Week 3 (parts 1 and 2) Flashcards
(34 cards)
what is an insidious/ overuse pathology
any disease that comes on slowly and does not have obvious symptoms at first
e.g OA/RA, PFPS, patella tendinopathy, adductor tendinopathy
what is a traumatic pathology
a sudden and acute knee pathology
e.g meniscal tears, fractures, ACL/ MCL rupture/ tear, LCL tear, PCL tear/ rupture
what is a post-operative knee pathology
a pathology that develops post surgery/ operation
e.g ACL repair, meniscal repair, TKR, arthroscopy, other ligament repair
what are the main pathological features of osteoarthritis
1) Joint space narrowing
2) Osteophyte formation
3) Sclerosis of the bone
4) Meniscal and articular cartilage degeneration
5) Exposure of subchondral bone
6) Muscle weakness
what problems will patients with OA present?
1) Pain on walking and weightbearing activities.
2) Weakness and feelings on instability.
3) Inability to continue with normal or previous activities.
4) Stiffness in the morning and after rest signs on inflammation.
what will be the findings on the assessment of OA (sub+obj)
1) Insidious onset, gradually worsening though episodic. Symptoms of pain, stiffness, weakness, giving way, hot knee, clicking. Functional limitations like a reduced ability to walk, kneel, squat.
2) Observed swelling or bigger knee, reduced AROM, reduced PROM, weakness in quads and hamstrings, joint line palpation pain.
what are the stages of knee OA
1 - Doubtful
2 - Mild
3 - Moderate
4- Severe
Patella pain syndrome
- One of the most common presentations seen in outpatient departments.
- Pain can be retropatella or around the patella and is often aggravated with stairs, squatting and prolonged flexion (movie goers knee)
what are the contributing factors to PFPS
Patella Alta (high), Patella Baja (low), Quads Weakness, Reduced quads flexibility, Reduced Gastroc flexibility, Hip abductor weakness, Increased knee valgus on landing, Overload, Gluteal weakness, Trochlea morphology, Osteochondral defects
what is Patella tendinopathy
- Point tenderness over the proximal tendon on its attachment to the distal pole of the patella.
- Load related patella tendon pain which follows the normal tendinopathy pattern.
- Pain is aggravated by loading the tendon and quads activation.
what are examples of traumatic pathologies
- Fractures
- Meniscal tears
- Ligament tears and ruptures – LCL, MCL, PCL and ACL
knee fractures + examples
Knee fractures are rare and usually result from high force sports trauma, falls or RTAs.
* Patella – usually a direct trauma or deceleration injury
* Tibial plateau – usually a fall or high trauma event
* Fibula head – usually lateral impact
Most knee fractures will need surgical fixation and immobilisation.
what are the Ottawa rules of the knee
a knee x-ray of the knee is only required when patients have these findings:
1- age 55 or older
2- isolated tenderness of patella
3- Tenderness at head of Fibula
4- Inability to flex to 90 degrees
5- Inability to bear weight both immediately and in the emergency department (4 steps)
ACL injuries
- ACL ruptures are most frequently non-contact sports related injuries.
- MOI is usually a cutting, twisting, or landing action where with foot is planted on the ground and the knee pivots into adduction and medial rotation.
- Can be audible ‘pop’ on rupture.
- Intra-articular swelling within few hours and a positive sweep test seen on examination.
- The Anterior draw test and Lachman’s test are often used to aid diagnosis.
PCL injuries
- The PCL is strong and prevents posterior translation of the tibia.
- Injury is usually through hyperextension or a forceful AP translation of the tibia while in flexion.
- Symptoms are often quite vague so they can go undetected.
- They are graded 1-3.
- G1 – partial tear
- G2 - complete tear
- G3 – complete tear with associated injuries eg PLC tear.
- The PCL is reported to be the strongest of the knee ligaments and twice as strong as the ACL. The role of the PCL is to prevent posterior tibial translation and increase rotational stability in the knee. Unlike the ACL it does not sit withing the joint, therefor will not elicit the same degree of swelling on injury.
- The posterior cruciate ligament prevents posterior tibial translation and is therefor injured when the tibia is forced posteriorly on the femur, usually in knee flexion for example when landing on a step or hard object following, a direct blow to the anterior tibia (eg a tackle), a fall into full flexion with the foot in plantarflexion or with a hyperextension injury.
- As the PCL is extraarticular there is no hemarthrosis and symptoms are classically vague with the knee feeling slightly unstable and just ‘not right’. Because of the difficulty in diagnosis they can be missed and present several weeks after the injury. The garding system is slightly different to normal ligament grading: A grade 1 is a partial tear, a grade 2 a complete tear and a grade 3 a complete tear with other associated injuries. With complete tears there will be a posterior tibial sag seen when both feet are parallel and knees flexed in supine, as shown on the next slide.
post operative knee problems
- Ligament repair
- Meniscal repair
- Total knee replacement - TKR
- Knee arthroscopy
- They will all have a post op protocol which can vary from consultant to consultant.
- Aims are initially to regain range and reduce swelling, then strengthen and return to function.
High level and sports specific rehabilitation might be appropriate
red flag pathologies and findings
- Septic OA
- Wound infection
- Compartment syndrome
- Bone tumours
- Blocked movement
- Gross instability
- Non-mechanical pain
- Calf redness/heat/pain
These are all very rare however they can be picked up within a Physiotherapy assessment.
Make sure you know what each of these are and how the conditions may present.
WEEK 3 pt2
Red flags and special questions + LSPJ
what is a masquerader
a condition which is not what it seems or presents as another condition
what is a red flag
a possible indicator of serious pathology
what is the definition of a serious pathology
clinical concern of potential condition which needs urgent or prompt medical assessment.
what is a red herring
a misleading biomedical or psychosocial factor that can lead to incorrect clinical reasoning
red flags: determining a level of concern
- Red flags are signs and symptoms that raise suspicion of serious pathology.
- Patients which invoke a high index of suspicion, or a high level of clinical concern must be referred on for further investigations.
- Patients with a lower index of suspicion need to be ‘safety netted’ and monitored closely through treatment.
- ‘Safety netting’ refers to giving the patient the appropriate advice and education on what to do if their symptoms worsen or start to include red flags.
- Patients with no concerning features can be treated and monitored less closely.
what levels of concern are there
no concerning features
few concerning features
some concerning features (urgent)
some concerning features (emergency)
