The Knee_flashcards_exam2.txt

  1. The Knee
    • Complex joint that endures great amounts of trauma due to extreme amounts of stress that are regularly applied
    • Hinge joint w/ a rotational component
    • Stability is due primarily to ligaments, joint capsule and muscles surrounding the joint
    • Designed for stability w/ weight bearing and mobility in locomotion
  2. Ligaments (and tendons) of the knee
    • ACL: Anterior Cruciate Ligament
    • PCL: Posterior Cruciate Ligament
    • MCL: Medial Collateral Ligament
    • LCL: Lateral Collateral Ligament
    • Meniscus (medial and lateral)
    • Patella ligament
    • Quad femoris tendon (quad to patella)
  3. Muscles of the Knee
    • Quad. Femoris
    • -Vastus intermedius (beneath rectus femoris)
    • -Rectus Femoris (down middle)
    • -Vastus lateralis
    • -Vastus medialis oblique (tear drop)
    • Hamstring group
    • -long head (middle)
    • -short head (under and out of long head on lateral side)
    • -Semitendinosus
    • -Semimembbranosus (most medial)
  4. Prevention of Knee Injuries
    • Physical Conditioning and Rehabilitation
    • -Total body conditioning is required
    • --Strength, flexibility, cardiovascular and muscular endurance, agility, speed and balance
    • -Muscles around joint must be conditioned (flexibility and strength) to maximize stability
    • -Must avoid abnormal muscle action through flexibility
    • Can make a non-flexible person more flexible, but not the opposite.
    • -In an effort to prevent injury, extensibility of hamstrings, erector spinae, groin, quadriceps and gastrocnemius is important
  5. ACL Prevention Programs
    • -Focus on strength, neuromuscular control, balance
    • -Series of different programs which address balance board training, landing strategies, plyometric training, and single leg performance
    • --Ensure correct form and aligned knees.
    • -Can be implemented in rehabilitation and preventative training programs
  6. Shoe Type
    • -Change in football footwear has drastically reduced the incidence of knee injuries
    • -Shoes w/ more shorter cleats does not allow foot to become fixed while still allowing for control w/ running and cutting
  7. Functional and Prophylactic Knee Braces
    • -Used to prevent and reduce severity of knee injuries
    • -Provide degree of support to unstable knee
    • -Can be custom molded and designed to control rotational forces and tibial translation
  8. Assessing the Knee Joint
    • Determining the mechanism of injury is critical
    • Determine if it is a current or chronic injury
  9. History- Current Injury
    • -Past history
    • -Mechanism- what position was your body in?
    • -Did the knee collapse?
    • -Did you hear or feel anything?
    • -Could you move your knee immediately after injury or was it locked?
    • -Did swelling occur?
    • -Where was the pain
  10. History - Recurrent or Chronic Injury
    • -What is your major complaint?
    • -When did you first notice the condition?
    • -Is there recurrent swelling?
    • -Does the knee lock or catch?
    • -Is there severe pain?
    • -Grinding or grating?
    • -Does it ever feel like giving way?
    • -What does it feel like when ascending and descending stairs?
    • -What past treatment have you undergone?
  11. Observation
    • -Walking, half squatting, going up and down stairs
    • -Swelling, ecchymosis
    • -Assessment of muscle symmetry/atrophy
    • -What is the athlete's level of function?
    • --Does the athlete limp?
    • --Full weight bearing?
    • --Does athlete exhibit normal knee mechanics during function?
  12. Palpation
    • -Athlete should be supine or sitting at edge of table with knee flexed to 90 degrees
    • -Should assess bony structures checking for bony deformity and/or pain
    • -Soft tissue
    • --Lateral ligaments
    • --Joint line
    • --Assess for pain and tenderness
    • --Menisci
  13. Special Tests for Knee Instability
    • -Use endpoint feel to determine stability
    • -Classification of Joint Instability
    • --Knee laxity includes both straight and rotary instability
    • --Translation (tibial translation) refers to the glide of tibial plateau relative to the femoral condyles
    • --As the damage to stabilization structures increases, laxity and translation also increase
  14. Valgus and Varus Stress Tests
    • -Used to assess the integrity of the MCL and LCL respectively
    • -Testing at 0 degrees incorporates capsular testing while testing at 30 degrees of flexion isolates the ligaments
  15. Lachman Drawer Test
    • -Will not force knee into painful flexion immediately after injury
    • -Reduces hamstring involvement
    • -At 30 degrees of flexion an attempt is made to translate the tibia anteriorly on the femur
    • -A positive test indicates damage to the ACL
  16. -Apley's Compression Test
    • -Hard downward pressure is applied w/ rotation
    • -Pain indicates a meniscal injury
    • -Used to detect meniscus tear
  17. Medial Collateral Ligament Sprain--Cause of Injury
    Result of severe blow or outward twist-->valgus force
  18. Medial Collateral Ligament Sprain--Signs of Injury - Grade I
    • Little fiber tearing or stretching
    • Stable valgus test
    • Little or no joint effusion
    • Some joint stiffness and point tenderness on lateral aspect
    • Relatively normal ROM
  19. Medial Collateral Ligament Sprain--Signs of Injury (Grade II)
    • Complete tear of deep capsular ligament and partial tear of superficial layer of MCL
    • No gross instability; slight laxity
    • Slight swelling
    • Moderate to severe joint tightness w/ decreased ROM
    • Pain along medial aspect of knee
  20. Medial Collateral Ligament Sprain--Signs of Injury (Grade III)
    • Complete tear of supporting ligaments
    • Complete loss of medial stability
    • Minimum to moderate swelling
    • Immediate pain followed by ache
    • Loss of motion due to effusion and hamstring guarding
    • Positive valgus stress test
  21. Medial Collateral Ligament Sprain--Care
    • RICE for at least 24 hours
    • Crutches if necessary
    • Knee immobilizer may be applied
    • Move from isometrics and STLR exercises to bicycle riding and isokinetics
    • Return to play when all areas have returned to normal
    • Continued bracing may be required
    • Conservative non-operative approach for isolated grade 2 and 3 injuries
    • Limited immobilization (w/ a brace); progressive weight bearing for 2 weeks
    • Follow with 2-3 week period of protection with functional hinge brace
    • When normal range, strength, power, flexibility, endurance and coordination are regained athlete can return
    • Some additional bracing and taping may be required
  22. Lateral Collateral Ligament Sprain
    • Cause of Injury
    • -Result of a varus force, generally w/ the tibia internally rotated
    • -Direct blow is rare
    • Signs of Injury
    • -Pain and tenderness over LCL
    • -Swelling and effusion around the LCL
    • -Joint laxity w/ varus testing
    • Care
    • -Following management of MCL injuries depending on severity
  23. Anterior Cruciate Ligament Sprain--Cause of Injury
    • MOI --athlete decelerates with foot planted and turns in the direction of the planted foot forcing tibia into internal rotation
    • May be linked to inability to decelerate valgus and rotational stresses - landing strategies
    • Male versus female
    • -Research is quite extensive in regards to impact of femoral notch, ACL size and laxity, malalignments (Q-angle) faulty biomechanics
    • -Extrinsic factors may include, conditioning, skill acquisition, playing style, equipment, preparation time
    • -Also involves damage to other structures including meniscus, capsule, MCL
  24. Anterior Cruciate Ligament Sprain--Signs of Injury
    • Experience pop w/ severe pain and disability
    • Rapid swelling at the joint line
    • Positive anterior drawer and Lachman's
    • Other ACL tests may also be positive
  25. Anterior Cruciate Ligament Sprain--Care
    • RICE; use of crutches
    • Arthroscopy may be necessary to determine extent of injury
    • Could lead to major instability in incidence of high performance
    • W/out surgery joint degeneration may result
    • Age and activity may factor into surgical option
    • Surgery may involve joint reconstruction w/ grafts (tendon), transplantation of external structures
    • Will require brief hospital stay and 3-5 weeks of a brace
    • Also requires 4-6 months of rehab
  26. Posterior Cruciate Ligament Sprain--Cause of Injury
    • Most at risk during 90 degrees of flexion
    • Fall on bent knee is most common mechanism
    • Can also be damaged as a result of a rotational force
  27. Posterior Cruciate Ligament Sprain--Signs of Injury
    • Feel a pop in the back of the knee
    • Tenderness and relatively little swelling in the popliteal fossa
    • Laxity w/ posterior sag test
  28. Posterior Cruciate Ligament SprainCare
    • RICE
    • Non-operative rehab of grade I and II injuries should focus on quad strength
    • Surgical versus non-operative
    • Surgery will require 6 weeks of immobilization in extension w/ full weight bearing on crutches
    • ROM after 6 weeks and PRE at 4 months
  29. Meniscus Injuries--Cause of Injury
    • Medial meniscus is more commonly injured due to ligamentous attachments and decreased mobility
    • Also more prone to disruption through torsional and valgus forces
    • Most common MOI is rotary force w/ knee flexed or extended while weight bearing
    • i.e.: Bucket Handle tear (a crescent moon shaped tear)
  30. Meniscus Injuries--Signs of Injury
    • Diagnosis is difficult
    • Effusion developing over 48-72 hour period
    • Joint line pain and loss of motion
    • Intermittent locking and giving way
    • Pain w/ squatting
  31. Meniscus Injuries--Care
    • Immediate care = PRICE
    • If the knee is not locked, but indications of a tear are present further diagnostic testing may be required
    • Treatment should follow that of MCL injury
    • If locking occurs, anesthesia may be necessary to unlock the joint w/ possible arthroscopic surgery follow-up
    • W/ surgery all efforts are made to preserve the meniscus -- with full healing being dependent on location
    • Torn meniscus may be repaired using sutures
  32. Joint Contusions
    • Cause of Injury
    • -Blow to the muscles crossing the joint (vastus medialis)
    • Signs of Injury
    • -Present as knee sprain, severe pain, loss of movement and signs of acute inflammation
    • -Swelling, discoloration
    • Care
    • -RICE initially and continue if swelling persists
    • -Gradual progression to normal activity following return of ROM and padding for protection
    • -If swelling does not resolve w/in a week a chronic condition (synovitis or bursitis) may exist requiring more rest
  33. Bursitis
    • Cause of Injury
    • -Acute, chronic or recurrent swelling
    • -Prepatellar = continued kneeling
    • -Infrapatellar = overuse of patellar tendon
    • Signs of Injury
    • -Prepatellar bursitis may be localized swelling above knee that is ballotable
    • -Presents with cardinal signs of inflammation
    • -Swelling in popliteal fossa may indicate a Baker's cyst
    • Care
    • -Eliminate cause, RICE and NSAID's
    • -Aspiration and steroid injection if chronic
  34. Loose Bodies w/in the Knee
    • Cause
    • -Result of repeated trauma
    • -Possibly stem from osteochondritis dissecans, meniscal fragments, synovial tissue or cruciate ligaments
    • Signs of Injury
    • -May become lodged, causing locking or popping
    • -Pain and sensation of instability
    • Care
    • If not surgically removed it can lead to conditions causing joint degeneration
  35. Iliotibial Band Friction Syndrome (Runner's Knee)
    • Cause of Injury
    • -Repetitive/overuse conditions attributed to mal-alignment and structural asymmetries
    • -Can be the result of running on crowned roads
    • Signs of Injury
    • -Irritation at band's insertion
    • -Tenderness, warmth, swelling, and redness over lateral femoral condyle
    • -Pain with activity
    • Care
    • -Correction of mal-alignments
    • -Ice before and after activity, proper warm-up and stretching; NSAID's
    • -Avoidance of aggravating activities
  36. Patellar Fracture
    • Cause of Injury
    • -Direct or indirect trauma (severe pull of tendon)
    • -Forcible contraction, falling, jumping or running
    • Signs of Injury
    • -Hemorrhaging and joint effusion w/ generalized swelling
    • -Indirect fractures may cause capsular tearing, separation of bone fragments and possible quadriceps tendon tearing
    • -Little bone separation w/ direct injury
    • Management
    • -X-ray necessary for confirmation of findings
    • -RICE and splinting if fracture suspected
    • -Refer and immobilize for 2-3 months
  37. Acute Patella Subluxation or Dislocation--Cause of Injury
    • -Deceleration w/ simultaneous cutting in opposite direction (valgus force at knee)
    • -Quad pulls the patella out of alignment
    • -Some athletes may be predisposed to injury
    • -Repetitive subluxation will impose stress to medial restraints
    • -More commonly seen in female athletes
    • Acute Patella Subluxation or Dislocation--Signs of Injury
    • -W/ subluxation, pain and swelling, restricted ROM, palpable tenderness over adductor tubercle
    • -Dislocations result in total loss of function
    • -First time dislocation = assume fx
  38. Acute Patella Subluxation or Dislocation--Care
    • -Immobilize and refer to physician for reduction
    • -Ice around the joint
    • -Following reduction, immobilization for at least 4 weeks w/ use of crutches
    • -After immobilization period, horseshoe pad w/ elastic wrap should be used to support patella
    • -Muscle rehab focusing on muscle around the knee, thigh and hip are key (STLR's are optimal for the knee)
  39. Chondromalacia patella
    • Cause
    • -Softening and deterioration of the articular cartilage
    • -Possible abnormal patellar tracking due to genu valgum, external tibial torsion, foot pronation, femoral anteversion, patella alta, shallow femoral groove, increased Q angle, laxity of quad tendon
    • Signs of Injury
    • -Pain w/ walking, running, stairs and squatting
    • -Possible recurrent swelling, grating sensation w/ flexion and extension
    • Care
    • -Conservative measures
    • -RICE, NSAID�s, isometrics for strengthening
    • -Avoid aggravating activities
    • -Surgical possibilities
  40. Patellar Tendinitis (Jumper's or Kicker's Knee)
    • Cause of Injury
    • -Jumping or kicking - placing tremendous stress and strain on patellar or quadriceps tendon
    • -Sudden or repetitive extension may lead to inflammatory process
    • Signs of Injury
    • -Pain and tenderness at inferior pole of patella and on posterior aspect of patella with activity
    • Care
    • -Avoid aggravating activities
    • -Ice, rest, NSAID's
    • -Exercise
    • -Patellar tendon bracing
    • Transverse friction massage
  41. Osgood-Schlatter Disease and Larsen-Johansson Disease
    • Cause of Condition
    • -An apophysitis occurring at the tibial tubercle
    • -Result of repeated pulling by tendon
    • -Begins cartilagenous and develops a bony callus, enlarging the tubercle
    • -Resolves w/ aging
    • Signs of Condition
    • -Both elicit swelling, hemorrhaging and gradual degeneration of the apophysis due to impaired circulation
    • -Pain with activity and tenderness over anterior proximal tibial tubercle
    • Care
    • -Conservative
    • -Reduce stressful activity until union occurs (6-12 months)
    • -Padding may be necessary for protection
    • -Possible casting, ice before and after activity
    • -Isometerics
Card Set
The Knee_flashcards_exam2.txt
knee injuries and care exam 2 sses319