MSK_Knee_ALL

  1. Knee ROM
    • Flexion - 135
    • Extension - 5-10
    • Tibia IR - 20-30
    • Tibia ER - 30-40
  2. Resting position - Tibiofemoral jt
    25° flexion
  3. Closed-packed position - Tibiofemoral jt
    • Full extension
    • ER of tibia
  4. Capsular pattern - Tibiofemoral jt; Tibiofibular jt
    • Tibiofemoral jt - Flex > Ext
    • Tibiofibular jt - Pain when jt is stressed
  5. 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
  6. Tibiofemoral Jt - Arthro/Osteo kinematics - direction in CLOSED chain of femur + direction
    • Flexion - anterior
    • Extension - posterior

  7. Knee position for maximum tibiofemoral IR/ER
    90 flexion
  8. Menisci - Movement - 2
    • Flex/Ext - Follow tibia
    • ER/IR - femoral condyles
  9. W/isolated tibial rotation, menisci move in same or opposite direction?
    • Opposite
    • Tibia IR meniscus goes anteriorly
    • Tibia ER meniscus goes posteriorly
  10. 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
  11. The menisci are avascular where?
    Inner 2/3
  12. 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
  13. Meniscal repair - how long should pt be NON-WB?
    • 3-6jQuery110107065239014948412_1483645783445
    • W/surgery WB @ end of post surgery wk 3
  14. Ligaments restricting IR/ER
    • IR - ACL, PCL - bc they are Inside knee
    • ER - MCL, LCL - bc they are External of knee
  15. LCL/MCL - what happens w/flex/ext
    • Flexion - slackened
    • Extension - taut
  16. Meniscus tear - precaution vs. CONTRA
    • Precaution - pivoting, twisting; deep squats
    • CONTRA - deep squats
  17. Meniscus tear - initial PT
    Pain management - modality for pain
  18. Meniscus tear - to reduce pathology
    • Surgery
    • Pain management
    • Knee stabilization exercise - closed-chain - theraband around knee, slight squat & straighten
  19. Acronym for Screw-home mechanism in CLOSED-chain
    • FEMUR
    • Flexion to Extension Medial Rotation of Femur on Tibia
    • (everything else is opposite)
  20. CLOSED chain "screw-home" mechanism"
    • Femur: IR
    • Tibia: ER
  21. OPEN-chain "screw-home" mechanism:
    • Femur: ER
    • Tibia: IR
  22. Ligament strengthening - posteromedial & posterolateral
    • Posteromedial - Oblique popliteal ligament
    • Poste­rolateral - Arcuate popliteal ligament
  23. Primary knee extensors - 1
    Quadriceps
  24. Primary knee flexors in open-chain activities - 1
    • Hamstring muscles:
    • Semimembranosus; Semitendinosus; Biceps femoris (lateral)
  25. Prime movers of tibial ER - 1
    Biceps femoris
  26. Prime movers of tibial IR - 3
    • Popliteus
    • Semimembranosus
    • Semitendanosus
  27. Vastus medialis oblique (VMO) resists what during closed-chain activities?
    Lateral displacement of patellar out of trochlear groove
  28. In closed-chain activities, what muscle controls hip flexion & knee extension?
    Hamstrings
  29. In closed-chain activities, what muscles act eccentrically to control knee flexion, absorb compressive forces, & decelerate LE?
    Knee extensors
  30. Action of Popliteus muscle?
    • Knee flexion
    • Unlocks knee joint
  31. Which muscle IR tibia & retracts medial meniscus?
    Semimembranosus
  32. Which muscle ER tibia?
    Biceps femoris
  33. Femur position w/pes planus, genu valgum, tibial ER
    IR
  34. Genu recurvatum - other contributing postures - 2
    • Ankle PF
    • Anterior pelvic tilt
  35. 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
  36. Genu Varum - leads to what LE look? - 4
    • BOWLEGS
    • Medial tibial torsion
    • Medial patella
    • Pigeon toed
  37. Genu Valgum - leads to what LE look? - 3
    • KNOCK KNEE
    • Lateral tibial torsion
    • Lateral patella
  38. 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
  39. Patella baja - S/S - 2
    • Patella tracks inferiorly
    • Results in restricted knee extension
  40. 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
    • Image Upload 1
  41. Image Upload 2What 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
  42. Initial Tx for Osgood-Schlatter disease
    • Ionto w/dexamethasone
    • Avoiding squatting/jumping
  43. 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
  44. 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
  45. 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
  46. Osteochondritis Dissecans - test; (+)
    • Wilson's test
    • Extend knee from 90 flexion maintaining IR
    • (+) Pain at 30 flexion & RELIEF w/tibial ER
  47. Differences bet Osteochondritis Dissecans & Osteomalacia Patela
    • Osteochondritis dissecans - children & adolescents
    • Osteomalacia Patela - ALL AGES
  48. Tibial fx - March fx - 2
    • Inferior 1/3 of tibia
    • Pts who take long walks when they arent used to acitivity
  49. Tibial fx - Compound fx - 1
    Direct blow to tibia - from bumper car
  50. 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
  51. 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
  52. Anterior tibial periostitis - aka; mm involved (2)
    • Also known as "Shin splints"
    • MM involved - anterior tibialis/EHL
  53. 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
  54. 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
  55. 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
  56. 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
  57. To INC knee flexion - 3
    • Tibiofemoral posterior glide
    • Pattelofemoral inferior glide
    • IR of tibia
  58. To INC knee extension - 3
    • Tibiofemoral anterior glide
    • Pattelofemoral superior glide
    • Tibial ER
  59. 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
  60. 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
  61. TKR - PT Phase III - 3; Amb distance; stairs how?
    • Return to pre-op abilities
    • Proprioceptive
    • Functional, endurance
  62. 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
  63. TKA - ambulation; driving
    • Acute - 200 ft
    • Subacute >4 blocks at a time
    • Driving - 2-4 wks
  64. TKA - ROM - acute vs. subacute - ext & flex
    • Acute - Ext 0-5/Flex 85-90
    • Subacute - Ext 0/Flex 100-110
  65. TKA - Contraindications - 3
    • Active infection
    • Extensor mechanism dysfunction
    • Severe vascular disease (Osteomyelitis)
  66. TKA - Rehab stages - lengths - acute; subacute; stage 3
    • Acute - 1-5 days
    • Subacute - 2-8 weeks
    • Stage III - 8-9 weeks
  67. Knee - special test for meniscus - 5
    • McMurray’s test
    • Appley test
    • Thessaly test
    • Bounce home test
    • Joint line tenderness
  68. Image Upload 3Name 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
  69. Image Upload 4Name 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
  70. Image Upload 5Name 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
  71. Image Upload 6Name 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
  72. Knee - special test for patellofemoral syndrome - 3
    • McConnell test
    • Passive patellar tilt test
    • Clarke’s sign (patellar compression test)
  73. 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
  74. 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
  75. Image Upload 7Name 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
  76. Knee - special tests for ACL integrity - 4
    • Lachman’s test
    • Anterior drawer test
    • Pivot-shift test
    • Slocum
  77. Image Upload 8Name 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
  78. Image Upload 9Name 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
  79. Image Upload 10Name test; tests what; describe; (+)
    • Anterior drawer test
    • Integrity of ACL
    • Pt supine/Knee flexed 90
    • (+) Excessive anterior glide of tibia
  80. 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
  81. Image Upload 11Name 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
  82. Varus/valgus stress test - tests what; describe; (+)
    • Integrity of collateral ligaments
    • Pt supine/Knee @ 20-30 flexion
    • (+) Laxity or pain
  83. Image Upload 12Name 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
  84. Image Upload 13Name 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
  85. Image Upload 14Name 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
  86. Image Upload 15Name 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
  87. 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"
  88. Proximal Tibiofibular jt - what happens to fibula w/talocrural DF?
    • Fibula head glides superiorly and posteriorly
    • Fibular shaft ER

    Opposite for PF
  89. To reduce recurvatum - intervention
    • Eccentric quadriceps control work (closed-chain exercises)
    • Open-chain, AROM don’t adequately address demands of gait
Author
Tanuisha
ID
323429
Card Set
MSK_Knee_ALL
Description
Knee
Updated