AT301_10

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Author:
itzlinds
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249701
Filename:
AT301_10
Updated:
2013-12-02 22:58:47
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Knee pathologies
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knee pathologies
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  1. a bony ridge spanning the length of the shaft of the femur's posterior aspect is called:
    linea aspera
  2. convex structures of the femur covered with articular hyaline cartilage that articulate with the tibia via the menisci are called:

    which is longer:
    • the medial and lateral condyles
    • longer: medial condyle, flares outward posteriorly
  3. the condyles of the femur share a common anterior surface, then diverge posteriorly, separated by:
    intercondylar notch
  4. an anterior depression through which the patella glides as the knee flexes and extends is called:
    femoral trochlea
  5. what are the fxns of the medial and lateral epicondyle and the adductor tubercle:
    • attachment sites for tendons
    • improve the mechanical advantage of the muscle
  6. how does the medial tibial plateau compare to the lateral plateau:
    The medial tibial plateau is 50% larger than the lateral plateau to accomadate for the flare of the femur's medial condyle
  7. the site of the patellar tendon's distal attachment, located on the proximal portion of the anterior tibia is called:
    tibial tuberosity
  8. what type of bone is the patella:
    sesamoid bone
  9. what are the 3 fxn of the patella:
    • improves the fxn of the quadriceps during knee extension
    • dissipates the foreces received from the extensor mechanim
    • protects the anterior portion of the knee
  10. describe the deep and superficial layers of the MCL:
    • deep: thickening of the joint capsule and is attached to the medial meniscus
    • superficial: arises from the borad band just below the adductor tubecle, follows a path deep to the pes anserine tendons
  11. which types of forces does the MCL resist:
    secondary restraint against:
    • MCL resists: valgus forces
    • secondary restraint:  external rotation
  12. list the origin of the LCL:
    list the insertion of the LCL:
    origin: on the lateral femoral epicondyles and inserts: proximal aspect of the fibular head
  13. which types of forces does the LCL resist:
    primary restraint against:
    secondar restrain against:
    • LCL resists: varus forces
    • primary restraint against: external rotation:
    • secondary restraint againse: internal rotation
  14. list the 4 motions that the ACL serves as a static stablilizer againse:
    • anterior translation of the tibia on the femur
    • internal rotation of the tibia on the femur
    • external rotation of the tibia on the femur
    • hyperextension of the tibiofemoral joint
  15. list the 2 discrete segments of the ACL:

    what are the position in which each of these segements are "taut":
    • anteromedial bundle
    • taut when the knee is fully flexed

    • posterolateral bundle
    • tight when the knee is fully extended
  16. which position places the most strain on the ACL:
    active open chain knee extension: the pull of the quadriceps translates the tibal anteriorly the amount of strain is greatest  between 0 and 30 degrees of flexion
  17. how is the PCL different from the ACL:
    PCL is stronger and 120 to 150% wider than the ACL
  18. list the 2 compartments of the PCL:

    what are the position in which each of these segments are "taut"
    • anterolateal
    • taut when the knee is flexed
    • loosens when the knee is extended

    • posteromedial
    • tightens when the knee is extened
    • lax when the knee is flexed
  19. when the knee is near extension, the primary restraint against posterior displacement of the tibia on the femur is obtained from the:
    poplitus
  20. the integrity of this structure's individual elements can be distrupted with relatively little joint instability, however if multiple structures are disrupted, profound instability can result:
    posterolateral complex (PLC)
  21. a Y shaped strcutre with origins from the tibia and fibula and inserting on the femur is called:

    list the 3 forces this structures resist:
    popliteofibular ligament

    • 3 forces this structures resists
    • posterior translation
    • varus forces
    • external rotation
  22. the structure found within the posterolateral corner contains the popliteus muscle and its tendons called:
    the popliteus complex

    also contains: popliteofibular ligament, popliteotibial fasicle, and the popleteomeniscal fascicles
  23. arising from the fibular head, this ligament passes over the popliteus muscle, where it diverges into the intercondyler area of the tibia and posterior aspect of the femur's lateral epicondyle is called:

    fxn:
    • arcuate ligament
    • fxn: assists in controlling posterolateral rotary instabililty.
  24. a relavively immobile joint where the proximal tibia and fibula are bound together by ligaments is called:

    list the ligaments:
    proximal tibiofibular syndesmosis

    • ligaments
    • superior anterior tibiofibular
    • posterior tibiofibular
  25. what is the purpose of the wedge shape of the menisci, with their outer borders thicker than their inner rims:
    creates a concave area on the tibia to accept the femur's articulating surfaces
  26. the narrow outer rim and the anterior and posterior horns of the menisci is called the:
    vascular (red) zone
  27. the inner portion of the meniscus is called:
    avascular (white) zone
  28. a thin, lightly vascular portion of the menisci between the red and white zone is called:
    the pink zone
  29. what is the difference between the vascular and avascular zones of the menisci:
    the vascular zones have an improved chance of healing compared to tears in the avascular zone, which rely on nutrient being delivered through the synovial fluid
  30. what is the fxn of the vastus medialis oblique (VMO):
    guides the patella medially during knee extension
  31. which muscle is responsible for unscrewing the knee from its locked position in extension is the:
    popliteus muscle
  32. list the structures contained in the popliteal fossa:
    • popliteal artery and vein
    • the tibial, common peroneal, and posterior femoral cutaneous nerves
    • small saphenous vein
  33. list the muscles that make up the pen anserine muscle group:

    fxn of group with foot is planted:
    fxn of group while foot not planted:
    • gracilis
    • sartorius
    • semitendinosus

    • fxn of group with foot planted: externally rotates the femur on a fixed tibia
    • fxn of group with not planted foot: internally rotates the tibia
  34. an extension of the tensor fasciae latae and the gluteus maximus musclar fascia is called:
    the iliotibial band (IT Band)
  35. the angle b/w the IT band and the tibia varies according to the position of the leg, which in turn, alters the biomechanics...

    when the knee is fully extended:
    when the knee is flexed beyond 30:
    • knee fully extended: IT band is anterior to or, located over, the lateral femoral epicondyle
    • knee flexed beyond 30: the IT band shifts behind the lateral femoral epicondyle, giving it an angle as if it were a knee flexor
  36. list the nerve roots that primarily act on the knee
    • L3
    • L4
    • L5
    • S1
    • S2
  37. list the 4 nerves of the knee:
    • femoral nerve (anteriorly)
    • saphenous nerve (medially)
    • cluneal nerve (posteriorly)
    • sural cutaneous nerve (laterally)
  38. list the 3 arteries of the knee:
    • popliteal artery (sprouts 5 geniculate arteries, 2 superior, 2 inferior, 1 middle)
    • anterior tibial artery
    • lateral femoral circumflex
  39. describe the pain in the following locations during the history of the present condition:

    collateral ligaments:
    ACL:
    PCL:
    vascular zone:
    avascular zone:
    • collateral ligaments: pain directly located in the corresponding area of trauma
    • ACL: "beneath the kneecap", "inside the knee"
    • PCL: mimic strain of the medial or lateral origin of the gastrocnemius
    • vascular zone of menisci: joint line pain
    • avascular zone of menisci: popping, clicking or locking within the knee
  40. true locking, the inability to fully extend the knee indicates which 3 pathologies:
    • unstable meniscal tear
    • subluxation of the posterior horn of the meniscus
    • loose body osterochondral fragment within the joint
  41. where does the patella normal rest within the knee:
    where does the patella normal rest within the knee: femoral trochlea, evenly aligned

    shifting of the patella away from its central position on the trochlea may indicate patellar malalignment or dislocation
  42. a unilateraly high-riding patella, when accompained by spasm of the quadriceps muscle group indicates:
    ruptured patellar tendon
  43. describe genu valgum:

    potential causes:

    consequences:
    • knock knees
    • an angle greater than 185 degress between the medial tibia and femur

    • potential causes
    • degeneration of the medial meniscus
    • structural or acquired hip abnormalities
    • excessive foot pronation

    • consequences
    • increased compressive forces on the medial joint structures
    • increased tensile forces on lateral joint structures
    • increased foot pronation
    • internal tibial rotation
    • medial patellar position
    • internal femoral rotation
  44. describe genu varum:

    potential causes:

    consequences:
    • bowleggs
    • an angle less than 175 degrees between the medial tibia and femur

    • potential causes
    • degeneration of the lateral meniscus
    • strcutural or aquired hip abnormalitites
    • excessive foot supination

    • consequences
    • increased tensile forces on medial joint structures
    • increased compressive forces on the lateral joint structures
    • increased foot supination
    • external tibial rotation
    • lateral patellar position
    • external femoral rotation
  45. a possible enlargement of the tibial tuberosity in adolescent patients could indicate:
    osgood-schlatters
  46. hyperextension is indicated by the posterior bowing of the knee called:

    potential causes:

    consequences:
    genu recurvatum

    • potential causes
    • rupture of the ACL or PCL

    • consequences
    • increased strain on the ACL and/or PCL
    • increased pressure between the patella and femur
  47. swelling within the joint capsule is called:

    the rapid onset of effusion indicates

    chronic effusion:
    swelling within the joint capsule is called: effusion

    • rapid onset of effusion indicates
    • tear of one of the knees major ligaments
    • fx to the knees articular surfaces
    • dislocation of the patella
    • fx tibial plateau
    • osteochondral fx

    • chronic effusion
    • excess synovial fluid such as in arthritic knees
    • mensical tear in the avascular zone
    • chondromalacia patella
  48. swelling outside of the joint capsule is called:

    the slow formation of this swelling indicates:
    swelling outside of the joint capsule is called: extracapsular swelling/edma

    • slow formation indicates
    • meniscal tear
    • inflammatory conditions
    • less significant ligamentous sprain
    • inflammed bursae
    • contusion
  49. list and describe the 2 ways joint effusion can be identified:
    • sweep test
    • the ability to mannually move "milk", the fluid from one side of the knee to the other

    • ballotable patella test
    • effusion can cause the patella to "float" over the femoral trochlea
  50. fx of the articular cartilage and underlying bone that are typically caused by compressive and shear forces are called:

    symptoms are characterized by complaints of:
    osteochondral defects (OCD)

    • characterized by complaints of:
    • diffuse pain within the knee
    • a "locking" sensation
    • knee giving away
    • a "clunking" sensation
  51. the pathology resulting from friction between the IT band and the lateral femoral condyle is called:

    list the 4 modalities of management for this:
    IT band friction syndrome

    • management
    • correct biomechanical issues
    • decrease inflammation
    • proprioceptive exercises
    • strengthening exercises
  52. individuals suffering from this pathology describe pain in the proximal protion of the tendon, immediately posterior to the LCL:

    how is the palpation of this most easily conducted:

    list the 2 modalities of management:
    popliteus tendinopathy

    • palpation
    • the foot of the involved leg is placed on the uninvolved knee
    • this position may produce in and of itself

    • management
    • correct biomechanics
    • decrese inflammation
  53. list the 4 MOI for a tibiofemoral joint dislocation:
    • MOI
    • uniplanar knee hyperextension
    • hyperextension combinded with tibial rotation
    • posterior displacement of the tibial with the knee flexed
    • any extreme force applied across the knee joint line
  54. the potential of permanment disability or loss of leg secondary to trauma to the neurovascular strctures makes this pathology a medical emergency:
    tibiofemoral dislocations
  55. the anterior cruciate ligament (ACL) serves as a static stabilizer against all but which of the follwoing movements:

    A. anterior translation of the tibia on the femur
    B. posterior translation on the femur
    C. hyperextension of the tibiofemoral joint
    D. internal rotation of the tibial on the femur
    B. posterior translation on the femur
    (this multiple choice question has been scrambled)
  56. which of the following is the strongest ligament of the knee and the primary stabilizer?

    A. ACL
    B. posterior cruciate ligament (PCL)
    C. MCL
    D. LCL
    B. PCL
    (this multiple choice question has been scrambled)
  57. what injury is assesd using the noble compression test:

    A. plica
    B. ostochondral defect
    C. IT band syndrome
    D. meniscal injury
    C. IT band syndrome
    (this multiple choice question has been scrambled)
  58. when compared to the goald standard of arthroscopy, which test combines sensitivity and specificity, making it the best examination technique for detecting whether or not an ACL sprain is present?

    A. lachman's test
    B. anterior drawer test
    C. slocum drawer test
    D. quadriceps active test
    A. lachman's test
    (this multiple choice question has been scrambled)
  59. in addition to its intrinsic ligaments, proper fxn of teh knee joint (tibiofemoral articulation) also depends on which 2 things:
    • the stability of the proximal tibiofibular syndesmosis
    • synergistic fxn of the patellofemoral articulation
  60. the shape of the menisci changes the geometry of the knee joint by:
    creating a convex-concave articular relationship
  61. trauma across the knee in a cardinal plane tends to lead to ________________.

    this force, coupled with a rotational force- or an isolated rotaitonal force- can lead to _____________.
    trauma across the knee in a cardinal plane tends to lead to: uniplanar instability

    • this force, coupled with a rotational force- or an isolated rotaitonal force- can lead to: multiplanar (rotational) instability
  62. swelling in the knee joint capsule can inhibit the oblique fibers of ____________.

    emphasis should be placed on controlling and eliminating swelling to avoid _______.
    • swelling in the knee joint capsule can inhibit the oblique fibers of: vastus medialis oblique (VMO)
    • emphasis should be placed on controlling and eliminating swelling to avoid: atrophy of the VMO

  63. a valgus stress test that yeilds a large opending of the medial knee may also involve traume to which 2 structures:
    • anterior cruciate ligament (ACL)
    • and/or
    • posterior cruciate ligament (PCL)
  64. meniscal tears may only be symptomatic when the damaged tissues is in which position:
    a position to be compressed between the tibia and femur
  65. injuries to this structure are complex, and the full extent of laxity often cannot be determined until the patient is anesthetized:
    • posterolateral corner
    • aka: the dark side of the knee
  66. a long term consequence of prior injury to the lower extremity that changes the joint's biomechanics is:
    • arthritis
    • this may also affect the patellofemoral articularion
  67. which will tighten the medial collateral ligament, internal or external rotation:
    external rotation
  68. what type of tissue covers the surface of the femoral condyle?
    articular hyaline cartilage
  69. which of the 4 quad muscles is not palpable?
    vastus intermedius
  70. which two structures insert on the head of the fibula?
    • LCL
    • biceps femoris
  71. describe the position to make the LCL more palpable:
    cross the legs (knee flexed 90 degrees, hip abducted and externally rotated)
  72. where do the biceps femoris, semimembranosus and semitendinosus originate:
    ischial tuberosity
  73. the IT band has attachment to what tendon:
    biceps femoris tendon
  74. what structures form the boundaries of the popliteal fossa:
    • medial and lateral heads of the gastrocneiums
    • biceps femoral (laterally)
    • semitendinosus and semimembranosus (medially)
  75. what structures are tested with an anterior drawer test?

    what does a positive test look like:
    the anterior drawer test for anterior cruciate laxity (ACL)

    • positive test
    • increased amount of anterior tibial translation compared with the opposite limb
    • lack of a firm end point
  76. what structures are tested with the lachman's test:

    what does a positive test look like:
    posterolateral bundle of the ACL

    • positive test
    • increased amount of anterior tibial translation compared with the opposite side
    • lack of a firm end point
  77. what structures are tesed with the posterior drawer test?

    what does a positive test look like:
    PCL instability

    • positive test
    • increased amount of posterior tibial translation compared with the opposite limb
    • lack of a frim end feel
  78. what structures are tested with the godfrey's test:

    what does a positive test look like:
    PCL laxity

    • positive test
    • a unilateral posterior (downward) displacement of the tibial tuberosity
  79. what structures are tested in the valgus stress test:

    what does a positive test look like:
    determines the integrity of medial capsular restraints (MCL) and cruciate ligaments (ACL and PCL)

    • positive test
    • increased laxity, decreased quality of the end-point compared to the uninvolved
  80. what structures are tested in the varus stress test:

    what does a positive test look like:
    determines the integrity of the lateral capuslar restraints (LCL)

    • positive test
    • increased laxity
    • decreased quality of the end point compared to the uninvolved limb
  81. what structures are tested in the proximal tibiofibular translation test?

    what does a positive test look like:
    anterior/posterior stability of the fibular head

    • positive test
    • perceived hyper or hypomobility of the fibula on the tibia compared with the uninvolved side
  82. what structures does the slocum drawer test for?

    what does a positive test look like:
    • isolates either the anteromedial or anterolateral joint capsule
    • internally rotation checks:  anterolateral rotatary instability
    • externally rotation checks: anteromedial rotatary instability

    • positive test
    • increased anterior tibial translation compared with the opposite side
  83. what structures does the crossover test, test for?

    what does a positive test look like?
    determines the presence of anterolateral rotatory instability

    • positive test
    • patients reports pain, instability, apprehension
  84. used the evaulate the ALRI, which test duplicates the anterior subluxation and reduction that occurs during fxnal activities in ACL-deficient knees:

    what does a positive test look like:
    lateral pivot shift

    • positive test
    • tibia's position on the femur reduces as the leg is flexed in the range 30-40 degrees
  85. what test is used to identify grade II and III PCL tears?

    what does a positive test look like?
    quadriceps active test

    • positive test
    • anterior translation of the tibia on the femur
  86. what are the 3 injuries of o'donohue's triad resulting from anteromedial rotary instability (AMRI):
    • ACL
    • MCL
    • medial meniscus
  87. which test aims to impinge the meniscus, especially the posterior horns, between the tibia and femur:

    what does a positive test look like:
    McMurrary's test

    • positive test
    • a popping or clicking, or locking of the knee; pain emanating from the menisci; or a sensation similar to that experienced during ambulation

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