Christina Fall 25 :) > MSK: 7B > Flashcards

MSK: 7B Flashcards

(61 cards)

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1
Q

chronic - microtrauma

A

*Instabilities
*Degenerative Changes (OA)
*Patellofemoral Pain Syndrome
*Patellar Tendinopathy

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2
Q

acute conditions - macrotrauma

A

*Ligamentous injuries
*ACL, PCL, MCL, LCL
*Instabilities
*Anteromedial, anterolateral,
posteromedial, posterolateral
*Meniscal and articular cartilage injuries

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3
Q

valgus force causes injury to

A

MCL

*Accompanied by injury to medial meniscus, anterior cruciate, posteromedial capsule
*“Unhappy Triad”-ACL/MCL/MM

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4
Q

hyperextension causes injury

A

*Injury to ACL (and sometimes PCL)
*Accompanied by injury meniscus tears

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5
Q

flexion w/ posterior translation injury

A

*Injury to PCL
*Classic “dashboard injury”

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6
Q

varus force injury

A

*Injury to LCL
*Accompanied by injury to posterolateral capsule and PCL

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7
Q

ACL tears MOI

A
  • Contact: Hyperextension, valgus force
    (and foot planted)
  • Non-contact:
    Deceleration/acceleration valgus force
    near extension (cutting, sudden
    direction change)
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8
Q

ACL symptoms

A

hear or feel pop

rapid swelling 0-2 hrs post

knee giving way

loss of enrange ext (swelling or pain with shearing)

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9
Q

special test ACL tear

A

lachman’s

anterior drawer

pivot shift - best

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10
Q

functional test for ACL tear

A
  • 6 m Single Limb timed hop test
  • (+) if <80% of uninvolved side
  • Return to sport: 49% Sn, 94% Sp
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11
Q

segond fx

A

sign on x ray that signals ACL injury

It’s an avulsion fracture caused by the attachment of the anterolateral ligament being pulled by the iliotibial band or joint capsule under stress, particularly in the context of internal rotation and varus stress on the knee.

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12
Q

concurrent bone bruising most common where

A

over lateral femoral condyle
bone bruises heal slow

The inner bone/trabecular bone can fracture and take 2-3 months – up to one year to heal

A kissing contusion (seen on MRI) is a strong indicator of an ACL tear; however, may be meniscus, or both. Can occur in isolation.

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13
Q

copers vs non copers

A

coper: return to sport w/o surgery; An ACL coper is someone with a ruptured ACL who can still function well during activities without experiencing episodes of “giving way” (instability) in their knee.

non: surgery; An ACL non-coper is someone with an ACL tear who experiences instability and cannot function at their desired level without surgical reconstruction of the ligament

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14
Q

delayed surgery may be associated with

A

increase damage to meniscus / articular articular

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15
Q

characteristics of a coper!

A

*No more than 1 episode of knee giving way

Characteristics of a caper:
Dynamic Stability:
They maintain stability through strong and activated surrounding muscles and efficient movement patterns, rather than relying on the passive stability of the ACL.

Functional Performance:
They can perform well in sports or daily activities, demonstrating stable knee movements and good functional scores on tests.

Minimal “Giving Way”:
They report few to no instances of their knee “giving way” or buckling since the injury.

Good Proprioception:
They likely have intact proprioception (the body’s sense of position and movement) despite the ligament tear.

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16
Q

Characteristics of non copers

A

Instability:
They experience episodes of the knee giving way, particularly during activity.

Muscle Deficits:
They often show deficits in quadriceps strength and activation, leading to altered movement patterns and a less stable knee.

Poor Functional Performance:
They perform poorly on functional tests, such as hop tests, and report reduced functional ability compared to the non-injured side.

Joint Laxity:
They may have a feeling of increased laxity or hypermobility in the knee.

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17
Q

However, non-copers can improve their likelihood of returning without surgery with proper rehab-specifically neuromotor re-education and proper strength training. ___

A

Perturbation training!!

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18
Q

screening process inclusion criteria

A
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19
Q

screening process rehabilitation candidates

A
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20
Q

more likely to recieve surgery if

A
  1. Higher activity level
  2. More episodes of giving way
  3. Lower KOS-ADL score
  4. Lower score on the International Knee Documentation
    Committee Subjective Knee Form 2000
  5. Lower limb symmetry index on the 6-meter timed hop test, and a lower quad strength index
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21
Q

PCL tears MOI

A
  • Trauma with a posterior tibial shear injury in
    flexion or hyperextension
  • Dashboard Injury
  • Sudden stopping while wearing cleats
  • Fall with hyperflexed knees and ankle plantarflexion
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22
Q

more likely to see PCL copers than ACL but

A

PCL takes longer to heal than ACL

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23
Q

visual cues of PCL tears

A
  • Abrasion or bruising anterior proximal tibia if hit
  • Loss of knee extension with ROM testing or gait
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24
Q

PCL patients say?

A

localized post knee pain while kneeling or decelerating

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25
special test PCL tears
posterior drawer posterior sag sign valgus stress at 0
26
MCL tear MOI
* Traumatic, valgus force * Possibly includes rotational trauma
27
visual presenation of MCL
* Normal knee ROM (b/c MCL for stability not motion) * Painful palpation of MCL
28
what they might say MCL tear
* Medial knee pain * Depending on severity, they might report minimal symptoms that sound like a meniscal injury
29
MCL special tests
valgus stress test at 20-30 degrees knee flexion grade 1 grade 2 grade 3
30
MCL valgus stress test grade 1
Joint space opens within 2 mm of contralateral side
31
MCL valgus stress test grade 2
Joint space opens 3-5 mm more than contralateral side
32
MCL valgus stress test grade 3
Joint space opens more than 5-10 mm more than contralateral side
33
MCL does it need surgery
often does well without
34
when is MCL surgery considered
* Surgery warranted acutely if bony avulsion or combined with ACL tear * Surgery warranted after 3 months if no progress and pt still has instability with valgus force during function
35
LCL tear MOI
traumatic varus force
36
LCL tear visual presentation
* Local effusion over LCL * Lack of or abnormal LCL with palpation
37
LCL tear might say
pain with palpating LCL
38
LCL tear special test
* Varus stress test at 30° knee flexion
39
rotary instabilites
anteriomedial instability anteriolateral instability posteriomedial instability posteriolateral instability
40
what is knee rotatory instability?
Knee rotatory instability is a complex condition involving abnormal rotation and displacement of the tibia relative to the femur, often caused by damage to ligaments, menisci, or bony structures. Symptoms include a sensation of the knee "giving way," locking, catching, or pain, especially during twisting or pivoting activities
41
anteriomedial instability
anterior and ER directed force
42
anteriorlateral instability
anterior and IR directed force
43
posteriomedial instability
posterior and IR directed force
44
posteriorlateral instability
posterior and ER directed force
45
anteriomedial stability involves
MCL POL - post oblique lig posteromedial capsule ACL
46
anterolateral stability involves
ACL LCL posterolateral capsule arcuate complex/popliteus IT band
47
postromedial stability involves
PCL POL MCL semimembranosis posteromedial capsule ACL
48
posterolateral stability involves
PCL arcuate complex/popliteus LCL biceps femoris posterolateral capsule
49
anteromedial rotary instability MOI
* Excessive valgus force and tibial ER motion * Caused by anterior subluxation of medial tibial plateau -Tibial ER causes the medial tibial plateau to shift anteriorly, while the lateral side may pivot posteriorly.
50
anteromedial rotary instability special test
* Anterior Drawer with ER *No diagnostic tests to date
51
anterolateral rotary instability MOI
* Excessive valgus force and tibial IR motion * Almost always associated with ACL tear * Caused by anterior subluxation of lateral tibial plateau
52
special test anterolateral rotary instability
-anterior drawer test with IR No diagnostic tests to date Half-ROM IR tests ACL and posterolateral capsule/ligaments Full IR ROM tests PCL, ACL, lateral/posterolateral structures -pivot shift Tibia subluxes near flexion (clunk) Tibia reduces with extension (may be clunky)
53
posteromedial rotary instability MOI
Traumatic force delivered into extension and tibial IR May have valgus movement as well
54
posteromedial rotary instability special test
hughston's psteromedial drawer -posterior drawer with slight IR
55
posterolateral rotary instability MOI
Requires laxity of the PCL in addition to other structures Tibial posterior and ER force
56
special test for posterolateral rotary instability
Dial test/PLR test posterolateral drawer test (15 tibial ER) reverse pivot shift (90° flexion, ER, valgus then extended slowly – sublux at 20° as ITB shifts)
57
PLC stabilizing contents
Popliteus tendon, Popliteofibular ligament, LCL
58
how to perform Dial test / PLR test
Pt prone, tibial ER ROM compared side to side Change to 10° or more from side to side is significant Increased ROM at 90° indicates PCL injury (isolated) (but PCL tests are better) Increased ROM at 30° indicates PL Corner injury (isolated) Increased at both indicated PCL and PLC
59
posterolateral corner injury MOI
Direct hit on proximal tibia with extended knee and varus force Posterior force on a flexed knee with the tibia ER Chronically after a trauma to ACL and/or PCL -Can cause failure of surgical site
60
posterolateral corner injury visual presentation
varus thrust gait hyperextension gait
61
posterolateral corner injury what the pt may report
Posterolateral instability Feeling that the knee may give way 1/24 pts report peroneal nerve irritation
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