ATH503 Exam 2

What are s&s of an mcl sprain?

Pn, swelling, stiffness
limited flex & ext
+ valgus
joint line pn

What is the ROM for an MCL sprain?

Flexion & extension

What is the MOI for an mcl sprain?

Valgus contact or non-contact valgus &/or rotation

What is the MOI for an lcl sprain?

— & tibial internal rotation

What are S&S for an lcl sprain?

Hearing “pop” or tear
Swelling
Point tenderness

What is the ROM for an LCL sprain?

Flexion & Extension

What is the MOI for an ACL sprain?

Anterior tibial translation or
posterior femoral translation, Noncontact rotational injuries, or Hyperextension

What are S&S of an ACL sprain?

hearing or feeling “Pop”, immediate function loss & swelling within 4-6 hours

What is the ROM for an ACL sprain?

As swelling sets in, theres a decrease in ROM

What are the extrinsic predisposing factors of an ACL sprain?

Muscle strength & fatigue
Muscle activation & coordination
Q angle
Female
Anterior pelvic tilt
Menstrual cycle

What are the intrinsic predisposing factors of an ACL sprain?

Small ACL size
Narrow intercondylar notch width
Joint laxity

What is the MOI for a PCL sprain?

posterior tibial translation, landing on anterior tibia with knee flexed, or landing on dorsiflexed ankle

What are the S&S for a PCL sprain?

may be asymptomatic, popliteal fossa pain & tenderness, & effusion develops over time

What is the ROM for a PCL sprain?

—
MMT: Quad strength decrease in chronic patients

What is the MOI for a posterolateral corner injury?

Hyperextension w/ varus, & Hyperextension w/ external tibial rotation

What are S&S of a posterolateral corner injury?

“Knee instability”, localized pain, giving way, rapid non-contained edema

What is the MOI for a meniscal tear?

rotation with flexion &/or valgus/varus stress

What are S&S of a meniscal tear?

“clicking” or “locking”
Joint line pain
Decreased motion
Swelling

What are the classifications of a tibiofemoral dislocation?

Tibial Displacement
Complete
Partial
Open
Closed
High or Low velocity

What is the MOI for a tibiofemoral dislocation?

Hyperextension
Hyperextension w tibial rotation
Posterior tibial displacement w flexed knee

What are S&S of a tibiofemoral dislocation?

Severe pain
Spasm
Deformity
“Dimple sign”
Suspect w impaired neuro symptoms

What are predisposing factors to IT Band friction syndrome?

Genu varum
Foot pronation
Leg length
Lateral heel strike

What is the MOI for IT Band friction syndrome?

Repeated flexion & extension

What are the S&S for IT Band friction syndrome?

“Burning”
Point tenderness
MMT pain, none with AROM

What is disrupted with Anterolateral Rotatory Instability?

ACL
Anterolateral & Posterolateral capsule
Biceps femoris
Lateral meniscus

What do patients complain of with rotary instability?

“giving out or giving way”
Decreased strength
Decreased performance
Lack of confidence

What are the special tests for IT Band syndrome?

Nobel’s & Ober’s

What is the Unhappy triad in anteriomedial rotary instabillity?

ACL
MCL
Medial meniscus

What are the special tests for anteriomedial rotary instability?

Crossover
Isolated ACL & MCL
Solcum drawer

What is a discoid menisucus?

Increased thickness & overs a larger area of the tibia
Size, shape & stability causes instability, clicking or locking

What is a meniscal cyst?

Associated w longitudinal tears
Often painless
Breaches joint capsule and fills with synovial fluid

What is an osteochondral lesion?

damage to the bone and cartilage

What are S&S of an osteochondral lesion?

Diffuse pain
Locking or clunking
Increased pain & decreased strength when WB

What are the special tests for uniplanar anterior instability?

Anterior drawer
Lachmans
Prone lachmans

What are the special tests for uniplanar posterior instability?

Posterior drawer
Godfrey’s
quad activation
Dynamic posterior shift
External rotation recurvatum

What are the special tests for uniplanar medial instability?

Valgus test

What are the special tests for uniplanar lateral instability?

Varus test

What are the special tests for multiplanar anteriolateral instability?

Slocum drawer
Crossover
Flexion/rotation drawer
Pivot shift

What are the special tests for multiplanar anteriormedial instability?

Crossover
Anterior drawer
Slocum drawer w/ ER to 15°

What is the MOI for an ACL sprain?

Anterior tibial translation or
posterior femoral translation, Noncontact rotational injuries, or Hyperextension

What are S&S of an ACL sprain?

hearing or feeling “Pop”, immediate function loss & swelling within 4-6 hours

What is the special test for a osteochondral lesion?

Wilsons

What are special tests for meniscal tears?

McMurrays
Apley’s
Thessaly

What are the purposes of the patella?

Increase mechanical efficiency
Anterior protection
Absorption & transmission of joint foreces

What are the planes of the patella?

Frontal & sagittal: Triangular
Frontal: superior portion is wider
Sagittal: Anterior, non-articulating, narrower posterior surface

What are the patella articulations?

Medial, lateral, odd
Medial & lateral have superior, middle & inferior facts
Odd facet has no articulation support

What is the patella ROM?

Medially: 45-18° into ext
Laterally: 18-0° into ext

Where is the lateral retinaculum?

Over the vastus lateralis & IT band

Where is the medial retinaculum?

Over the vastus medialis & adductor magnus

What is the primary patella lateral mover?

Vastus lateralis

What is the vastus lateralis supported by?

IT band

What movement does the vastus medialis oblique produce on the patella?

Medial & proximal gliding

What is the risk of decreased quad vs hamstring strength?

Patellofemoral risk

What do tight calves increase the risk of?

Decreased dorsi = increased pronation → Hip IR & medial patella tracking

What does a medial patella position cause?

Increased q-angle & lateral force

Where are the 4 bursae of the knee?

Suprapatella
Prepatellar
Subcutaneous infrapatellar
Deep infrapatellar

What are acute MOI’s for patellofemoral?

Contusions
FX’s
Strains
Subluxation/dislocation

what is movie goers sign?

After sitting for a while, getting up the anterior knee is swollen

What is the true leg length?

ASIS to medial malleolus

What is a functional leg length?

Belly button to medial malleolus

What is a J-sign?

A superior/lateral glide of the patella during extension

What is the MOI for a PCL sprain?

posterior tibial translation, landing on anterior tibia with knee flexed, or landing on dorsiflexed ankle

What are the S&S for a PCL sprain?

may be asymptomatic, popliteal fossa pain & tenderness, & effusion develops over time

What is the ROM for a PCL sprain?

—
MMT: Quad strength decrease in chronic patients

What is the MOI for a posterolateral corner injury?

Hyperextension & varus, & Hyperextension & external tibial rotation

What are S&S of a posterolateral corner injury?

“Knee instability”, localized pain, giving way, rapid non-contained edema

What is a positive test for clarkes sign?

Feeling of crunchiness, hurts

What is a positive apprehension test?

Guarding, verbal or non verbal apprehensiopn
Medial patellar retinaculum laxity

What is a positive medial synovial plica test?

Symptom reproduction
Plica palpation on medial femoral condyle from 60-45°

What is a positive stutter test?

Irregular motion between 40-60°
Medial plica syndrome

What are the S&S of patellofemoral pain syndrome?

pain w/ stairs “movie goers”
“giving out” & “clicking:

What are the observations for patellofemoral pain syndrome?

End ranges increase pain
Point tenderness along medial retinaculum
MMT: weak quads, abductors, hip er

What are the special tests for patellofemoral pain syndrome?

Glides

What are the MOI for acute patellar disloctions?

Valgus blow
tensile stress

What are the S&S for acute patellar dislocaions?

Large blood effusion
Deformity
Point tenderness & pain at MPFL, med retinaculum, VMO
cannot perform ROM

What are the special tests for acute patellar dislocations?

Apprehension to R/O major ligament involvement

What are the MOI for patellar subluxation?

Change of direction
Eccentric contraction

What are the S&S of a patellar subluxation?

Medial capsule pain
“giving out”

What are the ROM of a patellar subluxation?

pain between 0-30°
MMT: weak hip abd & Er

What are the special tests for uniplanar medial instability?

Valgus test

What are the special tests for uniplanar lateral instability?

Varus test

What are the special tests for multiplanar anteriolateral instability?

Slocum drawer
Crossover
Flexion/rotation drawer
Pivot shift

What are the special tests for multiplanar anteriormedial instability?

Crossover
Anterior drawer
Slocum drawer w/ ER to 15°

What are the special tests for multiplanar posteriolateral instability?

Posteriolateral drawer
Reverse pivot shift
Dynamic posterior shift
External rotation recurvatum test

What are the special tests for multiplanar posteriomedial instability?

Posteriomedial drawer
Lachman
Pivot shift

What are S&S of “hoffa’s disease”?

Pain on either side of patellar tendon
Symptomatic hamstring spasm
Reduced knee extension
Limited ROM

What is patellofemoral bursitis?

Inflammation of the bursa

What bursae is effect by direct trauma to the knee?

Superficial Prepatellar
Subcutaneous Infrapatellar

What bursae is effect by overuse?

Suprapatellar
Deep Infrapatella

What are S&S of patellofemoral bursitis?

Pn localized to bursa
point tenderness

What is the ROM for patellfemoral bursitis?

Pn at specific points
MMT: quad weakness

What is a plica?

An extra fold in the synovial membrane

What are the MOIs for a synovial plica?

Direct blow
Overuse

What are the S&S of a synovial plica?

Anterior knee pain
“Giving way”
Worse in the morning
Swelling over plica

What is the ROM for a synovial plica?

Pain & “catching”
MMT: quad weakness

What are the MOIs for a patellar fracture?

Rapid flexion
Acute blow

What are the S&S for a patellar fracture?

Edema
Deformity
Point tenderness

What is the ROM for a patellar fracture?

Extension lag
Limited flexion
Decreased quad strength

What are the predisposing factors for a patellar tendon rupture?

Rheumatoid arthritis
Diabetes
Lupus
Steroids

What are the MOIs for a patellar tendon rupture?

Extensor mechanism overload
Hyperflexion