Exam 3 Carruth The Knee

ILIOTIBIAL BAND FRICTION SYNDROME
- Common occurs with

distance runners and cyclist
- constantly moving knee from flexion to extension. Running injuries occurs mostly on the right hand side. (running at a slight angle putting additional pressure on the right side). The force exerted on you during run. causes pressure on the outside leg.
•Mostly due to abnormal alignment in the lower extremity

TFL and gluteus maximus

pulls on the IT BAND. general direction up IT BAND is up. These are the muscles we're concerned about. Can pull the IT Band to stretch these, because they stretch the IT BAND.

IT BAND ON Lateral condyle and Medial condyle

Rubbing of the IT BAND on outside of femur causes

irritation and swelling which will constantly catch until we get it to cool down.

IT BAND

Runs from the hip to the fibula. Band of connective tissue (silver skin). which is non flexible (cannot be stretched). excessive tightness here: muscles at the hip are pulling up on this muscle. IT band causes problem in the knee that originate in the hip.

ILIOTIBIAL BAND Friction Syndrome
- Signs and Symptoms

•Pain usually in the distal portion of IT band
•Maybe point tender - lateral femoral epicondyle
•Pain increase with flexion and extension of the knee.
- overused injury.

non of the lower leg muscles crosses the knee

however, they still interact with the foot.

Iliotibial Band Friction Syndrome
- Treatment

•Investigate causes
•Muscle tightness
•Correct abnormalities
•Activity Level
•Running surfaces
•Stretching of IT band and hip musculature
•Ice
•Anti-inflammatory medications

ILIOTIBIAL BAND FRICTION SYNDROME on general population:

Supinators: bowleg making it tighter on the inside leg. Vice Versa for pronators.

ILIOTIBIAL STRETCHING

Cross leg sitting up and laying down (gluteus), Straight TFL stretching, Rolling out (the best).

Knee

four bones: femur tibia, fibula, patella. (are held together by four ligaments except the patella).
Four ligament: MCL, PCL, ACL, LCL. Two Meniscus.

Collateral

on the side.

CHRONDROMALACIA OF THE PATELLA

a painful degenerative condition that results in the irritation and softening of the articular cartilage on the posterior patella

medial and lateral menisci

fibrocartilage pads, at femur-tibia articulations, cushion and stabilize joint, give lateral support

The patella is the

the tendon, the quads is ligament.

CHRONDROMALACIA
affects:

the underside of the patella

CHRONDROMALACIA is the

•Softening and deterioration of the cartilage
•Abnormal movement = friction between the underside of the patella and femur
•Vastus Medialis
•Q-angle:
- listed because they are the reason for the problem.

CHONDROMALACIA
Signs and Symptoms:

•Pain when extending the knee and terminal degrees of flexion
•May experience a grinding sensation

CHONDROMALACIA
Treatment:

•Modify activity level
•Stretching and Strengthen of quadriceps muscles (Vatus Literalis, Vastus Medialalis, Vastus Femoris).
•Bracing (suppose to act like mcconnell tape).
•If conservative measure fail, surgery may be considered

PATELLAR TENDINITIS

•Due to repetitive forceful contraction of the quadriceps muscle group
•Force produced in the quadriceps translated thru patella tendon
- inflammation caused by overuse.

PATELLAR TENDINITIS
- Signs & Symptoms

•Pain at inferior pole of patella
•Moderately point tender
•Tightness within the tendon
•Can eventually lead to rupture

PATELLAR TENDINITIS
- Treatment

•Modify activity level
•Stretching of quadriceps
•Massage
•Patella tendon strap

OSGOOD-SCHLATTER DISEASE

•Due repetitive pull of patellar tendon on its attachment side at the tibial tuberosity
•Small attachment site for a large and powerful muscle group
•Repetitive forces
•Inflammation
•Irritation of bone
•Leads to formation of callus - enlarged tibial tuberosity

OSGOOD-SCHLATTER DISEASE
- Signs & Symptoms

•Pain at tibial tuberosity
•Usually occurs in adolescents and teenagers

OSGOOD-SCHLATTER DISEASE
- Treatment:

•Modify activity
•Stretching and Treat inflammation
•Padding if point tender

MEDIAL COLLATERAL LIGAMENT SPRAINS
- Causes =

- Valgus Force at the knee and/or external rotation of the tibia. force that comes from the outside to inside.
•Foot planted
•Direct blow
- ligament on the inside. mcl runs from femur to fibula.

if it hurts on the side you got hit on

not worried about that ligament. now if it was the opposite you'd be worried.

MEDIAL COLLATERAL LIGAMENT SPRAINS
- Can BE

accompanied with damage to other structures

MCL SPRAINS

•Valgus Force

MCL SPRAINS
- Signs & Symptoms

•Mild to Moderate Pain is generally over the medial joint line
•Mild to moderate swelling located over entire medial knee
•Remember Degrees of Sprains
•With Grade II and III there will be instability
•Buckle or give way

MCL SPRAINS
- Treatment: Grade I:

•Depends on the severity
(no instability or laxity)
•Ability to walk w/o compensation
•Presence of swelling and pain
•Maintain strength and ROM
•FOCUS
•Limit Activities

MCL SPRAINS
- Treatment: Grade II

•Has Laxity and instability
•Ability to walk?
•Amount of swelling/pain
•PROTECTION (immobilization Period)
•RE-GAIN ROM AND STRENGTH
•FOCUS
•Isometrics to Isotonics
•Gradual return to activities

MCL SPRAINS
- Treatment: Grade III

•Rule out other ligaments and meniscus
Damage
Same Tx protocol as Grade II, just longer. Has Laxity and instability•Ability to walk?•Amount of swelling/pain•PROTECTION (immobilization Period)•RE-GAIN ROM AND STRENGTH•FOCUS•Isometrics to Isotonics•Gradual return to activities

LATERAL COLLATERAL LIGAMENT SPRAINS Causes

•Varus Force and/or Internal Rotation of the tibia

LATERAL COLLATERAL LIGAMENT SPRAINS
- Signs & Symptoms

•Pain and Swelling over lateral joint line
•Depends on Grade of Sprain

LATERAL COLLATERAL LIGAMENT SPRAINS
Treatment Grade I

•Depends on the severity
•Grade I (no instability or laxity)
•Ability to walk w/o compensation
•Presence of swelling and pain
•Maintain strength and ROM
•FOCUS
•Limit Activities
- Same as MCL Sprains.

LATERAL COLLATERAL LIGAMENT SPRAINS
Treatment Grade II & III

•Initially Protect
•Efforts to decrease pain and swelling
•Rehab focus: regaining ROM and Strengthing lateral structures of knee.
•Longer period of healing

MENISCUS INJURIES
- Cause:

•Weight-bearing position + rotational force at the knee + some degree of knee flexion

MENISCAL INJURIES
•Vascular Zone vs. Avascular zone

if cut and do not bleed meaning they would potentially not heal. would want bleeding to get blood to the area.

MENISCAL INJURIES
Signs & Symptoms

•Mild to moderate pain (everywhere)
- generally hurt in the morning, at night, moving up and down stairs.
Varying locations (front, back, sides).
With terminal degrees of ROM
•Diffuse swelling
•Loss of Range of motion (because of swelling or mechanical blockage).
•Feeling of instability or weakness
•Locking
Bilitibal Patellar = can tell it's swollen.

three different types of meniscus tears

bucket handle tear (most common).

pain will cause the

muscles to stop working. if you stop moving this will make it worse.

MENISCAL INJURIES
•Treatment

•Referral to confirm diagnosis
•Cease activity
•Surgery
Menisectomy vs. suture repair Vs. allograft
•Consequences of repeated
surgeries.

ANTERIOR CRUCIATE LIGAMENT SPRAINS
•Causes (MOI/Extrinsic Factors)

•Deceleration force
•Internal Rotation (most common) of the femur + external rotation of the tibia + external rotation of a planted foot
•Knee Hyperextension
•Direct blow vs. non-contact

ANTERIOR CRUCIATE LIGAMENT SPRAINS
- •Secondary Causes (Intrinsic Factors)

•Male vs. Female Characteristics
•Q-angle
•Hormonal

ANTERIOR CRUCIATE LIGAMENT SPRAINS
Dominance

Leg Dominance
•Muscle Dominance
•Ligament Dominance

ACL SPRAINS
Signs & Symptoms

•Remember S &S of associated with each Grade of Sprain
•Grade III - Audible pop
•Instability
•Intense pain -

ACL SPRAINS
- •Treatment Grade I & II

•Refer to a physician to confirm diagnosis
•Treat as any other sprain
•Protection, control pain and swelling, rehab, brace
•Chances of Rupture? if so, we'll have surgery.

ACL SPRAINS
- •Treatment Grade III

•Moderate Instability
•Surgery
•Prior to surgery, minimal swelling, full ROM, and good strength
•Considerations
•Hamstring (semitendinosis) Graft vs Patellar Tendon Graft
•Pros vs Cons
•Autogenous tissue vs. Allograft
•Pro vs Cons
•Physicians Experience vs Patients wants
•Quality Rehabilitation is Paramount
•4 - 9 months
Bracing

POSTERIOR CRUCIATE LIGAMENT SPRAINS
Causes

•Falling on a bent knee = posterior translation of tibia
Blow to anterior knee (Most common mechanism is a car injury).

POSTERIOR CRUCIATE LIGAMENT SPRAINS
Signs & Symptoms

Grade I & II: can't find it •Grade III - Audible Pop, felt in back of the knee
•Pain and tenderness in the back of the knee
•Instability in back of knee

POSTERIOR CRUCIATE LIGAMENT SPRAINS
•Treatment

•Initially PRICE
•Surgery? - Patient and Physician
•Immobilize for 6 wks in extended position
•At6 wks, Begin ROM exercises
•3-4 mos., begin strengthening
•Surgery, Depends on amt of instability and
Patients activity level