Prac Vivva

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  1. Dont forget pt history
  2. What are we observing when we look at a knee pt?
    • - begins when pt walks in the door
    • deformities:
    • - genu varum- bowed legs
    • - genu valgum- when knees face each other
    • - genu recurvatum- hyper extension
    • - fixed flexion deformity
    • Swelling
    • - synovial effusion bulges into the suprapatellar area
    • - swelling from prepatellar bursitis, sits forward over the anterior aspect of the patella
    • - swelling with meniscal cysts is best seen at 45 degrees flexion over the lateral jt line
    • - osgood- schlatters produces swelling over tibial tubercle mm wasting
    • - the wasting of the quads- compare each leg
    • - will waste quickly
    • - pain will inhibit quads
    • - adductors wastes and legs will take on a swoop appearence
  3. Conduct a general palpation of your pt with a sore knee
    • - not looking for a certain thing
    • - heat-knees are generally cooler
    • - swelling
    • - crepitus
  4. What are the active movements would you get your knee pt to do?
    • - functional movment- forwards and backwards squats
    • - flex- active- ext (not total ext), flex to ext, rot
    • - ext
    • - axial rot in flex and ext (have more internal)
    • - quad leg
  5. Anatomy of the knee
    Image Upload
  6. Conduct passive movements on your pt with knee problems?
    • Hyperflexion- lift foot- boney end feel
    • Flexion- on belly, rec fem on stretch- passive flexion gets youfurther in range
    • - hamstring length- dont bend the knee- so ressure is off the knee, push knee into ext
    • - axial rotation- seure knee rot at tibia/ fibula 1/2 way down. In supine and sitting
    • - ankle inverson/ eversion for sup tib/fib- fingers hold head of fib- invert/ evert. Evert- superior, inverts- drops down.
  7. Perform a tibiofemoral PA
    • Grade 1-2
    • 1.Supine, towel under leg putting into slight flexion
    • 2.Form a bridge with the index finger and thumb and come underneath the Joint line
    • 3.The movement should be small enough so that the whole leg is not moved (you aren’t going into resistance with this)

    • Grade 3-4
    • 1. pt is prone
    • 2. towel under thigh
    • 3. Flex the knee up and have the towel resting on your thigh
    • 4. thenar eminence is placed either side of the tibia
  8. Perform tibiofemoral AP on ur pts knee
    • Accessory movement for ext of the knee
    • Grade 1-2
    • 1. Pt put into slight flex, but putting a towe above the jt
    • 2. create a v with your index finger and thumb and place over the tibia
    • 3. use second hand to do the same and support
    • 4. Push in an AP direction (lines of mobilisation should be perendicular to the jt line)
    • Grades 3-4
    • 1. Same as above except knee is in about 90 degrees flexion (to take the slack off so you are further into resistance)
    • 2. Sit on their foot to support
  9. Perform treatment/ assessment using the accessory movement Tibiofemoral longitudinal caudad movement for ur knee pt
    • Used for a pt who cannot flex, doesnt respond well to AP/PA movement
    • Grades 1-2
    • 1. Not a strong movement
    • 2. Knee slightly flexed
    • 3. Put thenar eminence over tibia/fibular
    • Grade 3-4
    • 1. pt sitting leg over plinth
    • 2. perform same caudad movement
    • 3. Or pull down from ankle where you can get more leverage from the bone
    • of the ankle
  10. Perform a superior tibiofibular AP
    • - full range get a response?
    • 1. pt supine
    • 2. palpate head of fib
    • 3. thenar eminence on front of fibula
    • 4. stabilise the tibia distally
    • 5. move AP direction
  11. Perform a superior tibiofibular jt PA
    • 1. pt prone
    • 2. flex the knee up and have the leg resting againt your thigh
    • 3. palpate head of fib and place the thenar eminece over it
    • 4. push down in direction of PA
  12. Do the accessory movementf of the patellofemoral jt
    • Cup with both hands and move together
    • - transverse glides medial and lateral
    • - caudad
    • - cephalad
  13. Conduct specific palpations of the knee
    • - tibiofemoral jt lines
    • - medial collateral ligaments- usualy sprain-easy to find at jt lines
    • - lateral collateral ligaments- anteriorly tears @ proximal end
    • - inferior pole of patella
    • - head of fibular
  14. Assess the effusion of the knee: large
    • Large effusion:
    • 1. place index finger and thumb of theright hand on opposites sides of patellar
    • 2. place the left placed over the suprpatellar pouch (superior border of patellar) to squeeze the fluid distally
    • 3. if effusion is present the finger and thumb are separated further
  15. Assessment of effusion
    • Bulge sign:
    • 1. stroke up along themedial compartment of the knee, moving any fluid up into the suprapatellar pouch
    • 2. hold the fluid there with other hand whilst you move the first hand down over the medial compartmen
    • 3. slide the fluid down from the suprapatellar pouch, forces the fluid distally where is can be seen to bulge outward
    • Image Upload
  16. Perfrom a medial collateral ligament test
    • 1. Supine
    • 2. Ankle supported on iliac crest and the elbow
    • 3. kne flexed to 30* (when jt capsule is most lax)
    • 4. Index finger on medial jt line
    • 5. Other hand on lateral aspect of knee jt, wrist flexed back/ supinated, elbow out
    • 6. apply a valgus force by pushing the hand on the outside of the knee and rotating your trunck in the same direction
    • 7. results in medail gapping of the tibia on the femur
    • 8. repeat in an extended position
  17. Perform a lateral collateral ligament test
    • 1. Supine
    • 2. Reverse the hand position from the medial collateral ligament test
    • 3. Apply varum stress in 30* flexion
  18. Perform a special test- Anterior cruciate ligament test: Anterior draw test?
    • - ant cruciate ligament stops the tibia from coming forward
    • 1. supine
    • 2. knee flex to 90*
    • 3. Sit on pts foot to stabilise tibia and keep the hamstring mm relaxed (so they dont try and activate their mm to protect the knee)
    • 4. Put fingers around the back of the proximal tibia with the thumbs over the plateau of the tibia
    • 5. Pull the tibia forward in a quick motion
    • 6. Thetest is positive if the anterior displacement exceeds 6mm. Note the end feel
    • 7. If there is excessive movement it may be a capsular tear (posterolateral/posteromedial)
  19. Perform a special test- Anterior cruciate ligament test: Lachman's test
    • 1. knee flexed to 20* (all three band are under the least amount of tension) place towel under hamstrings
    • 2. One hand stabilises the femur
    • 3. Other hand under the proximal tibia
    • 4. Tibia is passively translate anteriorly
    • 5. Negative test = firm end feel
    • 6. Positive test is ant translation and a mushy, boggy end feel

    (positive on both ant draw tests- full rupture. Anterior draw is ositive, lachmans normal = partial tear)
  20. Perform the special test posterior cruciate ligament test
    • Posterior sag test
    • 1. Supine
    • 2. Knee flexed to 90* and hip to 45*
    • 3. Foot resting on a stool on the bed
    • 4. Observe the position of the patella and the tubercle from the side
    • 5. If the PCL is torn, the tibia will be displaced posterior on the femur
  21. Perform Meniscal testing
    • Apleys grind test
    • compression of menisci and rotating the tibia- looking to redevelop the pts pain
    • 1. Prone, towel under knee, knee flexed to 90*
    • 2 Apply downward pressure on the tibia/ top of foot, rotate the lower leg int and ext
    • 3. Repeat tibial rot with distraction. Place knee on distal femur to stabilse
    • 4. If you get a positive apleys test and no pain with distraction and rot= menisci problem
    • 5. If you get a positive apleys and pain on distraction = capsular pattern
    • 6. Pain on IR= lateral menisci
    • Pain on ER = medial menisci
  22. Perfrom meniscal testing- Mcmurrays test
    • Good test- limit is you need full range of flex
    • - nearly full range of flexion must be present to perform Mcmurrays test
    • - supine
    • - knee fully flexed
    • - for medial meniscus- lower leg is ext rot and abducted- maintain this position forcefully and ext the knee
    • - for lateral meniscus- lower leg is internally rotated- maintian this position forcefully and extend knee
    • - provocation of a painful area and a palpable click indicate a positive test

    Ext6 with both in ER
  23. What are the passive physiological of the knee?
    • - ext/ abd
    • - ext
    • - flex/ abd
    • - flex/ add
    • - patella apprehension
  24. Perform a passive physiological ext/ abd
    • - physio stands by pts ankle, facing towards their hip
    • - physio rests far knee and lower leg on bed at right angles to the ts leg, supporting the pts heel on the thigh adj to the ASIS
    • - one hand supports the knee by placing around the medial condyle of the tibia posteromedially, and the thenar eminence covers it anteromedially
    • - heel of other hadn directly over lateral jt line with forearm at right angles to femur and tibia

    • - for grade 3 movement, pt knee is raised and lowered through a range of approx 15cm by the physio's hands
    • - constant pressure is maintained against lateral surface of the knee

    - for grade IV+ physio stands by the pts knee, holds under the hel from the lateral side, other hand anteromedially over the jt line of the knee, apply controlled, firm small amplitude ext, ab movement. Scoops @ end range
  25. Perform the passive physiological ext/ add
    • physio stands by pts ankle, facing towards their hip
    • - physio rests far knee and lower leg on bed at right angles to the ts leg, supporting the pts heel on the thigh adj to the ASIS
    • - one hand supports the knee by placing around the medial condyle of the tibia posteromedially, and the thenar eminence covers it anteromedially
    • - heel of other hand directly over lateral jt line with forearm at right angles to femur and tibia
    • - take leg into an ext/ add direction
    • - physios forearm applies pressure to the medial jt line at right angles
    • - taking hand down into ext, hand over medial side- push knee then take into ext
  26. Perform the passive physioogical of the knee ext
    • - physio stands by pts thigh and kneels on bed to support distal end of pts femur and proximal tibia
    • - with both hands, hold around the pts lower leg from behind
    • - elbow should be at the inside of the knee so that the axis of the arm will coincide with the axis of the knee movement

    • Method:
    • - used for grade 3 movements- amplitude around 30*- physio raises and lowers the leg through the arc of movement using their arms
  27. Conduct the passive physiological flex/abd
    • - physio standing beside pt knee
    • - flex the hip to 90* and fully flex knee
    • - support the knee with the far hand
    • - grasp anteriorly around the ankle with the other hand so that fingers can push laterally against the medial surface of the cancaneus posteriorly and thumb around lateral malleolus to fully rotate the tibia

    • Method:
    • - oscillate in a diagonal movement into flex abduction while maintaining medial rot
    • -heel should be lateral to the ischial tuberosity
  28. Perform the passive physiological flex/ add
    • - identical to flex/ abduction except that strong lateral rotation of thetibia is maintained throughout the diagonal mveoment of flexion adduction
    • - starting position changes so the fingers are wrapped around the pts medial malleolus while the thumb and MCP 2 apply pressure in a posterior direction from the anterior surface of the tibia
    • - pts heel is directed medially towards their ischial tuberosity
  29. Perform a patella apprehension test on your pts knee
    • - pts knee 30*
    • - apply pressure to the medial aspect of the patella
    • - asses degress of hypermobility as patella slips over the lateral femoral condyle
    • - as pts begins to feel the patella sublux laterally, they actively resist further movement by activating quads
    • - patella glides laterally
    • - +ve test- pt says no, locks quads or rolls over
  30. How do you assess the recrvatm?
    • - pt supine
    • - pick up big toe- see if knee goes into hyperext
  31. What causes fast swelling of the knee
    • - ACL
    • - Patella dislocation
    • - condyle fracture
  32. What are meniscal cysts- cysts form tears
    Why get pt to walk backwards? Pts will exaggerate problem
Card Set:
Prac Vivva
2012-06-01 23:28:56

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