-
Knee ROM
- Flexion - 135
- Extension - 5-10
- Tibia IR - 20-30
- Tibia ER - 30-40
-
Resting position - Tibiofemoral jt
25° flexion
-
Closed-packed position - Tibiofemoral jt
- Full extension
- ER of tibia
-
Capsular pattern - Tibiofemoral jt; Tibiofibular jt
- Tibiofemoral jt - Flex > Ext
- Tibiofibular jt - Pain when jt is stressed
-
Knee - Arthro/Osteo kinematics - OPEN chain
- Tibiofemoral - OPEN chain - concave on convex
- Patellofemoral - convex on concave
- Proximal Tibiofibular - convex tibial facet on concave fibula head
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Tibiofemoral Jt - Arthro/Osteo kinematics - direction in CLOSED chain of femur + direction
- Flexion - anterior
- Extension - posterior
-
Knee position for maximum tibiofemoral IR/ER
90 flexion
-
Menisci - Movement - 2
- Flex/Ext - Follow tibia
- ER/IR - femoral condyles
-
W/isolated tibial rotation, menisci move in same or opposite direction?
- Opposite
- Tibia IR meniscus goes anteriorly
- Tibia ER meniscus goes posteriorly
-
McMurrays test - Tensile vs compressive forces w/IR; why?
- Compressive stresses - lateral side
- Tensile stresses - medial side
- bc w/IR tibia tibia glide forward on lateral side & glide posterior on medial side
-
The menisci are avascular where?
Inner 2/3
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Meniscal Injury - Pain location + 2 other major signs; Mechanism of injury
- Pain deep within knee
- Effusion
- Joint popping/locking/catching
- Jointline tenderness
- Knee buckling during ambulation
- Injury - flexed knee + planted foot + tibial rotation + values force
-
Meniscal repair - how long should pt be NON-WB?
- 3-6jQuery110107065239014948412_1483645783445
- W/surgery WB @ end of post surgery wk 3
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Ligaments restricting IR/ER
- IR - ACL, PCL - bc they are Inside knee
- ER - MCL, LCL - bc they are External of knee
-
LCL/MCL - what happens w/flex/ext
- Flexion - slackened
- Extension - taut
-
Meniscus tear - precaution vs. CONTRA
- Precaution - pivoting, twisting; deep squats
- CONTRA - deep squats
-
Meniscus tear - initial PT
Pain management - modality for pain
-
Meniscus tear - to reduce pathology
- Surgery
- Pain management
- Knee stabilization exercise - closed-chain - theraband around knee, slight squat & straighten
-
Acronym for Screw-home mechanism in CLOSED-chain
- FEMUR
- Flexion to Extension Medial Rotation of Femur on Tibia
- (everything else is opposite)
-
CLOSED chain "screw-home" mechanism"
-
OPEN-chain "screw-home" mechanism:
-
Ligament strengthening - posteromedial & posterolateral
- Posteromedial - Oblique popliteal ligament
- Posterolateral - Arcuate popliteal ligament
-
Primary knee extensors - 1
Quadriceps
-
Primary knee flexors in open-chain activities - 1
- Hamstring muscles:
- Semimembranosus; Semitendinosus; Biceps femoris (lateral)
-
Prime movers of tibial ER - 1
Biceps femoris
-
Prime movers of tibial IR - 3
- Popliteus
- Semimembranosus
- Semitendanosus
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Vastus medialis oblique (VMO) resists what during closed-chain activities?
Lateral displacement of patellar out of trochlear groove
-
In closed-chain activities, what muscle controls hip flexion & knee extension?
Hamstrings
-
In closed-chain activities, what muscles act eccentrically to control knee flexion, absorb compressive forces, & decelerate LE?
Knee extensors
-
Action of Popliteus muscle?
- Knee flexion
- Unlocks knee joint
-
Which muscle IR tibia & retracts medial meniscus?
Semimembranosus
-
Which muscle ER tibia?
Biceps femoris
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Femur position w/pes planus, genu valgum, tibial ER
IR
-
Genu recurvatum - other contributing postures - 2
- Ankle PF
- Anterior pelvic tilt
-
Anterior knee pain - common findings - 2
- DEC strength in hip ABD/ER
- Weakness during squat w/INC hip ADD/IR d/t poor eccentric control of these mm
-
Genu Varum - leads to what LE look? - 4
- BOWLEGS
- Medial tibial torsion
- Medial patella
- Pigeon toed
-
Genu Valgum - leads to what LE look? - 3
- KNOCK KNEE
- Lateral tibial torsion
- Lateral patella
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Patella alta - S/S - 3
- Patella tracks superiorly
- (+) camelback sign (2 bumps over anterior knee instead of typical one)
- May result in chronic patellar subluxation
-
Patella baja - S/S - 2
- Patella tracks inferiorly
- Results in restricted knee extension
-
Lateral patellar tracking - results from INC in what? what is seen on x-ray?
- Can result if there is INC in Q angle
- Tests - Plain film imaging including "sunrise" view
-
 What is pictured? - name; define; onset; pain location; DEC in what ROM?
- Osgood-Schlatter disease
- Mechanical dysfunction - traction of tibial tubercle @ patellar tendon insertion
- Insidious in adolescents
- Swelling over tibial tuberosity
- Pain & tenderness below kneecap
- Pain w/resisted extension & kneeling
- DEC knee flexion
- Antalgic gait
-
Initial Tx for Osgood-Schlatter disease
- Ionto w/dexamethasone
- Avoiding squatting/jumping
-
Patellofemoral syndrome - Define; aka; Onset; Pain location + INC w/what? What mm is weak? Problems in what knee position? Special tests - 3; PT - CONTRA
- Abnormal tracking of patella - aka "runner's knee"
- Onset - 20-50/Gradual
- Pain - diffuse ache behind patella
- Pain INC w/descending stairs, prolonged sitting (theater sign or movie-goer's knee)
- Weak vastus medialis (leads to poor activation/strength of VMO)
- Problems in terminal extension
- Tests - Clarke’s sign, INC Q angle, Step down test
- PT - NO isolated quad exercises - do quad exercises + others
-
Chondromalacia Patella - define; Age & sex; Pain where? Pain INC w/what activities? tests?
- Inflammation of underside of patella & softening of cartilage
- Close to patellafemoral in nature
- Females > males - ALL AGES
- Knee pain - retropatellar (behind kneecap)
- Pain INC w/squatting; WB activities esp single leg (descending stairs) sitting, running
- Instability - Giving way/Catching
- Transient swelling post exercise
- Tests - Pain/crepitus w/patella compression; X-ray may reveal spur
-
Osteochondritis Dissecans - define; What area is involved? Onset + age; S/S - 5 + 2 major ones
- Separation of articular cartilage from bone --> become loose within jt
- Involves Medial femoral epicondyle
- Gradual onset - seen w/children & adolescents
- Pain - Loading jt is very painful
- Fluid within jt/Tenderness/Crepitus
- Catching/Locking/Buckling
- ROM restriction - @ end ranges is painful - flexion or extension
-
Osteochondritis Dissecans - test; (+)
- Wilson's test
- Extend knee from 90 flexion maintaining IR
- (+) Pain at 30 flexion & RELIEF w/tibial ER
-
Differences bet Osteochondritis Dissecans & Osteomalacia Patela
- Osteochondritis dissecans - children & adolescents
- Osteomalacia Patela - ALL AGES
-
Tibial fx - March fx - 2
- Inferior 1/3 of tibia
- Pts who take long walks when they arent used to acitivity
-
Tibial fx - Compound fx - 1
Direct blow to tibia - from bumper car
-
Tibial plateau fx - Mechanism of injury; occurs in conjunction w/what other injury?
- Valgum & compression forces to knee when knee is in a flexed position
- Often occurs in conjunction w/MCL injury
-
Anterior compartment syndrome (ACS) - S/S chronic or exertional/acute - 2
- Acute - sudden trauma causing swelling within compartment (Medical emergency: fasciotomy)
- Chronic/Exertional - deep, cramping feeling
-
Anterior tibial periostitis - aka; mm involved (2)
- Also known as "Shin splints"
- MM involved - anterior tibialis/EHL
-
Medial tibial stress syndrome - aka; define; pain location; pain INC w/what? pathology from what foot position?
- Also known as - Posterior Tibialis Tendonitis
- Overuse injury of posterior tibialis/medial soleus (usually from running)
- Pain @ distal posteromedial border of tibia- behind medial malleolus
- Pain more at end of day as posterior tibialis controls pronation
- From excessive pronation
-
Pes Anserine Bursitis - S/S - pain location; pain INC w/what?
- Pain slowly developing on inside of knee/center of shinbone - 2-3” below knee jt
- Pain INC w/exercise or climbing stairs
-
Patellar tendonosis/tendonopathy - define; aka; pathology from what? pain INC w/what?
- Degenerative condition of patellar tendon
- Also known as "Jumper's knee"
- From - Repeated eccentric overloading during deceleration activities
- Pain INC w/jumping, running, squatting
-
Ligament sprains - Classification of injury
- 1st degree: resulting in little or no instability
- 2nd degree: resulting in minimal to moderate instability
- 3rd degree: resulting in extreme instability
-
To INC knee flexion - 3
- Tibiofemoral posterior glide
- Pattelofemoral inferior glide
- IR of tibia
-
To INC knee extension - 3
- Tibiofemoral anterior glide
- Pattelofemoral superior glide
- Tibial ER
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TKR - PT Phase I (acute) - 5 + 1 NO; Amb distance; stairs how?
- MM re-ed
- Soft tissue mobilization
- Lymphedema reduction
- Initiation of PROM/AROM
- DEC swelling
- DON'T use CPM for post-op uncomplicated TKR
- Amb distance = 200 ft
- Stairs - non-reciprocal
-
TKR - PT Phase II (subacute) - 2; Amb distance; stairs how?
- Regaining endurance, coordination, strength of mms surrounding knee
- Progressive amb stair climbing - reciprocal UP; non-reciprocal DOWN
- Amb distance - >4 blocks at a time
-
TKR - PT Phase III - 3; Amb distance; stairs how?
- Return to pre-op abilities
- Proprioceptive
- Functional, endurance
-
TKA - stairs - acute; subacute; stage 3
- Acute - non-reciprocal
- Subacute - reciprocal UP; non-reciprocal DOWN
- Stage 3 - step up 6-8; step down 4-6
-
TKA - ambulation; driving
- Acute - 200 ft
- Subacute >4 blocks at a time
- Driving - 2-4 wks
-
TKA - ROM - acute vs. subacute - ext & flex
- Acute - Ext 0-5/Flex 85-90
- Subacute - Ext 0/Flex 100-110
-
TKA - Contraindications - 3
- Active infection
- Extensor mechanism dysfunction
- Severe vascular disease (Osteomyelitis)
-
TKA - Rehab stages - lengths - acute; subacute; stage 3
- Acute - 1-5 days
- Subacute - 2-8 weeks
- Stage III - 8-9 weeks
-
Knee - special test for meniscus - 5
- McMurray’s test
- Appley test
- Thessaly test
- Bounce home test
- Joint line tenderness
-
 Name test; tests what; describe; (+)
- McMurray's test
- Meniscal tears
- Pt supine/Knee in maximal flexion
- Lateral meniscus: PROM IR & extend kneeMedial meniscus: PROM ER & extend knee
- (+) Click and/or pain in knee joint
-
 Name test; tests what; describe; (+)
- Appley test
- Helps differentiate bet meniscal tears & ligamentous lesions
- Pt prone/Knee flexed to 90°
- Stabilize pt's thigh to table
- Distract knee/Rotate tibia IR & ER
- Compress knee jt & rotate tibia IR & ER
- (+) for Ligamentous dysfunction - Pain or DEC motion during distraction
- (+) for Meniscal dysfunction - Pain or DEC motion during compression
-
 Name test; tests what; describe; (+)
- Thessaly test
- Meniscal tears
- Test performed @ 5 & 20 deg knee flexion
- Pt standing, rotates knee IR & ER keeping knee in 5 deg flexion
- Followed by same in 20 deg knee flexion
- (+) Pain at joint line or feeling of locking/catching
-
 Name test; tests what; describe; (+)
- Bounce home test
- Pt supine
- PT takes heel and maximally flexes knee
- Followed by passive knee extension
- (+) Full extension cannot be reached; Rubbery end-feel
-
Knee - special test for patellofemoral syndrome - 3
- McConnell test
- Passive patellar tilt test
- Clarke’s sign (patellar compression test)
-
McConnell test - tests what; describe; (+)
- Chondromalacia patella
- Pt seated/Knee flexed @ 30, 60, 90
- Pt does isometric quad contraction
- (+) Fixing glide at painful angle makes it better
-
Passive patellar tilt test - tests what; describe; (+)
- Pt supine/Knee 20 flexion
- PT tilts patella medially to see amount of upward movement on lateral side
- (+) Little to no upward movement
- Normally patella can be tilted upwards above horizontal
-
 Name test; tests what; describe; (+)
- Clarke’s sign
- Patellofemoral dysfunction
- Pt supine/Knee in extension
- AP push on superior pole of patella
- Ask pt to perform active contraction of quads
- (+) Pain in knee
-
Knee - special tests for ACL integrity - 4
- Lachman’s test
- Anterior drawer test
- Pivot-shift test
- Slocum
-
 Name test; tests what; describe; (+)
- Slocum
- Anterior rotary instability
- Anterolateral (IR) - ACL/PCL; LCL; ITB; arcuate lig – popliteus complex; posterolateral capsule
- Anteromedial (ER) - ACL; MCL; posterior oblique lig, posteromedial capsule
-
 Name test; tests what; describe; (+)
- Lachman’s test
- Integrity of ACL
- Pt supine/Knee flexed 20°-30°
- PT stabilizes femur/Passively try to glide tibia anterior
- (+) Excessive anterior glide of tibia
-
 Name test; tests what; describe; (+)
- Anterior drawer test
- Integrity of ACL
- Pt supine/Knee flexed 90
- (+) Excessive anterior glide of tibia
-
Difference between Lachman’s test & Anterior Drawer test
- Which is more accurate?
- Anterior Drawer Test is less accurate than Lachman Test and Pivot Shift Test
- Anterior drawer - knee flexion 90 = At this position anterior knee joint capsule becomes taut & can get a false (-) result for ACL deficiency
- Lachman’s - knee flexion 20-30 (physiological neutral - open packed position) = At this position capsule is lax & allows for a better assessment of ACL. Also takes away tight hamstrings as issue
-
 Name test; tests what; describe; (+)
- Pivot-shift test
- Integrity of ACL - anterolateral
- Pt supine/Knee ext/Hip flex & ABD 30° w/slight IR
- PT holds knee & foot in opposite hands
- Places valgus force through
- Flexes knee
- (+) Ligament laxity as indicated by tibia relocating during test - clunks @ 30-40 deg
-
Varus/valgus stress test - tests what; describe; (+)
- Integrity of collateral ligaments
- Pt supine/Knee @ 20-30 flexion
- (+) Laxity or pain
-
 Name test; tests what; describe; (+)
- Posterior drawer test
- Integrity of PCL
- Pt supine/Hip flexion 45°/Knee flexion 90°
- Pt prone/Knee flexion 30°
- PT glides tibia posteriorly
- (+) Excessive posterior glide
-
 Name test; tests what; describe; (+)
- Reverse Lachman
- Integrity of PCL
- Pt prone/Knees flexed to 45
- PT stabilizes femur
- Passively try to glide fibula posterior
- (+) Ligament laxity
-
 Name test; tests what; describe; (+)
- Posterior sag
- Integrity of PCL
- Pt supine/Hip flex 45°/Knee flex 90
- Observe to see whether tibia "sags" posteriorly in this position
- (+) Sag of tibia relative to femur
-
 Name test; tests what; describe; (+)
- Noble compression test
- Distal iliotibial (IT) band friction syndrome
- Pt supine/Hip flex 45°/Knee flex 90°
- PT applies P to lateral femoral epicondyle & extends knee slowly
- (+) Pain over lateral femoral epicondyle at 30° flex
-
Hughston's plica test - tests what; describe; (+)
- Pt supine/Knee flexed /Tibia IR
- Passively glide patella medially, while palpating medial femoral condyle
- Feel for popping as you passively flex & extend knee
- (+) Pain and/or "popping"
-
Proximal Tibiofibular jt - what happens to fibula w/talocrural DF?
- Fibula head glides superiorly and posteriorly
- Fibular shaft ER
Opposite for PF
-
To reduce recurvatum - intervention
- Eccentric quadriceps control work (closed-chain exercises)
- Open-chain, AROM don’t adequately address demands of gait
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