MS 1 knee 4
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locking/buckling in knees is a sign of...?
- meniscal tears
- this'll happen on stairs, causing instability and falls
two biggest causes for problems in knees
trauma and OA
swelling in knee happens in what structures?
what to do if pt complains of swelling?
- bursae, infrapatellar fat pad, popliteal fossa
- first - palpate, then- measure
LEFS (lower extremity functional scale) what kind of test?
self reporting scale for hip, knee, and ankle
World Scale basic format
just 2 qs about whether the pt is better or worse than at 1st visit
KOOS scale - stands for?
- knee injury and osteoarthritis outcome scale
- is't a slef-reported scale
Ottawa Knee rules - idea and 6 q's
used for determining the necessity of ordering an x-ray
- is pt > 55
- tenderness over fibular head
- isolated tendernes over patella
- unable to flex to 90 degrees
- unable to wt bear immediately and in ER
- is tapping the bone exquisitely painful?
this class's numbers for how much flexion you need for tying your shoes, sitting, up stairs, down stairs, swing gait
- tie: 106
- up stairs: 83
- down stairs: 90
- swing gait: 67
q-angle is made by the intersection of what lines? normal numbers?
- from ASIS to middle of patella
- from middle of patella to tibial tuberosity
how do pronated feet affect the Q angle?
why you have to palpate edema
- it could be one sided atropy or callus formation making it look like edema
- be careful to write WHY there's a diff in girth
rule #1 about palpation
pes answerine is where?
med knee distal to tibial plateau
how to palpate the trochlear groove of the femur
flex knee 30 degrees - this gets patella out of the way w/o making quad tendon tight
the tg is in the ant distal femur - where the patella rests
- look for ER of tibia as leg extends
- if this doesn't happen, there's a block stopping the tibia from rotating
in active movement testing you want what degrees of flex and ext?
- flex: 135
- ext: 0, or -5 to -10 (a bit of hyper ext)
diff btwn hyperext and genu recurvatum
- hyperext is the ability to get knee past 0 (most of us get 5-10 past)
- genu recurvatum is when you stand in this position or get into it on a regular basis
endfeels of flex, ext, and IR/ER
- flex: soft
- ext: firm
- IR/ER: capsular (firm and abrupt)
position for testing end feel of IR/ER
- supine, nkee flexed, ankle on table
- have her rotate foot w yr hands on sup knee and sup tibia
position for doing resisted mvmnt testing for knee
- put pt in resting pos of 25-40 degrees flexion
- resist flex and ext
- however, the break test here doesn't give a ton of info, so it's best to have pt go thru the range
position of knee for valgus stress test
- full extension but not hyper ext
- then repeat stress w knee slightly flexed
structures involved w supporting knee in extension, in order of support
- posteromedial capsule
- medial quadriceps expansion
- semimembranosus muscle
predictor variables for MCL tear
- history of external force to leg
- rotational trauma
- pain and laxity w valgus stress
posterior oblique ligament
upper margin of the intercondyloid fossa and posterior surface of the femur close to articular margins of the condyles, --> posterior margin of the head of the tibia
to test for instab of MCL, hand placement
- stabilizing hand: sup to joint on distal lat femur, with a finger on the knee joint to feel for movement - can angle elbow into yr waist
- moving hand: on distal fibula
what not to do in MCL instability test
- don't add ER to tibia
- don't rotate hip
varus stress test (testing primarily the LCL)
- support the knee and press on the ankle as in the MCL test
- should have less movement than did the valgus test
- note: when we put knee in flexion we get rid of the screw home mechanism
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