521 Atraumatic Knee

22.7% (28.9% in adolescent populations)

annual prevalence of anterior patellofemoral pain

SI joint, low back, hip

common regional areas that refer to the knee

true

true or false? for most people, activity will aggravate knee pain and rest will typically relieve it

morning stiffness for 30 minutes, pain worsens at end of the day, knee can throb when lying down at night

typical presentation of pain with knee arthritis

pain not alleviated with rest, feels hot and swollen without history of trauma, night pain, calf or thigh pain after surgery or after period of immobilization

red flags in a knee exam

Q-angle

degree of angle when measureing from midpatella to ASIS and tibial tubercle.

13, 18

normal q angle is ___ degrees for man and ___ degrees for a woman.

patellar tracking issues

if Q angle is larger than normal, what specific knee issue could we consider?

anterior knee pain

most common clinical symptom of atraumatic knee conditions

lumbar (SLR, CSLR, slump, kemp's, repeated movements), SI Joint (PSIS pain → SI test cluster), Hip (FADDIR + MtS breakouts)

What is included in the "screening" for the knee?

MtS breakouts as needed

What is included in the regional joint exam for the knee?

ASLR, PSLR, double knees to chest, prone rock

How to break out a dysfunctional Multi-Segmental Flexion

Lumbar locked T-spine rotation, prone on elbows lumbar extension/rotation, FABER, Thomas Test, Prone press up

How to break out a dysfunctional Multi-Segmental Extension

measure hip extension in prone

If the Thomas test is (-) in the regional joint exam, what is the next step?

Lumbar locked T-spine rotation, prone on elbows lumbar extension/rotation, Hip IR and ER seated and prone

How to break out a dysfunctional Multi-Segmental Rotation

false

True or False? If Multi-Segmental Rotation is not dysfunctional, then we do not need to look at tibial IR and ER in the local exam of the knee

DF, PF, Inversion, Eversion

How to break out a dysfunctional SLS

lift back toes off ground, clear base of the 5th met

criteria to look for when assessing DF in the regional screen in standing

20º ROM

criteria to look for when assessing DF in the regional screen in prone (if not passed in standing)

PF foot, 40º ROM, No rolling to outside of the foot

criteria to look for when assessing PF in the regional screen in standing

40º ROM

criteria to look for when assessing PF in the regional screen in prone

medial foot clears floor (bilaterally)

criteria to look for when assessing Invesion in the regional screen in sitting

lateral foot clears floor (bilaterally)

criteria to look for when assessing eversion in the regional screen in sitting

tandem stance against wall, bending knees down

how to we break out a dysfunctional squat pattern (CKC DF)?

40º ROM, No valgus collapse, no heel lifting

criteria to look for when assessing CKC DF in the regional screen in standing

30º

criteria to look for when assessing CKC DF in the regional screen in prone

eversion, inversion, hip flexion, hip IR, Hip ER

if not assessed previously, what else (other than CKC DF) needs to be assessed for a dysfunctional squat pattern?

tibiofemoral joint, patellofemoral joint, tibial IR, tibial ER

major things to assess in the local biomechanical assessment of the knee

patellofemoral pain syndrome

anterior knee pain of insidious onset where the pain is on or behind the patella

walking up/down stairs, prolonged sitting, squatting, running

common activities which cause pain with PFPS

inflammation of patellar fat pad

hoffa's disease

inflammatory degenerative process on the backside of the patella and trochlear groove; cartilage irritation

chondromalacia

multifactorial

true PFPS =

glute med, glute max

weakness in these muscles are common sources of PFPS

flexion, adduction, IR

if the glute med and max are weak, what position will the hip want to be in

patella doesn't sit flat at rest

patellar tilt

high riding patella

patella alta

patellar tilt test, Clarke's Sign/Patellar Grind, Lateral pull test, eccentric step down, movie goer's sign

special tests of PFPS

Clarks' Sign

what PFPS test is being performed?

patellar tilt test

what PFPS test is being performed?

No (+ for reproduction of pain)

during the eccentric step down, the patient goes into valgus collapse. Is this a positive test?

ruling in

are the PFPS tests typically used for ruling in or ruling out?

pain with squatting?

pain with stair climbing?

pain with kneeling?

pain with resisted knee extension?

what questions could you ask that have diagnostic utility for ruling OUT PFPS?

clear patellar and regional mobility, pain control, McConnell taping, motor control, core stability, quad strengthening, hip abductors, hip extensors

txment for PFPS

1. muscle performance deficits

2. Movement coordination deficits

3. Mobility impairments

4. Overuse/Overload without other impairments

PFP Classification System to Guide Treatment

patellar tendinopathy

acute degeneration of the patellar tendon from overuse, misuse or underuse

jumper's knee

other name for patellar tendinopathy

location of pain

difference between patellar and quad tendinopathy

pain with palpation, pain with stretch, pain with resistance

special tests for patellar tendinopathy

clear local and regional mobility, eccentric quads, soft tissue mobilization, Quad/Hamstring stretching, pain control, compression strap, core stability

txment for patellar tendinopathy

Osgood Schlatter

partial avulsion of the tibial tuberosity in pubescent males and females involved in running, jumping, and landing

gradually increasing pain and swelling below involved knee, pinpoint tenderness, limited and painful knee flexion, painful resisted knee extension

symptoms of Osgood Schlatters

Sinding Larsen-Johansson

Traction injury at patellar tendon insertion on patella

clear local and regional mobility, activity modification, quadriceps soft tissue mobilizations/stretching, knee pads, self-limiting

txment for Osgood Schlatter/Sinding Larsen-Johansson

ITB Syndrome

overuse injury typically caused by a tight iliotibial band. aggravated by excessive or abnormal rotational movements of the femur and tibia while running or walking.

painful popping (especially with hill running), lateral knee pain, pain at insertion of IT band

symptoms of ITB syndrome

Ober

special tests for ITB syndrome

Thessaly's, Appley's, Joint line palpation, McMurray's

special tests for degenerative meniscus lesions

insidious onset if pain/stiffness (30 min in morning), pain with EB, buckling, locking, giving way, difficulty with stairs/walking/rising from seat

Patient presentation of OA at the knee

varus/valgus knee, joint effusion, diffuse joint line tenderness, capsular pattern of loss

Exam findings of OA

greater loss of flexion that extension

capsular pattern of loss for knee

age >50, daily knee stiffness <30 minutes, crepitus, bony tenderness, bony enlargement, no palpable warmth

Criteria to diagnose OA at the knee

4

# of criteria need to rule in OA

3

# of criteria need to rule out OA

narrow joint space, bone sclerosis, periarticular cysts, osteophytes

what will imaging reveal in knee OA?

corticosteroids (4/year), improve hip mobility, hip strengthening, pain relieving mobs, foot orthotics, non-WB aerobic exercise

txment for knee OA