deg F and back to E (repeat) +ve: if tibular posterior translates during bend (due to tightening of ITB)/ clunk sound/pt feel giving way
34
Is the pivot shift better at ruling in or ruling out?why?
Ruling out as specificity > sensitivity
35
which is stronger? The ACL or PCL?
PCL
36
What is the most frequent mechanism of injury to the PCL?
direct blow to the anterior aspect of the proximal tibia on a flexed knee with the ankle in plantarflexion (MVA + dashboard)
37
Special tests for PCL?
Sag sign Posterior Drawer Posterior lachman's test
38
How to do post. draw test?
Supine, hip 45 knee 90 (same as ant. draw test), pt on feet place both hands on either side of prox. tibia and apply force for post. translation +ve: soft/mushy end feel (high spec and sens)
39
How to identify sag sign?
Patient supine with hip F 45 and knee F 90 Observe levels of tibial tuberosities +ve: concave distal to patella (normal tibial plateau extends 1cm anteriorly)
40
What tests could give a false positive ACL test is PCL is torn?
Anterior draw and Lachman's
41
If a patient is aboriginal, who should they be linked to in the mdt?
Aboriginal liason health officer
42
How to determine need for imaging of acute ankle injury and avoid unnecessary x-rays ?
Ottawa Ankle Rules
43
What are the 5 components of the Ottawa ankle rules?
A. Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus B. Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus C. Bony tenderness at the base of 5th metatarsal D. Bony tenderness at the navicular E. Inability to bear weight both immediately after injury and for 4 steps during intial evaluation
44
What is indicative of an ankle x-ray according to Ottawa ankle rules?
Pain in malleolar zone + - tenderness on A OR B OR inability to WB both immediately and in ED
45
What is indicative of an foot x-ray according to Ottawa ankle rules?
Pain in mid-foot zone + - bone tenderness on C OR D OR inability to WB both immediate and in ED
46
Tests for suspected lateral ankle sprains?
Talar Tilt test
47
What are the lateral ligaments of the ankle?
anterior talofibular lig posterior talofibular lig calcaneofibular ligament
48
What ligaments does the talar tilt test?
Calcaneofibular ligament anterior talofibular ligament
49
How to conduct talar tilt test and differential bw/ CFL, ATFL and PTFL
Patient sitting PT hold distal tibia, other hand inverts ankle while holing calcaneous lateral side of foot while ATFL: in 20 deg PF CFL: in anatomical pos. (NEUTRAL) PTFL: in max DF +VE: pain + excessive gapping
50
Anterior drawer test how to? Is it best for chronic or acute?
Better for acute (Weak for chronic) Patient supine w/ slight knee flexion. Hand on heel w/ foot resting on PT forearm in PF 10-15deg Other hand on ant. tibia + pull heel up +ve: increase ant. translation. soft end-feel
51
When does patellofemoral joint instability occur?
after cute dislocation
52
Patellar tendinopathy is a load sensitive condition to what common acitivities?
jumping hopping squats
53
Outcome measure for patellar tendinopathy
Victorian Institute of Sport Assessment-Patella (visa-p)
54
Mx for patella tendinopathy
load mofication 24/24 pain monitor Inital: isometric load Progress to isotonic (quad strength)
55
Mx for pre-patellar/infrapatella bursitis
NSAIDS, cortico steroid injection
56
Fat pad impingement where is pain?
anterior inferior patellar pole dept to patellar tendon
57
Movement that aggs fat pad impingement of knee
hyperextension
58
What age does Osgood-Schlatter lesion affect? M vs F
M>F M: 13-15 F: 10-12
59
What is Osgood-Schlatter lesion?
- Osteochondrosis (traction apophysitis) of tibial tuberosity related to growth spurt - Multiple mini-avulsion ‘fractures’ - Bony response plus irritated tendon
60
Signs of Osgood Schlatter?
mechanical pain – on loading e.g. running, squatting, jumping i.e. forceful contractions of quads pulling on tibial tuberosity
61
Mx of Osgood Schlatter?
ice for immediate relief – load management – relative rest – self limiting condition but can take yearsto settle – correct biomechanics as needed (hip / foot etc) – stretching quadriceps
62
Meniscal degeneration physical exmaination
-positive McMurray’s test, mechanical catching and locking, giving way -Palpable tenderness on joint line (medial >L)
63
Meniscal degeneration Mx
education – specific knee strengthening (quads) and general exercise – weight management (if overweight) – gait aid
64
Typical clinical knee OA diagnosis points (6) + 3
– aged 45 years or over – has activity related joint pain – morning stiffness that lasts <30minutes – crepitus on active movement – bony enlargement – no detectable warmth addit: deformity (fixed flexion or varus), instability, joint line tenderness, pain on patellofemoral compression
65
OA vs RA?
OA: chronic synovial joint condition RA: chronic inflammatory autoimmune disease
66
Signs of RA:
joint pain, tenderness, stiffness, and swelling. 'flare-ups'
67
PT Mx of RA
pain relief – maintaining joint ROM – muscle function and muscle strength – knee function and gait re-education
68
Immediate swelling vs delayed swelling
Immediate: haemarthrosis (0-2hrs) Delayed: Effusion (6-24hrs)
69
What conditions indicated w/ effusion (delayed swelling)
Meniscal injury (inner 2/3) Chondral injury
70
What does a pop/snap indicate in acute knee injury?
ACL rupture
71
What does a click/lock indicate in acute knee injury?
meniscal injury
72
Functional knee tests:
– Squat – Hop (and land!) – Step-ups and step-downs – Running – straight line / cutting
73
Ottowa Knee rules -x-ray indicated if one is present: (5)
Pt age >55 or <18 years - Tenderness fibular head - Tenderness over patella - Inability to flex knee 90 degrees - Inability to weight bear for four steps at the time of injury and at examination
74
What imaging can confirm ACL
MRI
75
Conservative mgmt of ACL
-strengthen muscles around joint
76
Surgical mngmt of ACL
§Hamstring graft (semitendinosis or gracilis) §Patellar graft (middle 1/3) §Allograft (potential advantage as decreases co-morbidity) §Synthetic graft (LARS)
77
ACL reconstruction rehab at 0-6 weeks
Quad strength (static, mini squats) calf raise support Hip ABd Bike
78
ACL reconstruction rehab at 6-12 weeks
Patellar mob massage hams strengthening Quads vmo LEG PRESS, LUNGE, STEP UP BRIDGE(OKC contraindicated?) jog
79
physical examination for mcl injury
- +ve stress test - tender on palpation - Lack of full extension
80
Mx of MCL
Strengtg - Strength -Functional strength - ROM -Hinged Knee Brace / Taping (RTS)
81
First time Mx for patellar dislocation
Extension splint 2/52 - Quads -Hip strength / pelvic ‘stability’ - Knee flexion 100 degrees by 6/52 - RTS 8 -12/52
82
Plantar facsitis causes:
Overuse, Pes Planus (stress on medial structures) or Pes Cavus (reduced shock absorption).
83
Presentation of plantar fascitis?
Insidious onset, Inferior heel pain, often calcaneal tubercle (insertion) or arch - Worse in the morning, often warms up with exercise, agg with loading and standing
84
Differential diagnosis for plantar fascitis
Calcaneal stress # and fat pad contusion
85
Mx for Plantar fascitis
Load management - Ice, NSAIDs - Stretching of plantar fascia, and calf complex - Strengthening of intrinsic mm of foot to maintain arch - Strengthening of the calf complex (gastroc + soleus) -Taping (inversion and splinting of medial arch)
86
What classifies ankle (lat. malleolar) fractures?
Webers classification
87
Lat lig. sprain Mx:
Reduction of pain and swelling - Early, controlled mobilisation – think principles of soft tissue healing etc. - Restoration of ROM: active and passive - Strength (active, resisted theraband, functional) - Proprioception++
88
Mobilisation to improve ADF
- Passive mobilisation of talocrural dorsiflexion – Accessory Glide: Anterior-Posterior glide of talus
89
Cause of navicular stress #
veruse and training errors § Poor biomechanics (reduced TC Dorsiflexion, strength- decrease shock absorption
90
Best way to see navicular stress #?
MRI or Isotopic bone scane (x-ray poor sensitivty)
91
Mx for navicular stress #
6/52-8/52 non-weight bearing immobilisation in a cast Surgery (screw) +/- bone graft if significant separation of fracture of delayed union Rehab: mobilisation stiff joints, muscle strengthening, load management
92
Avulsion # base of 5th MT mechanism
inversion injury -Avulsion of peroneus brevis tendon from its attachment 5th MT
93
Mx of avulsion # of base of 5th MT
immobilisation (cam walker) for 2/52 followed by controlled mobilisation
94
How long do tendinpathies take to rehab?
average 12-18 month rehabilitation
95
Achille Tendinopathy Mx
Take away abusive load Load management
96
End feel for bone, ligament/capsule, muscle stretch, soft-tissue limiting (instead of joint)
Bone: hard Lig: firm Muscle: Springy Soft tissue: Soft
97
2 types of dynamic stretch
Contract relax Reciprocal inhibition
98
Contract relax involves?
Take the person to the point of stretch * At end of range (EOR) , contract muscle isometrically against resistance while lengthened * It then relaxes more, so the passive stretch can be increased
99
Reciprocal inhibition
Take the person to the point of stretch * Concentric contraction(shortening)of the muscles opposite the range limiting muscles * When an antagonist contracts, it causes a reciprocal inhibition of the range limiting muscle
100
Inflammatory stage of # length
1-2 weeks
101
Tendinpathy. Stage 1Exercise dosage
Isometric 45s hold x 5 4-5x/day
102
Tendinopathy. Stage 2 exercise dosage
Isotonic 4 x6-8 slow and heavy, every 2nd day
103
Tendinopathy stage 3
Stretch shorten cycle (jumps/hops) every 2-3 days maintain stage 2
104
Tendinopathy stage 4
Sport specific e..g sprinting, jumping specfic every 2-3 days.
105
When to progress to next stages in tendinopahty?
Load tolerant: Acceptable pain during activity (3/10) pain settles within day.

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