MS 1 knee 6

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  1. bounce home test - evaluates what?
    meniscal tear
  2. bounce home test - how?
    • pt supine and relaxed/distracted, else quads or hamstrings will restrict mvmnt
    • PT hold up calf so knee is in resting pos
    • then pull it out suddenly into ext
    • look for a failure to bounce or for pain
  3. Apley's test - evaluates for what?
    meniscal or collateral lig tear
  4. Apley's test - how to test for ligamentous injury
    • pt prone, knee bent to 90 degrees
    • distract up towards ceiling w med/lat rot  - if painful it's a sign of ligamentous injury

    (apply compression force w tibial IR/ER - if painful it's a sign of meniscal damage)
  5. apley's test - how to test for meniscal damage
    • pt prone, knee bent to 90 degrees
    • apply compression force w tibial IR/ER - if painful it's a sign of meniscal damage
    • it's ok to press thru the calcaneous here bc the ankle joint will be stable enough (unless there's some injury to it)

    (distract up towards ceiling w med/lat rot  - if painful it's a sign of ligamentous injury)
  6. predictor variales for knee effuion
    • self-noticed knee swelling
    • postive ballottement test
    • standard reference MRI w intra articular fluid within suprapatellar, med, and lat compartment
  7. ballotable patella test aka patella tap test
    • pt supine, knee extended, push down on patella
    • if there's excess fluid it'll push to the side, and then when it comes back under the patella it'll cause the patella to rebound up
  8. wipe test
    • used for minor effusion in infrapatellar fat pad
    • put 2 thumbs on one side of knee and 2 indexes on the other
    • push on med or lat side and feel fluid shift to other side
  9. indentation test
    • observe outline of patella lig in extension
    • flex knee, and see if contour disappears (it will if there's effusion)
  10. how to move the patella to pluck plica
    • move it med to pluck the med plica
    • move it lat to pluck the lat plica

    the plica test is just to see if there's pain when the patella is displaced or when you pluck
  11. Clarke's test diagnoses what, what nickname?
    • patellofemoral dysfunction or chondromalacia
    • patella grind test
  12. Clarke's test - how?
    • extend leg, compress patella w palm
    • if not provacative enough, ask pt to contract quads
  13. patella stability test - how much should patella move?
    • 1/3 its width
    • if retinaculum is tight it'll move less
  14. Fairbank's test - apprehension test for patella dislocation
    • supine, knee in resting pos
    • gently push the patella laterally
    • test is pos if pt feels like patella is going to dislocate and abruptly contracts the quads (displays apprehension)
  15. Waldron test - tests for what?
    patello-femoral arthritis
  16. Waldron test - how?
    • pt performs several deep knee bends slowly (single leg if possible)
    • compress patella while pt squats to 90
    • mod degree specificity
    • low-mod degree sensitivity
    • you're looking for pain or crepitus
  17. patella mobility testing - directions and holds
    • inf, sup, med, lat glides: put thumbs on one side of patella, indexes on other, and push gently
    • distraction: use a hook graps or a junior plunger to pull it ant
    • perform w knee a bit bent
  18. pt body and PT hand pos for tibial distraction testing
    sitting, knee in resing pos, stabilize femur on table, hand around malleoli to mobilize tibia in longitudinal direction

    • optional pos - pt prone, PT holding down the distal femur and pulling on the malleoli - stand in a lunge so you can use body wt
    • pt's knee is flexed to end of range for treatment
  19. anterior glide of tibia - pt positioning
    • pt supine, knee flexed to 90 (or less if knee doesn't go that far)
    • PT's handson post prox tibia, pulling anteriorly
  20. anterior glide of tibia is good when ___ is restricted

    since ps are usually restricted closer to 0, though you may start this in 90 degrees flexion, proceed towards 0 
  21. distracting the tibia, cool tool for this
    • the strap - fastens to pt's ankle, so you can just press into the lower strap w your foot
    • put fingers at joint line to feel the distraction
    • this is for tx, not for testing - do it sustained or ossilating
  22. posterior glide of tibia fascilitates what?
  23. how to do post glide of tibia
    • pt supine, knee flexed to 90 degrees
    • mobilizing hands on ant prox tibia pressing post

    if flexion is limited, increase the angle to chase the anatomical limit
  24. piccolo distractions
    • tiny distractions that help bones/cartilage not to rub
    • makes gliding easier
    • use these when doing tibial distractions (for tx, not for testing)
    • beware of pulling too much - you'll stretch the capsule in the distraction so it won't have any give left for the glide
    • easy method - clamp your thighs around the calf and let gravity pull down a little
    • can also use strap
  25. going from ant to post tibial glide
    • don't do it in one mvmnt - don't vacillate
    • it's ok to hit both in one session, but don't swing from one dir to the other - just return to neutral
  26. lat and med glide of tibia positioning
    • pt sitting, knee in resting pos hanging off side of table
    • PT stabilize distal lat femur
    • mobilizing hand on prox med tibia, pressing lat
    • reverse pos for med glide

    • can do in sidelying, but it's a hassle - for lat mob, treat lower leg with it hanging off the table past the knee
    • for med mob, prop upper leg on a hard 1/2 foam roll
  27. tx for hypmobile knee for end range ext
    dorsal glide of femur
  28. how to do dorsal glide of femur to help end range ext
    • pt supine, knee close to end of range
    • stabilize prox ant tibia, mobilized distal ant femur, pressing it down into table
    • have a towle under the calf
  29. a nice diagnostic thing about meniscal and ligament lesions in the knee
    pretty localized pain - it'll hurt where the tear is
  30. refered pain to the knee
    • front gets L2,3,4,5 segments
    • post gets S1, 2, 3
    • disorders of the knee seldome refer pain posteriorly unless it's post bursitis of a cyst - most knee pain goes ant, med, or lat
  31. predictor variables for OA of the knee (if you have > 3 you prob have OA)
    • age > 50
    • morning stiffness < 30 min
    • crepitus w active motion
    • bony tenderness
    • bony enlargement
    • no palpable warmth (bc OA isn't an inflam response - RA is)

    but, of course, the gold standard for diagnosing OA is the x-ray
  32. forces pulling the patella latterally
    • lateral retinaculum
    • vastus lateralis
    • ITB
  33. forces pullig patella medially
    • medial retinaculum
    • vastus medialis oblique

    tightness to one side --> uneven wer on post/inf patella
  34. 6 factors affecing patella alignment
    • increaed Q angle - pulls lat
    • tight lat structures
    • tight gastroc and hamstrings
    • excessive pronato
    • patella alta
    • VMO insufficiency
  35. in patella orientation, what is glide? how do you look for it?
    • med/lat translation of patella
    • pt supine, PT looking at patella from above
  36. in patella orientation, what is tilt? how do you look for it?
    • tilting to med or lat side (raising up on opp side)
    • look at from below, looking at the med/lat sides compared to frontal plane - first view it passively, then ask pt to flex quads
  37. in patella orientation, what is rotation? how do you look for it?
    • like a steering wheel
    • look at from the front
  38. in patella orientation, what is anteroposterior? how do you look for it?
    • rel of sup/inf pole to frontal plane (it's like a vertical tilt)
    • look at laterally
    • if the inf pole is dipped down it's "posterior"
    • seen w pain on hyperext
  39. external rot in the patella
    inf pole moves laterally
  40. 3 tx of patellofemoral pain
    • stretch tight lateral structures (by gliding atella, stretching ITB, etc)
    • patient self-stretch
    • passively position w tape to maintain position (give it a 3 day trial, coming off at night, and if it helps have pt buy a roll of liner and a roll of tape)
  41. woman responsible for patella taping
    Jenny McConnell
  42. VMO training sequence
    • sitting: w foot on floor try to activate quad - use biofeedback to see contractions
    • standing stance: w knees flexed a little
    • shallow knee bends
    • steps: eccentric step-downs
    • gait
    • sport specific activity
    • HEP
  43. training the VMO - never do __, and the progression of what to increase
    never train thru pain - the more you hurt the knee the more inhibited it and the quad will be

    • Progression:
    • increase load
    • increase endurance
    • increase step size (a lot of eccentric controlled step downs, slowly increasing the height)
    • increase speed

    train conc and ecc
  44. weaning off taping
    • initially wear every day for 2 weeks, removing tape at night
    • when VMOcomes in w stepdowns for one minut reduce to taping every 2nd day for a week then every 3rd day
    • eventually only tape for sports activities

    taping - she taped Bridget - use the tape to pull the patella into proper alignment, reducing angling, rotation, whatever the problem may be
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MS 1 knee 6
2012-10-20 16:08:42
MS knee

MS 1 knee 6
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