Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DPT 516 > Quiz #9 > Flashcards

Quiz #9 Flashcards

1
Q

do SCFEs happen more in younger or older populations?

A

younger (12 for girls, 14 for boys)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the most common disorder of the hip in adolescents?

A

SCFE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is SCFE?

A

displacement of the femoral neck from the capital femoral epiphysis

the neck migrates up and out as the head remains in the acetabulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

does coxa vara or coxa valga cause more shear forces?

A

coxa valga

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

t/f: SCFEs often occur from innocuous causes

A

true, things that you wouldn’t expect to cause damage do

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the initial symptom of a SCFE in 45% of cases?

A

knee and lower thigh pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is done to determine if the hip is stable or unstable with a SCFE?

A

radiographs, physical exam, and symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

t/f: intervention for SCFE is focused on relief of symptoms and containment of the femoral head

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the PT focus on SCFE treatment?

A

strength and ROM once stability is achieved (don’t often see them prior to surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SCFE is bilateral in ___% of cases

A

20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

if a SCFE is found in one leg, there is a __% chance it will occur in the other leg too

A

40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

t/f: there is a risk for AVN in SCFEs

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the 2 types of femoroacetabular impingement syndromes?

A

cam impingement

pincer impingement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is a cam impingement?

A

abnormal shape of the sup/ant FEMORAL head and neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the ratio of males to females affected by cam impingements?

A

14:1 (young males mostly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

t/f: cam impingements are associated with future development of osteoarthritis

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is a pincer impingement?

A

abnormal bone growth of ant/sup ACETABULUM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the ratio of females to males (age 40) affected by pincer impingements?

A

3:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

t/f: both cam and pincer impingements can occur together and most have an element of both

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the presentation of femoroacetabular impingement syndrome?

A

loss of ROM prior to onset of pain

unilateral ant hip/groin pain

pain and decreased flex and IR

pain with sitting, squatting, and sports

clicking/popping w rotation

may just initially feel stiff with no pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how is femoroacetabular impingement syndrome diagnosed?

A

(+) FADIR (flex, add, IR)

plain film x-ray

MRI arthrogram (labrum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

will putting a pt into ant or post pelvic tilt help with a femoroacetabular impingement?

A

posterior pelvic tilt will help, anterior pelvic tilt will irritate it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the surgical interventions for a pincer impingement?

A

peel off labrum

resect bone

repair labrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the surgical interventions for a cam impingement?

A

remove excess bone

contour the head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

can increased lower abdominal strength reduce anterior pelvic tilt in impingements at the hip?

A

possibly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the PT interventions for femeroacetabular impingement syndrome?

A

hip jt manual therapy

strengthening (adductors, abductors, extensors, ERs and trunk)

functional progression and education targeted at individual physical impairments

not fixing the impingement but improving ROM and relieving symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

t/f: there is chondrocyte proliferation of the labral fibrocartilage at the border of an acetabular labral tear

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

where is there increased microvascularity in an acetabular labral tear?

A

at the base of the tear adjacent to the bone insertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

t/f: there is osteophyte formation with an acetabular labral tear

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

which type of femoroacetabular impingement can lead to calcification of the labrum, further deepening the acetabulum?

A

pincer impingment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

do acetabular labral tears occur more in younger or older populations?

A

younger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is a common cause of hip dysfunction in the active populations?

A

acetabular labral tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what position can cause an acetabular labral tear?

A

ER with hyperextension of the hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the cause of athletes with groin pain in more than 20% of cases?

A

acetabular labral tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what can put an older person at risk for acetabular labral tears?

A

hx of hip or acetabular dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

how are acetabular labral tears classified?

A

by location, etiology, and anatomic features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

order these from most to least common location for an acetabular labral tears: posterior, superior (lateral), anterior

A

anterior>posterior>superior (lateral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what are the etiologies of acetabular labral tears?

A

degenerative, traumatic, and idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what are the anatomic features of various acetabular labral tears?

A

radial flap, radial fibrillation, longitudinal, and detached

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is the most common anatomical feature of an acetabular labral tear?

A

radial flap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is the least common anatomical feature of an acetabular labral tears?

A

longitudinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

how is an acetabular labral tears diagnosed?

A

with resisted straight leg raises

pain in groin, trochanter, and buttock with flexion and rotation

sharp pain with clicking, catching or locking

confirmation with MRI arthrogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is the test for an anterior acetabular labral tears?

A

reproduction of symptoms with abd, ER, flex TO add, IR, ext

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is the test for a posterior acetabular labral tear?

A

reproduction of symptoms with add, IR, ext TO abd, ER, flex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what are the interventions used to treat acetabular labral tears?

A

body mechanics

manage forces

avoid pivoting

strengthening through progressive ROM

open/closed, arthrotomy/osteotomy, labral resection, labral repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what is the post-op intervention for an acetabular labral tear in phase 1 (wk 1-4)?

A

WB may be none to 50% per surgeon

not more than 90 deg flexion

0 deg ext

25 deg abd

0-25 deg ER (per surgeon)

0-10 deg add (per surgeon)

light PREs

STM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is the post-op intervention for an acetabular labral tear in phase 2 (wk 4-8)?

A

progressive WB to full WB

restore full ROM

progress strengthening

initiate CKC (light)

improve neuromuscular control

might have them using 1 crutch for a week or so

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what is the post-op intervention for an acetabular labral tear in phase 3 (wk 8-12)?

A

advance strengthening

improve neuromuscular control

advance CKC strengthening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what is the post-op intervention for an acetabular labral tear in phase 4 (wk 12 to return to sport/fxn)?

A

progress strengthening

advance to multiplanar hip strengthening

advance to plyometrics bilaterally to unilaterally

sports specific training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

order the following from most to least common causes of greater trochanter pain syndrome: glut min tendinopathy, glut med tendinopathy, bursitis

A

glut med tendinopathy>glut min tendinopathy>bursitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what is a frequent cause of lateral hip pain?

A

greater trochanter (GT) pain syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what actions can cause GT pain syndrome?

A

direct trauma or repeated friction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

t/f: pts with GT pain syndrome may be TTP over the GT

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are the symptoms of GT pain syndrome?

A

pain with stretching the ITB into add, ER, and IR (Ober sign)

pain with resisted abd, ext, and IR

tightness of adductors

weakness of abductors and ERs

LBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

t/f: GT pain syndrome is associated with LBP

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

in pts with lateral hip pain what tests will be positive?

A

(+) GT palpation
(+) resisted abduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

t/f: MRI alone is sufficient to diagnose GT pain syndrome

A

false

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

at the pre-clinical/sub-clinical stages of GT pain syndrome, will pts have symptoms?

A

they may have no/little symptoms and will not be at the level of pain or dysfunction that they feel the need to do anything about it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what is the Trendelenburg sign?

A

hip drop on the opposite side of glut med weakness

(R weakness=L hip drop, L weakness=R hip drop)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what are the interventions for GT pain syndrome?

A

stretching the ITB and TFL

TFM

glut med (and max) ER PREs

correct biomechanical causes anywhere along the chain

maybe modalities but not sure about its effectiveness

stretching and manual techniques may have more benefits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

t/f: the knee is triplanar

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what are the shapes of the medial and lateral menisci?

A

lateral=O
medial=C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

is the medial or lateral condyle more posterior?

A

the lateral condyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

is the med or lat meniscus attached to the popliteus?

A

lat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

is the med or lat meniscus more mobile?

A

lat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what pulls the lat meniscus back a bit?

A

the hamstrings and popliteus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

is the med or lat meniscus attached via the coronary ligs, tibfib jt capsule, and MCL?

A

med

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

t/f: the med meniscus has a larger diameter but covers a smaller % of the knee

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

is there a higher incidence of injury in the med or lat meniscus?

A

med

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

is the med or lat condyle more distal and curved?

A

med

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

t/f: the knee capsule secretes synovial fluid and has a supracondylar pouch

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what happens to the synovial fluid in the knee with flexion?

A

it moves posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what happens to the synovial fluid in the knee with extension?

A

it moves anteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

does the knee capsule become more taught anteriorly or posteriorly with knee flexion?

A

anteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

does the knee capsule become more taught anteriorly or posteriorly with knee extension?

A

posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what is the plica?

A

a fold in the synovial layer of the knee capsule that wraps around the patella

usually on the medial side

not everyone has it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

t/f: the plica can mimic patellofemoral problems

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

do ligs have greater affects at mid or end range?

A

end range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

are the ACL and PCL extra synovial or intraarticular?

A

both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

when are the ACL PCL taught?

A

with rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

where does the PCL go from and to?

A

from the posterior tibia to the lateral aspect of the medial femoral condyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

where does the ACL go from and to?

A

from the anterior tibia to the posterior aspect of the medial side of the lateral femoral condyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

is the PCL more taught in flexion or extension?

A

in flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

does the ACL or PCL prevent posterior translation of the tibia on the femur?

A

PCL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

how is the PCL often injured?

A

with a fall on the tib tub and a posterior force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

does the ACL or PCL prevent anterior translation of the tibia on the femur?

A

ACL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

does the ACL or PCL draw the femur into the skrewhome mechanism when the knee is fully extended?

A

ACL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what are the 2 bundles of the ACL?

A

AM and PL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

is the ACL most taught in flexion or extension?

A

extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

does the ACL or PCL control med/lat (valgus/varum) and rotational motion?

A

ACL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

t/f: the MCL inserts onto the medial meniscus

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

are the MCL and LCL most taught in flexion or extension?

A

extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

do the MCL and LCL play a greater role in controlling varus/valgus in flexion or extension?

A

extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what is the “terrible triad”?

A

ACL, MCL, and medial meniscus injuries together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

why are there less LCL injuries than MCL?

A

it’s not as common to experience a hit from the medial side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

what is a bi-partite patella?

A

extra bone formed off the lateral aspect of the patella that may look like a fx on imaging

can lead to PF problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

is med or lat patellar tracking usually at the heart of many patella problems?

A

lateral tracking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

how does the patella move?

A

in a C pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

at the greatest degree of extension, should the patella pull medially or laterally?

A

medially bc of the pull of the VMO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

when is there max contact bw the patella and the femur?

A

at 45-60 deg of flexion at the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

where does the knee generate the most forces and can be a problem area for wearing and p!?

A

45-60 deg of knee flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

should the patella be more sup or inf with knee ext?

A

sup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

should the patella be more sup or inf with knee flex?

A

inf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

what is patella alta?

A

patella pulling sup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

what is patella Baja?

A

patella pulling inf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what is the shape of the femoral trochlea?

A

should be higher laterally to prevent lateral subluxation/dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

should we focus more on the “track” or the “train” with PF pain syndrome?

A

the track

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

what other things should we look at with PFPS?

A

the hip and ankle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

when the talus moves medially or laterally, what happens with the tibia?

A

it follows

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

does overpronation lead to increased medial tibial rotation or lateral tibial rotation?

A

medial tibial rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

does medial tibial rotation lead to genu valgus or genu varum?

A

genu valgus

112
Q

what can be strengthened in the foot to help with PFPS?

A

the foot intrinsics

113
Q

what is chondromalacia patella?

A

softening of the cartilage on the posterior aspect of the patella that may occur from extra forces

114
Q

what population is PFPS most common in?

A

ectomorphic female athletes (tall and slender)

115
Q

what is blanket term for the following?:

excessive lat compression syndrome

global patella compression syndrome

patella instabilities

biomechanical dysfunction

trauma

suprapatellar plica syndrome

IT band friction syndrome

fat pad syndrome

overuse syndrome

A

PFPS

116
Q

what are some causes of PFPS?

A

muscles imbalances (VMO vs lateralis)

inflammation

instability

anatomic variance

abnormal Q angle

foot contributions (bottom up)

hip contributions (top down)

117
Q

what are some anatomic variantions that can cause PFPS?

A

femoral condyle dysplasia (femoral condyle not as high as it should be)

patellar congruence

patellar position

118
Q

what happens when the femoral condyle is high up than it should be?

A

higher chance of lateral tracking and subluxation/dislocation

119
Q

how is the Q angle measured?

A

ASIS–> mid patella–> tib tub

120
Q

is the Q angle larger in males or females?

A

females

121
Q

is there genu valgus or varum with increased Q angle?

A

valgus

122
Q

t/f: the Q angle is usually observed and not measured

A

true

123
Q

what are some top down contributions to PFPS?

A

the hip goes into excessive IR with WB

significant weakness of the hip ERs and abductors often in women

quad overuse

excessive hip adduction

excessive femoral IR

124
Q

what are top down causes of increased PF rxn forces?

A

excessive hip adduction

quad overuse

125
Q

what is a top down cause of decreased PFJ contact area?

A

excessive femoral IR

126
Q

is there increased glut work with increased trunk lean or with upright posture?

A

increased trunk lean

127
Q

is there more PF compression with increased trunk lean or with upright posture?

A

with upright posture

128
Q

in the CKC, does the patella move laterally on the femur or does the femur rotate medially under the patella?

A

the femur rotates medially under the patella

129
Q

in the OKC, does the patella move laterally on the femur or does the femur rotate medially under the patella?

A

the patella moves laterally on the femur

130
Q

what are some bottom up causes of PFPS?

A

pronation of the talonavicular and talocalcaneal jts

131
Q

how does pronation at the mid foot affect PFPS?

A

increased tibial IR

increased genu valgus

increased lat PFJ contact

lower arch height=ant knee p!

132
Q

what is the step down test?

A

looking at the WB limb, have pt take a step down from a platform and see if the patella/knee moves in (dynamic valgus)

133
Q

what is a (+) step down test?

A

the knee moves into dynamic valgus

134
Q

what is the typical intervention for PFPS?

A

taping/bracing (may be helpful)

PF mobilization (helpful)

ITB stretching (may be helpful)

VMO PREs (not helpful)

135
Q

what are effective treatment goals for PFPS?

A

reduce swelling and p!

restore volitional mm control

emphasize quads

control the knee through the hip

emphasize hip and and ER strengthening

enhance soft tissue flexibility

improve soft tissue mobility

enhance proprioception and nm control

normalize gait

shoe/orthotics recommendations

136
Q

are there better results from strengthening the knee or the knee and hip together for PFPS?

A

knee w /hip

137
Q

do pts with PFPS have more problems going up or down stairs? why?

A

down bc the quads work more in upright posture and we tend to stand more upright when going down stairs

138
Q

what is movie goers sign?

A

anterior knee pain from long periods of sitting

139
Q

does an EMG show increased glut med, max, and TFL in the stance limb or moving limb during sidestepping?

A

in the stance limb

140
Q

when squatting in sidestepping, does the glut activity increase or decrease?

A

increase

141
Q

when squatting in sidestepping, does the TFL activity increase or decrease?

A

decrease

142
Q

in sidestepping, is the abduction increased in the stance limb or moving limb?

A

the stance limb

143
Q

does a lateral J brace pull the knee medially or laterally?

A

medially

144
Q

is bracing or taping more effective?

A

bracing

145
Q

what is the likely reason taping may work for someone?

A

increased proprioceptive input to the muscle

146
Q

at 5 years, does surgery with a HEP or the HEP alone provide better results for PFPS?

A

both provide similar results

147
Q

what is the Elmslie-Trillat surgery for PFPS?

A

transverse osteotomy of the tibial tubercle

take off the tib tub and move it medially for better tracking

148
Q

what is the Maquet-Straight surgery for PFPS?

A

anterior shift of the tib tub by splitting the tibia and pulling the patella of the femur more

149
Q

what is the Fulkerson surgery for PFPS?

A

a combo of the Elmslie-Trillat and Maquet-Straight surgerical methods

med and ant shift of the tib tub w/oblique osteotomy

150
Q

what is the most common cause of mechanical knee pain?

A

meniscal injury

151
Q

what motions cause meniscal injury?

A

turn/twist/change in direction in WB

med/lat contact with the foot planted

152
Q

t/f: aging leads to delamination of the menisci

A

true

153
Q

t/f: edema produces symptoms in meniscal injuries

A

true

154
Q

is there greater med or lat meniscal motion?

A

lat

155
Q

what can a longitudinal tear of the meniscus that separates out lead to?

A

a bucket handle tear

156
Q

which meniscal tear tends to have the poorest prognosis?

A

radial tears

157
Q

what are the symptoms of a meniscal tear?

A

swelling, popping, clicking, catching at the jt line

no immediate swelling, it’s more delayed

locked in flex position (bucket handle)

p! w/flexion and WB

tender medial jt line (esp with med men injury)

158
Q

would delayed swelling indicate a meniscal injury or a ligamentous injury?

A

meniscal

159
Q

would immediate swelling indicate a meniscal injury or a ligamentous injury?

A

ligamentous

160
Q

what are the tests for meniscal injury?

A

(+) McMurray
(+) Appley
(+) Thessaly

161
Q

what is the McMurray test for meniscal injury?

A

varus and valgus stress w/rot at the knee to feel for pop/p!

ER and valgus force moving the knee into flex/ext tests the med meniscus

IR and varus force moving the knee into flex/ext tests the lat meniscus

162
Q

what is the Appley test for meniscal injury?

A

prone, knee flexion, and grind on the tibia to see if it produces p!

163
Q

what is the Thessaly test for meniscal injury?

A

pt stands on one leg with their arms crossed out in front of them for you to steer them into rot both ways

pt may do this in full ext or squatting position

164
Q

does a meniscectomy involve the inner third or peripheral third of the meniscus?

A

inner third

165
Q

does a meniscal repair involve the inner third or peripheral third of the meniscus?

A

peripheral third (red red zone)

166
Q

t/f: the ACL extends superiorly, posteriorly, and laterally

A

true

167
Q

does the ACL have vascular supply?

A

yes, some but not a lot so it will still swell

168
Q

what muscles works with the ACL?

A

the hamstrings

169
Q

what are the intrinsic factors in ACL injury?

A

narrow intercondylar notch

generalized jt laxity

LE malaignments

hormonal influence (estrogen, estadiol, relaxin)

ACL size

strength and recruitment

170
Q

do men or women tend to have a more narrow intercondylar notch?

A

women

171
Q

t/f: the ACL get impinged on the anterior intercondylar notch in full extension

A

true

172
Q

what are the extrinsic factors in ACL injury?

A

altered neuromuscular control

playing surface

playing style

shoe wear

173
Q

what sports tend to cause ACL injuries in younger populations?

A

soccer

football

basketball

174
Q

what sports tend to cause injuries in older populations?

A

skiing

trampoline

175
Q

the risk factors for ACL injury are __ to ___ times higher in ___ basketball and soccer players

A

4, 8, female

176
Q

is there an increased rate of ACL injuries in female or male collegiate athletes?

A

female

177
Q

is there increased incidence of ACL injury in males or females?

A

males

178
Q

is there higher ACL injury exposure in males or females?

A

males

179
Q

is there higher ACL injury risk factors in males or females?

A

females

180
Q

do men or women have:

smaller intercondylar notch

smaller ACL

wider pelvis

increased hamstring flexibility

generalized jt laxity

quads dominance

increased post tibial slope

A

females

181
Q

what is only a female risk factor in ACL injury?

A

increased tibial slope

182
Q

why does increased hamstring flexibility put one at risk for ACL injury?

A

looser hamstrings can’t provide secondary support to the ACL

183
Q

what is a grade 1 ACL injury?

A

stretched out (attenuation/attenuated)

184
Q

what is a grade 2 ACL injury?

A

partial tear

185
Q

what is a grade 3 ACL injury?

A

complete full thickness tear

186
Q

t/f: almost all complete tears of the ACL are mid-substance

A

true

187
Q

what does mid-substance mean in an ACL tear?

A

the tear is in the middle of the tendon

188
Q

how much force can the ACL handle before it tears?

A

2160 N of force

189
Q

what are some MOI for ACL injury?

A

strength of the lig (force >2160 N)

deceleration injury (non-contact)

hyperextension

valgus stress

sports related

contact injury (hyperext or foot planted w/rot then contact)

190
Q

what is the MOI in 70% of ACL injuries?

A

deceleration (non-contact) injury

191
Q

in ACL tears, a pop is heard/felt in __% of cases

A

70

192
Q

what % of ACL injuries are sports related?

A

80%

193
Q

is there immediate or delayed disability and hemarthrosis with ACL injury?

A

immediate

194
Q

there is hemarthosis in ACL injuries within __ hours

A

2-6

195
Q

how is the ACL injured in non-contact injuries?

A

hip straight, hip IR, tib rot, straight knee

deceleration/acceleration

valgus moment

feet flat

anterior shear

increased ground rxn force

muscles don’t dissipate the forces so the ligs take the brunt of it

196
Q

in what zone do ACL injuries usually occur?

A

in the transformational zone

197
Q

how is the ACL injured in contact injuries?

A

hyperextension or foot planted in rotation then contact

198
Q

what are the s/s of ACL injury?

A

pop at time of injury

giving away

hemarthrosis

quads atrophy

(+) ant drawer

(+) Lachman

(+) KT-1000 findings

rotary instability

(+) MRI

199
Q

what are the different rotary instabilities that lead to ACL injury?

A

AMRI, ALRI, PMRI, and PLRI

200
Q

t/f: MRI is sensitive for the presence of an ACL tear and MCL or meniscal involvement

A

true

201
Q

t/f: an MRI is sensitive for discriminating b/w partial and complete tears

A

false

202
Q

in an ACL physical exam, the side to side difference is <___mm in 95% of pts

A

3

203
Q

what is the most sensitive test for ACL injury?

A

Lachman test

204
Q

what other special test can be used for ACL injury?

A

pivot test

205
Q

what is the Lachman test?

A

hold the pt knee stable and pull forward on the tibia

reverse: in prone pull the tibia down towards the table

206
Q

what % of acute ACL injuries also have a meniscal tear?

A

45%

207
Q

what % of chronic symptomatic ACL tears have meniscal tears?

A

about 88%

208
Q

what imaging can be done for ACL injury?

A

x-ray, MRI

209
Q

what fx is common assocaited with ACL injury?

A

Segond fx

210
Q

what is a Segond fx?

A

avulsion fx from IR w/varus force

211
Q

what % of ACL cases have Segond fx?

A

9-12%

212
Q

what % of Segond fx are indicative of ACL tears?

A

75%

213
Q

what would be found in an MRI for acute ACL injury?

A

lateral meniscal tear

214
Q

what indicates bone bruising from an ACL injury on a x-ray?

A

whiteness on the lateral femoral condyle (central) and lateral tibial plateau (posterior)

215
Q

what would be found on an MRI for chronic ACL injury?

A

med meniscal tear due to instability

chondral injury

216
Q

what is the general non-operative management of complete ACL tears?

A

progressive rehab program

brace for activities (NM feedback)

217
Q

what are the 3 outcomes after ACL rehab?

A

1/3 pursued recreational activities (copers)

1/3 compensated by eliminating activities (partial copers)

1/3 required ACL reconstruction (non-copers)

218
Q

t/f: choice of treatment affects fxn but not development of arthritis in ACL recovery

A

true

219
Q

why do most ppl post ACL injury eventually develop arthritis?

A

bc the jt is never quite as stable as it was pre-injury

220
Q

what are typical ACL pre-hab goals?

A

no flexion contractures or quad lag

quad contraction w/sup patellar slide

normal PF mobility

little to no effusion

walk w/o a limp

221
Q

what are the benefits of pre-hab in ACL injury

A

provides platform to guide decisions

may be able to work pt to the point of not needing surgery anymore

222
Q

what is the preferred surgical intervention for ACL tears?

A

autografts

223
Q

what tendons can be used in ACL autografts?

A

patellar tendon (BPTB)

hamstrings (semiten)

quad tendon

Achilles tendon

224
Q

t/f: there is a higher incidence of patellar tendinopathy w/BPTB procedures in ACL repair bc of moving the patellar tendon to use as an ACL

A

true

225
Q

what is one of the most important factors in good recovery from ACL repair?

A

good graft positioning

226
Q

what are the principles of post ACL surgery?

A

consult the surgeon for updated protocol

understand potential risk factors of graft disruption

control p! and edema

utilize locked brace (0-90 deg) early during some PREs

respect healing contraints

emphasize early restoration of ROM

emphasize closed chain training

emphasize hamstrings recruitment

focus on fxn

227
Q

what is ligamentization?

A

when a tendon is used in ACL graft itreorganizes and becomes more dense

becomes weaker at 3-4 months post-op

228
Q

what is superficial and deep infrapatellar bursitis?

A

inflammation from mechanical irritation, or direct trauma

229
Q

what is prepatellar bursitis (housemaid’s knee)?

A

from recurrent trauma or prolonged kneeling

easily observable

230
Q

what is superficial pes anserine bursitis?

A

seen in swimmers, runners

medial knee p!

tibia in ER

231
Q

what is MCL bursitis?

A

deep to the MCL

misdiagnosed

palpable mass

tender w/ER/IR of tibia

232
Q

what is the intervention for bursitis?

A

correct malalignement

correct mechanics

stretching

strengthening (look at the hip too)

surgical resection

233
Q

what can cause patellar tendinopathy?

A

eccentric overload

234
Q

where is a pt tender with patellar tendinopathy?

A

at the tibial insertion site or mid-substance

235
Q

can patellar tendinopathy be self-limiting?

A

yes

236
Q

what can be done to help with patellar tendinopathy?

A

RICE

tendon strap around the patellar tendon(Chopat strap) during activity

TFM

correct malalignement

237
Q

what is IT band friction syndrome (ITBFS)?

A

a common overuse injury in runners caused by repeated friction of the ITB at 30 deg of knee flexion

increased with road chamber (curve) downhill

better with faster speeds

238
Q

where would someone with ITBFS be tender?

A

over Gerdy’s tubercle

239
Q

what may cause ITBFS?

A

structural or functional malalignment

weak abductors/ERs

240
Q

what tests would be positive with ITBFS?

A

(+) Ober

(+) Noble

241
Q

what is Osgood Schlatter Disease?

A

osteochondritis (patellar tendon pulls small bit of immature bone off the tib tub)

irritation of the growth plate

form of patellar tendonitis (patella tendon pulling on the growth plate)

242
Q

when does Osgood Schlatter Disease tend to occur in life?

A

12-15 yo

during growing years when the muscles can’t keep up with bone growth

243
Q

what are possible cuases of Osgood-Schlatter Disease?

A

indirect trauma

sudden forceful quad contraction

repetitive stress (knee flexion against a tight quad)

longitudinal traction during bone growth (tension on patellar tendon during growth spurts)

malalignment

rigorous activity in young adults

244
Q

what malalignment pmay contribute to Osgood Schlatter Disease?

A

bilateral genu valgus

pes planus

patella alta

245
Q

what is the presentation of Osgood-Schlatter Disease?

A

p! at the tib tub

enlarged tib tub

possible swelling and warmth

tenderness

p! w/activities involving forceful quads contraction

potential inflexibility of the quads or hamstrings

246
Q

how is Osgood-Schlatter Disease managed?

A

rest/activity modification (2-3 wks to 2-3 months)

NSAIDS and ice

exercise to stretch

possible bracing

patellar tendon strap top reduce quad pull

247
Q

can Osgood-Schlatter Disease be self-limiting?

A

yes

248
Q

what are the primary reasons someone gets TKA?

A

OA (72.7%) or RA (21.2%)

249
Q

other than RA and OA, what are reasons for getting a TKA?

A

fx, AVN, septic arthritis

250
Q

what are indications for TKA?

A

DJD on radiograph (not difinitive criteria)

breakdown of tibfib jt area

pt lossing fxning

251
Q

t/f: higher p! prior to TKA surgery is associated with poorer outcomes

A

true

252
Q

is the severity of DJD seen on radiographs predictive of outcomes of TKA?

A

no

253
Q

what are TKA prognositic indicators of poor outcomes?

A

female

older age

low socioeconomic status

> # of comorbidities

poor p! coping strategies

somatization of p!

low social support

unrealistic expectations

BMI >40

254
Q

what is the most popular TKA surgical approach?

A

medial parapatellar (paramedian)

255
Q

what are the pros of the paramedian TKA approach?

A

familiar

popular

256
Q

what are the cons of the paramedian TKA approach?

A

incision through the quad tendon

detaches the VM from the extensor mechanism

reduces blood flow to the patella

257
Q

what is the general TKA procedure?

A

ACL, PCL, and menisci are removed (PCL may be spared)

femur and tibia ends are excised using a cutting jig

implanted metal tibial and femoral components

polyethylene tibial spacer bw the metal tibial and femoral components

patellar surface (patellar button)

258
Q

t/f: PCL substituting implants may give better roll-back kinematics for lunging and step-ups

A

true

259
Q

is a unicompartmental TKA usually medial or lateral?

A

medial

260
Q

does a bi or tricompartmental TKA involve the patella?

A

tri

261
Q

what are the indications for a unicompartmental TKA?

A

non-inflammatory OA

unicompartmental degernation

low impact sports

job with repetitive squatting

intact cruciate ligs

near normal weight

jt space narrowing is isolated to one side of jt

malalignment is correctable w/o a major tissue release

flexion contracture not >10 deg

adequate flexion

valgus/varus <10-15 deg

262
Q

are more or less ppl going to a rehab hospital following TKAs?

A

less

263
Q

what is the early focus of TKA rehab?

A

p! control and functional recovery

264
Q

are pt usually WB following TKA?

A

yes! and often notes decreased p! w/WB

265
Q

when beginning ROM post TKA, what exercise may be done?

A

heel slides in supine or sitting

266
Q

what strengthening exercises may be done post TKA?

A

quad activation (QS and SLR)

SAQ

sidelying abd

progressive closed chain strengthening

267
Q

what is a major LE risk post-op?

A

DVTs

268
Q

what is a DVT?

A

occlusion of deep veins from a thrombus that interrupts blood flow

results in edema and p!

269
Q

what is done prophylactically post TKA to prevent DVTs?

A

pts are given blood thinner and monitored regularly so blood isn’t too thin

270
Q

what are symptoms of a DVT?

A

p! in the calf or associated muscles

(+) Homan’s sign (passive dorsiflexion-not done anymore)

271
Q

what does a Wells score of >3 mean?

A

high probability of DVT risk

272
Q

what does a Wells score of 1-2 mean?

A

moderate probability of DVT risk

273
Q

what does a Wells score of 0 mean?

A

low probability of DVT risk

274
Q

how are DVTs treated?

A

anticoagulant therapy

275
Q

how is a DVT dx?

A

US imaging

DPT 516 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions