quiz #3 – Knee

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quiz #3 – Knee
2011-04-03 12:18:01

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  1. Knee Rehab Must
  2. get rid of swelling ASAP ----_____ method?
  3. what will contribute to a contracture at the knee
    putting pillows underneath the knee
  4. true or false – physical therapist want knee extension as soon as possible
    • true
    • Quad sets, straight leg raises TKE, stretch gastroc, soleus, walk backwards, femur dorsal glides, patellar mobs
  5. true or false – physical therapist want to get to 90° as soon as possible
    • true
    • heel slides, knee flexion stretch, prone knee bands, table/stool scoots, bike, tibial dorsal mobs, CMP
  6. true or false – it is important to look above and below the knee
  7. normal gait mechanics
    • motion before strength – precursor to all other ambulatory movements
    • no pain, no limp, match assistive devices
    • want to be functional in all three planes
  8. balance/proprioceptive training
    • want to work in all three planes
    • multiple moving parts – arm and leg drivers, works balance or static leg
  9. exercise progression
    • if no soreness from last visit, modify exercises by one variable
    • if soreness is present but gone after warm-up, stay put
    • if soreness remains, increased swelling, backoff progression
  10. range of motion norms for ADLs
  11. normal gait and stairs
    2 – 70°
  12. rising from seated position
    93° flexion
  13. tying shoelace
    106° flexion
  14. taking a bath
    135° flexion
  15. Ligaments of the Knee
  16. anterior cruciate ligament
    • primary restraint to anterior tibial translation
    • Lockman's test; test only the integrity of ACL
    • anterior drawer – shows integrity of all other ligaments capsule – rotate feet to look at other ligaments
    • pivot shift – strictly anterior lateral rotary instability (ALRI)
  17. posterior cruciate ligament
    • prevents posterior tibial translation – twice as strong as ACL
    • posterior drawer test
  18. medial collateral ligament
    • valgus restraint
    • grades I, II, III – posterior oblique ligament, valgus opening in full extensions
  19. treatment
    mostly nonoperative, brace to protect range of motion
  20. areas most commonly injured
    most common injuries and anterior lateral quad, anterior medial quad, and posterior lateral quad
  21. accelerated ACL protocol
    0 – 3
  22. goals
    protect draft, full and gentle range of motion by sixth week, quad function, minimize the swelling, normalize gait
  23. cautions
    • vigorous OKC the extension for six weeks
    • hamstrings autographs – avoid vigorous resisted knee flexion until six weeks
    • avoid twisting for six weeks
  24. range of motion
    • two weeks;0– 90°
    • three weeks; 0 – 120°
    • six weeks; full flexion
  25. brace / weight-bearing
    • immediate weight-bearing – brace 0 – 90, locked in extension for ambulation
    • after one week unlocked when quad control appears to allow normal gait
  26. accelerated ACL protocol
    4 - 12 weeks
  27. goals
    • protect graph from extreme forces
    • gradually increase functional activities
    • full range of motion, build a straight
    • proprioception
    • cardiovascular fitness
  28. cautions
    • avoid quick and uncontrolled twisting
    • 10 – 12 weeks
    • avoid extremes shearing stress
  29. ACL pathologies
  30. true or false – 30% of people can function without ACL
  31. true or false – ACL deficit needs get early onset of arthritis
  32. true or false ACL ruptures are often associated with posterior cruciate tears
    false – meniscal tears
  33. true or false –allograph maybe a little behind autograph because of slower capillary generation
  34. when is the knee the weakest
    weakest at about four weeks when patient thinks that they're fine
  35. ACL pathology facts continued
    • bracing not a bad idea, but won't prevent injury
    • over 100,000 injuries in US; 2-8 risks for females, most noncontact mechanism
    • healing; 6-8 weeks= weak link because of vascular part hasn't grown all the way back yet, return to place six months – one year
    • ACL prevention – strengthen hip and knee extensors, and hip abductors – avoidance, flexibility, strengthening, plyometrics, agility
  36. posterior cruciate ligament
  37. protection
    • get full extension
    • avoid hyperextension
  38. precautions
    active forcible flexion for six weeks
  39. range of motion
    • gradual range of motion into flexion 0 – 60 for 1 to 2 weeks
    • 90° 2 to 3 weeks,
    • full range of motion six-day weeks
  40. other
    similar to ACL protocols, only opposite precautions
  41. Meniscus Repair
  42. tear type
    • radial
    • longitudinal
    • vertical
    • bucket handle
    • degenerative
  43. precautions
    • weight-bearing restrictions
    • don't ruin the repair with sharing activities
    • twisting or flexed the ambulation can disrupt repair
  44. associative conditions
    • ACL reconstruction
    • arthritis
    • malalignment
  45. testing
    McMurray's test – does it show specific medial or lateral meniscus
  46. treatment options
    • activity modifications
    • NSAIDs
    • injections
    • surgery
    • will mask, not heal
  47. Tear locations
    • white tears probably won't heal so removed torn portion
    • red white and red tears can heal, the further out the increased ability to heal
  48. meniscectomy
    can increase risk of arthrosis, total meniscectomy me increases joint load 300%
  49. repair
    suture repair, all inside, protected weight-bearing, high repair rates
  50. Knee Arthritis
  51. characteristics
    • 43 million Americans
    • 100 types – OA= wear and tear, most common type
    • geriatric role = 40 to 65%
    • women are more than 60%, the less likely to have knee replacements
  52. symptoms
    • effusion
    • malalignment (varus)
    • limited range of motion
    • crepitus
    • tenderness
  53. treatment
    • viscosupplementation
    • arthroscopy
    • cartilage transplants
    • knee replacement surgery
    • NSAIDs
  54. rehab suggestions
    • load sharing ( hip/gastroc/soleus strength
    • extensibility ( hip – ankle foot)
    • heel wedges/orthotics
    • Unloader braces
  55. Knee Replacement Surgery
  56. when is the surgery considered?
    only when nonsurgical interventions aren't alleviating pain and symptoms are bad enough to do surgery
  57. what are the four different options
    • uni– compartmental arthroplasty
    • patellofemoral arthroplasty
    • bicompartmental arthroplasty
    • total knee arthroplasty
  58. Unicompartmental arthroplasty
    • used for isolated medial> Lateral compartmental disease
    • all ligaments need to be intact
    • thin, elderly, females have best outcomes
  59. patellofemoral arthroplasty
    • used for isolated patellofemoral arthritis -often get total knee arthroplasty after this procedure
    • all ligaments must be intact
  60. bicompartmental arthroplasty
    • used when medial compartment and the patellofemoral joint are involved – not done often because durability questioned
    • all ligaments must be intact
  61. total knee arthroplasty
    three designs based on keeping PCL or not, all remove ACL – all outcomes are similar
  62. cruciate retaining – most common Louisville
    • uses patients PCL to help balance knee
    • small risk of late PCL rupture resulting in instability requiring revision
  63. cruciate substituting or posterior stabilized – second most common
    • typically easier to balance flexion and extension gaps
    • with clunk with posterior drawer test
    • risk of jumping the post and dislocation
  64. rotating platform
    • increase surface area to reduce contact stresses
    • increase conformity to tibiofemoral articulation
  65. what's hot
    • minimally invasive
    • gender specific knee to pick different sizes
  66. follow-up for total knee replacement – torture to get motion back
    • within two weeks want; 5 – 90°
    • within first six weeks want about 95% motion – 115°
    • hip easier to cover than knee
  67. important need facts as they are related to rehab
    • surgically pick procedures; used need rehab must, but be careful not to get the PF mad
    • transplantation procedures; talk to physician but more than likely range of motion and weight-bearing restrictions
  68. Tendon Ruptures
  69. characteristics
    • quads and 60 – 70 year olds
    • Patella under 40 year old
  70. symptoms
    typically avulse from patella, paplable defect, extensor lag, operative treatment
  71. differential diagnosis
    • extensor mechanism
    • cruciate injury
    • meniscal tear
    • osteochondral fracture
  72. Patella Dislocation
  73. characteristics
    • instability and giving out
    • extensor lag
    • minimal defect if reduced
  74. pathology
    • medial patella femoral ligament
    • bone bruise
    • osteochondral fragment
    • congenital/anatomical issue
  75. treatment
    • nonoperative – bracing, taping, therapy (VMO and abductor strengthening
    • operative – fix what's broken, trend toward anatomical restoration of MPFL
  76. congenital issues
    • females age 10 – 17 have high-risk of dislocation
    • first time this locators may likely the participatingin sports – afterwords happens more often
    • risk factors; prior dislocation,younger age at initial injury, family history, hip dysplasia
  77. anatomical issues – anything making knee more valgus
    • increased Q angle - leads to reflects lateral force on the patella
    • patellofemoral bony constraints - trochlear depth, patella congruency
    • TT-TG ( tibial tubercle trochlear groove distance) - increases distance protective against patellar instability
  78. Anterior Knee Pain
  79. characteristics
    soft tissue and biomechanical issues – both can be a result of each other
  80. classification system
    • Wilk
    • Merchant
    • Fulkerson and Schutzer
    • Insall
  81. Wilk classification
    patellar compression syndromes, patellar instability, biomechanical dysfunction,direct patellar trauma, soft tissue lesion/overuse syndromes, osteochondritis, neurological disorders
  82. general risk factors
    decreased quad flexibility, hyper mobile patella, patella alignment (alta vs baja), week abductors and external rotators, altered biomechanical alignment, altered VMO response
  83. Global Patellar Pressure
    avoid: patellar taping or bracing, bike, stairs or steppers, OKC exercises, squatting
  84. excessive lateral pressure; lateral rectinacular pain and medial peripatellar pain
    • pain increases on stairs, squatting, stooping, painful crepitus
    • patellar tilt higher with atrophy of VMO
    • ROM and MMT: grossly within limits, decreased length of ITB/quads/hamstrings, and pain and week quads
    • reflex and sensation normal
    • tenderness over lateral and medial retinaculum, decreased medial glide of patella
    • intervention; stretch tight lateral retinaculum structures, medial patellar glide and tilts, patellar taping, racing, stretching upper leg muscles, straighten quads (VMO, anti-inflammatory treatments
    • avoid: bike, stairs or steppers, OKC exercises, squatting