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locking/buckling in knees is a sign of...?
- meniscal tears
- this'll happen on stairs, causing instability and falls
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two biggest causes for problems in knees
trauma and OA
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swelling in knee happens in what structures?
what to do if pt complains of swelling?
- bursae, infrapatellar fat pad, popliteal fossa
- first - palpate, then- measure
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LEFS (lower extremity functional scale) what kind of test?
self reporting scale for hip, knee, and ankle
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World Scale basic format
just 2 qs about whether the pt is better or worse than at 1st visit
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KOOS scale - stands for?
- knee injury and osteoarthritis outcome scale
- is't a slef-reported scale
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Ottawa Knee rules - idea and 6 q's
used for determining the necessity of ordering an x-ray
- is pt > 55
- tenderness over fibular head
- isolated tendernes over patella
- unable to flex to 90 degrees
- unable to wt bear immediately and in ER
- is tapping the bone exquisitely painful?
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this class's numbers for how much flexion you need for tying your shoes, sitting, up stairs, down stairs, swing gait
- tie: 106
- sit:93
- up stairs: 83
- down stairs: 90
- swing gait: 67
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q-angle is made by the intersection of what lines? normal numbers?
- from ASIS to middle of patella
- from middle of patella to tibial tuberosity
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how do pronated feet affect the Q angle?
enlarge it
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why you have to palpate edema
- it could be one sided atropy or callus formation making it look like edema
- be careful to write WHY there's a diff in girth
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rule #1 about palpation
DON'T DIG!
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pes answerine is where?
med knee distal to tibial plateau
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how to palpate the trochlear groove of the femur
flex knee 30 degrees - this gets patella out of the way w/o making quad tendon tight
the tg is in the ant distal femur - where the patella rests
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Helfet test
- look for ER of tibia as leg extends
- if this doesn't happen, there's a block stopping the tibia from rotating
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in active movement testing you want what degrees of flex and ext?
- flex: 135
- ext: 0, or -5 to -10 (a bit of hyper ext)
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diff btwn hyperext and genu recurvatum
- hyperext is the ability to get knee past 0 (most of us get 5-10 past)
- genu recurvatum is when you stand in this position or get into it on a regular basis
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endfeels of flex, ext, and IR/ER
- flex: soft
- ext: firm
- IR/ER: capsular (firm and abrupt)
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position for testing end feel of IR/ER
- supine, nkee flexed, ankle on table
- have her rotate foot w yr hands on sup knee and sup tibia
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position for doing resisted mvmnt testing for knee
- put pt in resting pos of 25-40 degrees flexion
- resist flex and ext
- however, the break test here doesn't give a ton of info, so it's best to have pt go thru the range
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position of knee for valgus stress test
- full extension but not hyper ext
- then repeat stress w knee slightly flexed
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structures involved w supporting knee in extension, in order of support
- MCL
- POL
- posteromedial capsule
- ACL
- PCL
- medial quadriceps expansion
- semimembranosus muscle
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predictor variables for MCL tear
- history of external force to leg
- rotational trauma
- pain and laxity w valgus stress
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posterior oblique ligament
upper margin of the intercondyloid fossa and posterior surface of the femur close to articular margins of the condyles, --> posterior margin of the head of the tibia
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to test for instab of MCL, hand placement
- stabilizing hand: sup to joint on distal lat femur, with a finger on the knee joint to feel for movement - can angle elbow into yr waist
- moving hand: on distal fibula
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what not to do in MCL instability test
- don't add ER to tibia
- don't rotate hip
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varus stress test (testing primarily the LCL)
- support the knee and press on the ankle as in the MCL test
- should have less movement than did the valgus test
- note: when we put knee in flexion we get rid of the screw home mechanism
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