MSK 2 Exam 2

When sleeping, what are the two ways you can unload the ant-lat hips + lumbar spine for a patient w/ gluteal tendinopathy?- Supine w/ pilow under knees - SL w/ eggshell mattress overlayIT Band releases are a good example of a load management intervention for a patient w/ a gluteal tendinopathy.False - that's too provocative! You MUST avoid hip adduction stretches.To improve muscle hypertrophy for a patient w/ gluteal tendinopathy, you do _____ (high/low) velocity, (high/low) load ABD exercises.low velocity, high load ABDCondition in which you feel a snapping sensation ("popping" sound) in your hip when you walk, get up from a chair, or swing your leg around. Happens when a muscle or tendon moves over a bony protrusion in your hip.Snapping Hip (Coxa Sultans)The iliopsoas snapping over structures as it moves from flex → ext. is what type of snapping hip disorder? a. internal b. external c. posterior d. intraarticulara. internalThe snapping of the ITB or gluteus maximus over the greater trochanter is what type of snapping hip disorder? a. internal b. external c. posterior d. intraarticularb. externalExternal Snapping Hip is more common in what demographic?Females w/ wider pelvis and prominent greater trochantersIntervention ideas for snapping hip pathology?Strengthening imbalances, stretching tight muscles, corticosteroid shots for painL(1),2,3 nerve root irritation would indicate which nerve? a. lateral cutaneous b. sciatic c. ilioinguinal d. obturatora. lateral cutaneousL4,5 and S1,2 nerve root irritation would indicate which nerve? a. lateral cutaneous b. sciatic c. ilioinguinal d. obturatorb. sciaticL1-2 nerve root irritation would indicate which nerve? a. lateral cutaneous b. sciatic c. ilioinguinal d. obturatorc. ilioinguinalL2-4 nerve root irritation would indicate which nerve? a. lateral cutaneous b. sciatic c. ilioinguinal d. obturatord. obturatorA pt feels p! and tingling to his ant-lat thigh as a result of wearing a compressive tool belt everyday to work. The nerve affecting this may be running over what ligament in the thigh?Inguinal ligamentA patient w/ a neuropathy is told by her PT to avoid wearing tight jeans. Other treatments the therapist did were CFM to the inguinal ligament and instruction this patient to do some hip flexor stretches and glute bridges. What nerve was most likely impacted?Lateral femoral cutaneousWhat muscles are innervated by the sciatic nerve?- Hamstrings - ADD magnus (hamstring portion) - All muscles of the leg/footA patient reports a shooting pain from the lower back, through the buttock, and down the back of her legs. It is more aggravated when she sits for long periods of time. What nerve roots may be affected here?Sciatic Nerve So L4-5, S1-2How do you differentiate lumbar sciatica from a neuropathy vs lumbar radiculopathy?- Check Hip ROM provocation (attention to recruitment of motion) - Sensory exam (specificially plantar sensory changes in the neuropathy) exception of S1 level - Muscle bulk - sciatic neuropathy will spare glute min and med - PFT - sciatic notch - MMT - lumbar radiculopathy - IR and flexion rules in, ER and flexion rules out - SLR from 30-60 deg, contralateral (+) specific for disc herniationA patient is being treated for a neuropathy. The PT has the patient avoid activity such as heavy lifting, and too much bed rest, and advises him to sit on firm chairs instead of soft couches. What possible nerve is being affected?SciaticA patient is being treated for a neuropathy. He reports pain in the lower abdomen and groin, radiating to the upper inner upper leg and to the genitals. The PT has the patient do "corset training" to strengthen the transversus abdominis. What nerve was affected?Ilioinguinal nerveWhat does the anterior branch of the obturator nerve innervate? (Select all) a. ADD longus and brevis b. Obturator externus c. ADD magnus d. Gracilisa. ADD longus and brevis d. GracilisWhat does the posterior branch of the obturator nerve innervate? (Select all) a. ADD longus and brevis b. Obturator externus c. ADD magnus d. Gracilisb. Obturator externus c. ADD magnusAlong with acute knee pain, what other s/s should a patient have to indicate a Knee Fracture?- > 55 yrs. - Isolated tenderness of patella - Tenderness of fibular head - Inability to flex knee to 90 degrees - Inability to WB immediately (~4 steps) Just one of these has to be present to indicate it.What are the roles of the meniscus?- Lubricate the joint - Distribute forces - Stability - Increase joint congruency - Secondary restraints and to reduce friction.What is NOT a soft tissue attachment for the medial meniscus? -Joint Capsule -MCL -Patellar tendon -SemimembranosusPatellar Tendon - the 3 ST attachment sites fro the medial meniscus are the Joint capsule, MCL, SemimembranosusWhat is NOT a soft tissue attachment for the lateral meniscus? -Coronary ligaments -popliteal tendon -Biceps Femoris TendonBiceps Femoris Tendon - the 2 ST attachment sites for the lateral meniscus are the coronary ligaments and popliteal tendonHow does the meniscus move during knee flexion and extension?Posteriorly and Anteriorly, rescpectivelyWhat are the different types of meniscal tears?Longitudinal/Bucket handle, transverse/flap, Radial/Parrot Beak (all three are body tears → reduced blood → poor healing) Torn horn → peripheral tear so heals well due to better blood supplyWhat is the better test to confirm a meniscus injury McMurray's or Apley's?McMurray's is the better choice because it is more specific.What is the better test to screen and rule OUT a meniscal pathology?Apley's. You want to use a test that is high in sensitivity (Apley's)What population is an acute meniscus tear more common in?Younger - teens to middle ageWhat are the s/s of a meniscal pathology?- Hx of catching or locking - Joint line tenderness - Pain with forced hyperextension - P! With max knee passive flexion - Pain or audible click with McMurray - if all 5 are (+), 92% positive predictive value of a positive meniscal tear. If 3 are (+), this value decreases to 75%T/F: Just exercises is beneficial for tibiofemoral OA rehabilitation.False - together with manual therapy, they're found to be beneficial, but just strengthening has little clinical difference in pain reduction.Does research fully support the repositioning of the patella during taping?No, but some patients do report a decrease in painA study by Spencer et al. revealed that the onset of 20-30mL of effusion shows inhibition of the _____________.Vastus medialisA study by Spencer et al. revealed that the onset of 50-60 mL of effusion shows inhibition of the _____________.entire quadricepsA _________________ repair usually involves a lesion to the outer vascular zone. A partial _______________ is usually done if tear is present in the avascular zonemeniscal; meniscectomyName three possible complications of a meniscal repair?Med Meniscus → risk of damage to saphenous n. Lat Meniscus → risk of damage to peroneal (fib) n. Nerves can become entrapped by adherent scar tissueThese are the factors that influence progression of rehabilitation after a meniscal repair. What is missing? - Location and size of the tear (i.e., the zone[s] affected and their vascularity) - Type of tear (tear pattern and complexity) - Type of surgical fixation device used - Concomitant injuries (ligament, chondral defect) with or without reconstruction or repairAlignment of the knee joint (normal, varus, valgus) - These are all the factors influencing the progression of rehab after meniscus repairHow is bracing different between a meniscal repair and meniscectomy?A repair requires a locking brace while a meniscectomy can have a brace post-op, but there is no ROM limitationsHow are the WB requirements different for meniscal repair and meniscectomy?Repair depends on the type and time post-op, but it will start with a required partial WB, while a meniscectomy is just WBAT.What are the criteria to progress from maximum protection to moderate protection for a meniscal repair rehab? - __________ joint effusion and pain - Evidence of _____________ gliding of the patella with quadriceps - Full, active knee ______________ (no extensor lag) - Approximately _____° of knee flexion- Minimal joint effusion and pain - Evidence of superior gliding of the patella with quadriceps - Full, active knee extension (no extensor lag) - Approximately 120° of knee flexionWhat are the criteria to progress from moderate protection to the return to function phase for a meniscal repair rehab? - ______ pain or joint effusion - Full, active knee ROM - Lower extremity strength (maximum isometric contraction): ____% to ____% compared to the contralateral side- No pain or joint effusion - Full, active knee ROM - Lower extremity strength (maximum isometric contraction): 60% to 80% compared to the contralateral sideWhat are the clinical findings of knee OA?Swelling (varies from minimal to severe) Jt. can be warm to touch depending on SOC P! With WB activities & p! w/ rest * Loss of motion is present in a capsular pattern (flexion > extension) Muscle weaknessWhat are some conservative treatments for knee OA?NSAIDS Cortisone Injections Pt Education Weight Loss Thermal Modalities OrthoticsWhat are some additional clinical findings that are present with knee OA?Over 50 years Crepitus Morning stiffness for 30 minutes or moreWhat are some subcategories of PFPS that may cause anterior knee pain? (8)(STOP TATS) - Soft Tissue Lesions - Tight medial and lateral retinacula or patellar pressure syndrome - Osteochondritis dissecans of the patella or femoral trochlea - Patellofemoral OA - Traumatic Patellar Chondromalacia - Apophysitis - Trauma - Symptomatic bipartite patellaPlica syndrome, fat pad syndrome, tendonitis, IT band friction syndrome, & bursitis are in what subcategory of lesions that may cause anterior knee pain in PFPS patients?Soft Tissue Lesions______________ disease (traction apophysitis of the tibial tuberosity) and ______________________ syndrome (traction apophysitis on the inferior pole of the patella) occur during adolescence as a result of overuse during rapid growth. They are self-limiting conditions and may cause anterior knee pain in PFPS patients.Osgood-Schlatter, Sinding-Larsen JohanssonWhat are some local factors that may lead to PFPS?Pathology with the infrapatellar fat pad, surrounding ligaments, quadriceps tendon, retinaculum, and subchondral bone.What are some Proximal factors that may lead to PFPS?Increased hip ADD/IR during tasks due to hip ABD/ ex/ ER muscle weakness.Some Distal factors that may lead to PFPS: Factors arising from the foot, including _____ (ER/IR) foot during relaxed stance, rearfoot _________ (inversion/ eversion) at heel strike, delayed or prolonged rearfoot _____________ (inversion/eversion) during walking and running and inc midfoot mobility.Factors arising from the foot, including ER foot during relaxed stance, rearfoot eversion at heel strike, delayed or prolonged rearfoot eversion during walking and running and inc midfoot mobility.A patient w/ PFPS may have specifically increased hip ____ and _____ and dynamic knee valgus (valgus collapse) that occurs during WB activities, such as ascending and descending stairs, squatting, or landing after a jump.ADD/ IRSome activity limitations and participation restrictions of a patient w/ PFPS?- Limited performance of basic ADL as the result of pain or poor knee control (valgus collapse). - Pain-related limitations of functional mobility (e.g., reduced ability to get in or out of a chair or car, ascend and descend stairs, walk, jump, or run) that are necessary to carry out ADL and IADL, work, and community, recreational, or sport activities. - Inability to maintain prolonged flexed knee postures, such as sitting or squatting, as the result of pain and stiffness in the knee.Other than patient education, what are some categories of treatments for PFPS?- Increase flexibility of restricting tissues (this includes patellar taping and mobilization) - Improve Muscle Performance and NM control (open --> closed chain exercises, NWB --> WB, functional activities) - Modify Biomechanical StressesPFPS Treatment: Early Phase rehab exercises: Improve strength of knee _________________ (flexors/ extensors) (including VMO), hip ______/ ______/ _____ (three movements), and trunk side flexors Function Phase: Want to make sure to strengthen the posterior lateral hip musculature to help maintain proper knee alignmentEarly Phase rehab exercises: Improve strength of knee extensors (including VMO), hip ext/ABD/ER, and trunk side flexorsWhich of the following is NOT an open chain exercise to do on a PFPS patient? a. Hip abduction in side lying b. Hip ER in sidelying c. Hip flexion in standingd. Hip flexion in standing You would do hip extension in standing.What two structures limit knee valgus?MCL, ACLIn normal WB activities, does the GRF vector pass medial or lateral to the knee joint center? What type of moment does it create?During weight bearing activities such as walking and running, the resultant GRF vector passes medial to the knee joint center, thereby creating a varus moment at the knee.How does the varus moment impact soft tissue structures on the medial aspect of the knee? Lateral?Varus moment is resisted by lateral soft tissue restraints of the knee, namely the IT band and the LCL. It creates greater compressive forces within the medial compartment of the knee compared to the lateral compartment.What happens to the pelvis if the hip abductors are weak? What is this sign called? How does it affect the varus moment arm? What does it do to the forces within the soft tissue structures?In the presence of hip abductor weakness, the contralateral pelvis may drop during single-limb support (Trendelenburg sign), causing a shift in the center of mass away from the stance limb. Movement of the center of mass away from the stance limb increases the distance from the resultant GRF vector and the knee jt. center, thereby increasing the varus moment at the knee. The ability to generate greater hip abductor moment during walking was protective against ipsilateral medial compartment OA progression in older adults.A common compensation for hip abductor weakness is to (elevate/drop) the contralateral pelvis and leaning the trunk (towards/ away from) the stance limb. Known as the 'Compensated Trendelenburg sign', this moves the resultant GRF vector closer to the hip joint center, thereby reducing the demand on the hip abductors. This could create a (varus/valgus) moment at the knee (lateral to knee joint center) during movements such as cutting or landing from a jump which would place a greater strain on the medial structures unlike the typical (varus/ valgus) movement.A common compensation for hip abductor weakness is to ELEVATE the contralateral pelvis and leaning the trunk TOWARDS the stance limb. Known as the 'Compensated Trendelenburg sign', this moves the resultant GRF vector closer to the hip joint center, thereby reducing the demand on the hip abductors. This could create a VALGUS moment at the knee (lateral to knee joint center) during movements such as cutting or landing from a jump which would place a greater strain on the medial structures unlike the typical VARUS movement.During the loading phase of walking, the GRF vector falls where with respect to the hip and knee causing what moments at these joints? To counteract these moments, what muscles must work and how are they firing? ____________ The resultant GRF falls (anterior/posterior) to the hip and (anterior/posterior) to the knee, thereby creating (flexion/extension) moments at both joints. As such, (concentric/ eccentric actions) of the hip and knee extensors are required to counteract these moments.The resultant GRF falls anterior to the hip and posterior to the knee, thereby creating flexion moments at both joints. As such, eccentric actions of the hip and knee extensors are required to counteract these moments.How does encouraging our patients to perform a forward trunk lean during a drop-jump task change the position of the GRF vector? How does it impact the hip and knee extensors? A forward trunk lean would move the GRF vector (anteriorly/ posteriorly), thereby (increasing/ decreasing) the demand on the hip extensors, while simultaneously (increasing/decreasing) the demand on the knee extensors. Landing with more of an erect trunk would have an opposite effect, (increasing/ decreasing) the demand on the knee extensors and (increasing/decreasing) the demand on the hip extensors.A forward trunk lean would move the GRF vector anteriorly, thereby increasing the demand on the hip extensors, while simultaneously decreasing the demand on the knee extensors. Landing with more of an erect trunk would have an opposite effect, increasing the demand on the knee extensors and decreasing the demand on the hip extensors.When is the strain on the ACL the greatest? Occurs w/ a combined loading pattern consisting of frontal and transverse plane joint moments and anterior tibial shear. The strain on the ACL has been reported to be greater when these loads are applied with the knee in a position of (flexion/ extension) compared to greater (flexion/ extension) values.Occurs w/ a combined loading pattern consisting of frontal and transverse plane joint moments and anterior tibial shear. The strain on the ACL has been reported to be greater when these loads are applied with the knee in a position of relative EXTENSION compared to greater FLEXION values.Females exhibit a biomechanical profile that is thought to place them at an increased risk for ACL injury. Notably, female athletes have been shown to perform athletic maneuvers with (increased/ decreased) knee and hip flexion, (increased/ decreased) quad activation, and (greater/ lesser) knee valgus angles (leads to increased ACL injury) and moments when compared to males.Female athletes have been shown to perform athletic maneuvers with DEC knee and hip flexion, INC quad activation, and GREATER knee valgus angles (leads to increased ACL injury) and moments when compared to males.Several studies have reported that reduced hip strength is related to (greater/lesser) knee valgus angles and moments due to little usage of hip extensors and more usage of muscles in the frontal plane.Several studies have reported that reduced hip strength is related to GREATER knee valgus angles and moments due to little usage of hip extensors and more usage of muscles in the frontal plane.How are the joint kinematics of the PFJ different in NWB vs. WB positions?When NWB, the patella tilts and displaces laterally relative to the fixed femur. In contrast, the primary contributor to lateral patella tilt and displacement during WB is IR of the femur underneath a stable patella. The patella attaches to a stable tibia via the quad tendon. As such, quad contraction during WB anchors the patella to the comparatively stable tibia, allowing the femur to move underneath the extensor mechanism. In NWB, in knee extension the patella moves relative to fixed femur.What two general principles should be incorporated into the design of a program to address proximal impairments related to knee injury?Increased Q-angle → increased valgus = bad Diminished hip strength especially in females = badExcessive ant tilt of the pelvis resulting from weakness of the posterior rotators of the pelvis (like the gmax, hamstrings, abdominals) and/ or tightness of the hip flexors may result in compensatory lumbar ____________ (lordosis/kyphosis) and a resulting posterior shift in the trunk position. A posterior shift in the COM during functional activities would ________ (inc/dec) the knee flexion moment and the demand on the knee extensors, while simultaneously ___________ (inc/decreasing) the hip flexion moment and the demand on the hip extensors.Excessive anterior tilt of the pelvis resulting from the weakness of the posterior rotators of the pelvis and/ or tightness of the hip flexors may result in compensatory lumbar LORDOSIS and a resulting posterior shift in the trunk position. A posterior shift in the COM during functional activities would INC the knee flexion moment and the demand on the knee extensors, while simultaneously DEC the hip flexion moment and the demand on the hip extensors.The primary goal of taping is to pull the patella away from the painful area, thereby unloading it and reducing pain, rather than as an adjustment for malalignment of the joint. Does this significantly affect patellofemoral lateralization or tilt?No. While it is effective in controlling anterior knee pain, it does not significantly affect patellofemoral lateralization or tilt. In addition to taping, biofeedback, stretching of the lateral structures and an HEP are recommended,Which of the following is NOT an advantage of a bone-patellar-bone graft? a. High tensile strength/stiffness, similar or greater than the ACL b. Secure and reliable graft fixation with interference screws c. No disturbance of epiphyseal plate in skeletally immature patient d. Rapid revascularization/biological fixation (6 weeks) at the bone-to-bone interface permitting safe, accelerated rehabilitation e. Ability to return to preinjury, high-demand activities safelyc. No disturbance of epiphyseal plate in skeletally immature patient This is an advantage of a semitendinosus-gracilis graftWhich of the following is NOT a disadvantage of a bone-patellar-bone graft? a. Ant knee pain in area of graft harvest site b. Pain during kneeling c. Extensor mechanism/patellofemoral dysfunction d. Long-term quadriceps muscle weakness e. Longer healing time (12 weeks) f. Patellar fracture during graft harvest g. Patellar tendon rupturee. Longer healing time (12 weeks) This is a disadvantage of a semitendinosus-gracilis graftWhich of the following is NOT an advantage of a semitendinosus-gracilis graft? a. high tensile strength/stiffness greater than ACL with quadrupled graft b. No disturbance of epiphyseal plate in skeletally immature patient c. Evidence of hamstring tendon regeneration at donor site d. Loss of knee flexor muscle strength remediated by 2 years postop e. Ability to return to preinjury, high-demand activities safelye. Ability to return to preinjury, high-demand activities safely This is an advantage of a bone-patellar-bone graftWhich of the following is NOT a disadvantage of a semitendinosus-gracilis graft? a. Not as reliable b. Longer healing time (12 weeks) c. Hamstring muscle strain during early rehabilitation d. Short- and long-term knee flexor muscle weakness e. Pain during kneeling f. Possible inc ant knee translatione. Pain during kneeling This is a disadvantage of a bone-patellar-bone graftWhat graft has the patient returning to preinjury, high demand activities safely? a. Bone-Patellar-Bone b. Semitendinosus-Gracilisa. Bone-Patellar-BoneWhich graft is more reliable? a. Bone-Patellar-Bone b. Semitendinosus-Gracilisa. Bone-Patellar-Bone Because bone-to-bone fixation is more reliable than tendon-to-boneWhat graft takes longer to heal? a. Bone-Patellar-Bone b. Semitendinosus-Gracilisb. Semitendinosus-GracilisPostop ACL surgery, how does the patient present in the max/mod/min protection phases in terms of pain, ROM, and ambulation?Max - pain and hemarthrosis - dec ROM - ambulation w/ crutches Mod - pain controlled - full or near full knee ROM - independent ambulation Min - no pain or swelling - full knee ROM - symmetrical gait, unrestricted ADLsWhat should be a PT's goals from the max to min protection phase for a pt post ACL surgery?Max - Protect healing tissues - Dec effusion - ROM 0-110 - AROM - WB (75% to WBAT) Mod - Full, pain free ROM - 4/5 MMTs - Dynamic control of knee - Normalize gait pattern/ ADLs Min - Inc strength, endurance, power, NM control, balance - Regain ability to fxn at highest desired levelWhat are some possible interventions for a pt in all the phases post ACL surgery?Max - PRICE, crutches/ PWB training, patellar mobs I-II, isometrics - progress to FWB, closed chain squats, heel/toe raises Mod - closed-chain exercises, balance board proprioceptive training, elastic band/ stabilization exercises, PNFs Min - initiate isokinetic training and advance closed chain exercises - pylometrics - advanced proprioceptive/ balance training - skill-specific exercisesAfter ACL reconstruction, progress more gradually for a hamstring tendon graft than bone-patellar tendon-bone graft. T or F?TProgress knee flexor strengthening exercises cautiously for a patellar tendon graft and knee extensor strengthening for a hamstring tendon graft. T or F?F - progress knee flexor strengthening exercises cautiously for a hamstring tendon graft and knee extensor strengthening for a patellar tendon graft.List 2 exercises precautions regarding closed-chain training for a pt post ACL reconstruction.When squatting, ensure that the knees do not go past toes as the hips descend b/c this increases shear forces on the tibia and could potentially place excess stress on the autograft. Avoid closed-chain strengthening of the quadriceps between 60° to 90° of knee flexion.*List 3 exercise precautions regarding open-chain training for a pt post ACL reconstruction.During PRE to strengthen hip musculature, initially place the resistance above the knee until knee control is established. Avoid resisted, open-chain knee extension (short-arc quadriceps training) between 45° or 30° to full extension for at least 6 weeks or as long as 12 weeks.* Avoid applying resistance to the distal tibia during quadriceps strengthening.*Which of the following is NOT true regarding ACL reconstruction? a. progress knee flexor strengthening exercises cautiously for a hamstring tendon graft b. avoid applying resistance to the distal tibia during quads strengthening c. When squatting, ensure that the knees do not go past toes as the hips descend. d. Allow resisted, open-chain knee extension between 45° or 30° to full extension for at least for the 1st 6 weeksd. Allow resisted, open-chain knee extension between 45° or 30° to full extension for at least for the 1st 6 weeks You must actually avoid thisPatients w/ fat pad syndrome have pain in which direction of the knee?Knee ext (particularly hyperextension)List some treatments for fat pad syndrome.- PRICE - anti inflammatory meds - iontophoresis or phonophoresis - local corticosteroid injections into the fat pad are preferred by some physicians - addressing the causes of hyperextension through orthotic interventions, such as heel lifts or taping the superior pole posteriorly and holding the patella in a superior glide with a tape.What nerve is the largest branch of femoral nerve, & provides sensation to the med aspect of the leg & the foot?saphenous nerveA patient reports a tingling pain down her distal lateral R leg and the dorsum of her foot. She normally wears high heels to work, and suffered an ankle sprain (forced inversion and PF) when walking to her office building. What nerve is being affected?The common fibular (peroneal) nerveWhat are some treatments you can do for a common fibular neuropathy? (List 4)- Removal of compression is key once cause is found. - Neuromuscular re-education for motor weakness. - Fibular and/or soft tissue manipulation - Potentially a lateral post to encourage calcaneal pronation and slacken the nerve.Regarding ACL injuries, females perform high risk tasks (landing/cutting/deceleratiom) with: (Smaller/ larger) knee flexion angles (Lower/ higher) gluteus medius activity (Lesser/ greater) knee valgus angles (Lesser/ greater) hip IR angles (Lesser/ greater) quads to hamstrings activation ratioSMALLER knee flexion angles LOWER gluteus medius activity GREATER knee valgus angles GREATER hip angles GREATER quads to hamstrings activation ratioWhat are the 4 extrinsic risk factors of an ACL injury?Type of competition Shoe/surface interface Knee bracing WeatherWhat are the 4 intrinsic risk factors of an ACL injury?Hormonal Posterior tibial slope Medial tibial plateau depth Notch sizeWhat special test is better to test for an ACL injury?Stable Lachman's - because patient cannot guard, and there is a loose pack position.Individuals who are able to resume all preinjury activities, including sports, without episodes of knee giving way and do NOT require surgery.CopersIndividuals who can manage WITHOUT surgery by modifying/lowering activity levels.AdaptersIndividuals who either did not return to their previous activity level, experienced giving way and CHOOSE to require surgery.Non-CopersCopers meet the following criteria: 1. Hop test index of _____% or more for the timed 6-meter hop test 2. Knee Outcome Survey ADLs scale score of ____% or greater 3. Global rating of knee function 60 or greater 4. No more than _____ episode(s) of giving way since the initial injury1. Hop test index of 80% or more for the timed 6-meter hop test 2. Knee Outcome Survey ADLs scale score of 80% or greater 3. Global rating of knee function 60 or greater 4. No more than one episode of giving way since the initial injuryAn allograft comes from a cadaver, and can be taken from what three types of tendons?Patellar Tendon TA Tendon Achilles TendonAn autograft comes from your own body, and can be taken from what two types of tendon?BPTB (bone patellar tendon bone, made from middle 1/3 of patellar tendon) Hamstring tendon (semitendinosis, gracilis)Pyramid of Progression (9 steps)1. Protection, treat inflammation/ pain, early hyperextension, quad firing 2. Quad control, ROM, normal gait, patellar mobility, early proprioception, inflammation control 3. Straight plane basic therex 4. Alter speed, surface, WB, perturbations 5. Multiplanar functional movements 6. Safe landing techniques 7. Plyometrics 8. Running 9. Sport Specific AgilityThe ACL video and the Wilk article discuss the impact of neuromuscular fatigue on increasing the risk of ACL injury. When during the treatment session should you have your patient perform neuromuscular control drills?We routinely begin basic proprioceptive training during the second postoperative week, pending adequate normalization of pain, swelling, and quadriceps control.The video mentions that trunk position is important during functional tasks following ACL reconstruction. Should we encourage a forward trunk or an erect trunk? Why?Forward trunk --> less force on the knee extensors and more on the hip extensorsAccording to the Wilk article, which graft type will allow for a more aggressive course of rehabilitation? Why?The healing of bone to bone in the osseous tunnel (patellar tendon autograft), which occurs in approximately 8 weeks in most instances, is faster than the healing of tendon to bone (hamstring autograft), which takes approximately 12 weeks. The theoretical advantage of a larger, stronger allograft that allows more aggressive rehabilitation remains unproven.Both the video and the Wilk article mention the importance of performing patellar mobilizations. According to the Wilk article, what two factors may be limited if patellar mobility is not restored? Why is it important to know the location of an MCL tear, if you patient has a MCL tear along with the ACL tear? How would it affect rehab?The loss of patellar mobility, referred to as infrapatellar contracture syndrome, results in ROM complications and difficulty activating the quadriceps. MCL tears from the proximal origin or within the midsubstance of the ligament tend to heal with increased stiffness without residual laxity. In contrast, MCL injuries at the distal insertion site tend to have a lesser healing response, often leading to residual valgus laxity. Injuries involving the distal aspect of the MCL may be progressed more cautiously to allow for tissue healing; in some instances, these individuals may be immobilized in a brace to allow MCL healing prior to ACL reconstruction. In contrast, injury to the midsubstance or proximal ligament may require a slightly accelerated restoration of ROM to prevent excessive scar tissue formation, and early motion is encouraged and beneficial to the healing of the MCL.What is the medial longitudinal arch composed of?calcaneus, talus, navicular 3 cuneiforms and 3 medial metatarsalsWhat is the role of the medial longitudinal arch?helps with WB activities; major source of frontal plane motion of the footWhere does the medial longitudinal arch get most of its support from?anterior calcaneonavicular ligament, plantar fascia, TP, FDL, FHL, & fib longMedial longitudinal arch is more stable than the Lateral Longitudinal arch? True or False?False lateral longitudinal arch is more stable and less mobileWhat is the lateral longitudinal arch made up of and where does it get support from?Anatomical: calcaneus, cuboid, 4-5th metatarsals Support from: sup/ deep longitudinal plantar lig, fib brev/long/ tertius, ABDM, FDBWhat is the anterior transverse arch made up of?metatarsal 1-5; including sesamoids (arch I), cuneiforms & cuboid (arch II)This pathology comes from an MOI of excessive inversion and PF, and leads to loss of AROM PF, PROM DF, and dec A/P talar glide and/or dec talar ER.Anterior TCJ SubluxationThis pathology comes from an MOI of flatfoot or DF injury, and leads to loss of AROM DF, PROM PF, and dec P/A talar glide and/or dec talar IR.Posterior TCJ SubluxationWhat kind of technique can you apply to a TCJ subluxation that we haven't learned yet in MSK 2?High-velocity thrustThe main causes of this impairment that have been found are: decreased proprioceptive abilities and damage to the structural integrity of the ligaments during a lateral ankle sprain. Symptoms of this pathology can last over 6 months, and there is a presentable high arch along with swelling and brusing over the lateral ligs.Chronic Ankle InstabilityList two outcome measures for CAI.LEFS and the foot & ankle ability measurement (FAAM)What special test is more specific and preferred for chronic ankle instability?Talar tilt testWhat special test is more sensitive for chronic ankle instability?Anterior drawer testIn this pathology, you may see these kinds of complaints... - Frequent sprains - Difficulty running on uneven surfaces - Difficulty cutting/ jumping - "Giving away" feeling - Recurrent p! & swelling - Tenderness - Inability to run - WeaknessChronic Ankle InstabilityThe test can be used to assess physical performance, but can also be used to screen deficits in dynamic postural control due to musculoskeletal injuries (e.g. chronic ankle instability), to identify athletes at greater risk for lower extremity injury, as well as during the rehabilitation of orthopedic injuries in healthy active adults.Star Excursion TestMOI of an ankle syndesmosis sprain?Excess ER or forced DF while in WBWhere would you feel tenderness in a patient with a high ankle sprain?Ant distal tib/fibName 6 special tests for could do for a high ankle sprain.Cotton test Kleiger (ER) test (shown in pic) DF Compression test Fibular translation (drawer) test Heel-thump test Squeeze testA patient with a high ankle sprain can return to sport when they are able to do what 3 things and at what percent of the uninvolved joint?Return to sport when able to: one-leg broad jump, vertical, and 10 crossover hop @ 80% of uninvolved jointMOI of a medial ankle sprain?Excessive eversionYou are less likely to have a medial ankle sprain than the other ankle sprains. If you did do excessive eversion, what might've really happened instead?There is an avulsion from a fracture of the medial malleolus.3 special tests you can do for medial ankle sprain?Talar tilt (shown) Anterior drawer Medial talar glideWhat ligament lies within the sinus tarsi of the ankle, and may be susceptible to injury w/ both a pronatory and/or supinatory MOI?Interosseous Talocalcaneal LigamentWhich demographics would you most likely see ankle impingements?Young dancers, ice skaters, or gymnastsWhat is the MOI of ankle impingement?Excessive DF or PF, compressing the ant or post structures of the ankle.What could be an anterior bony structure that could be impinged on the ankle?Periosteum of the talar neckWhat could be a soft tissue etiology of a posterior ankle impingement?FHL irritation Thickened posterior capsule Synovitis Calcific debrisSome interventions you could do for an ankle impingement?Ice and anti inflammatories Stretch Achilles tendon and strengthen DFsYou patient feels p! behind and distal to the lateral malleolus, and p! w/ resisted eversion and PF. What tendinopathy could this be?Peroneus brevis/ longusYour patient feels p! distal to the medial malleoli w/ inv/PF, and you see that they have a loss of their medial arch height (pronated foot). What tendinopathy could this be?Posterior tibialisYour p! feels p! w/ great toe flexion and extreme PF, and the p! is posterior and inferior to the medial malleolus. What tendinopathy could this be?Flexor Hallucis LongusTHA Interventions in each phasePost-Op - early mobilization Max - isometrics (hip ABD) Mod - AROM, mobs, normalize gait (symmetrical), hip ABD/ext strength like clams Min - resisted clams/ side-steps, step-downs off a boxTKA Interventions in each phasePost-Op - ice/ compression sleeve, TENS Max - quad strengthening, gait training w/ AD Mod - knee mobs, closed chain strengthening, stabilization/ balance Min - sport specific stuff, like lunges in multiplanesPrecautions post THANo ADD past neutral Ant - No hip ext, no leg ER, no crossing legs Post - No flex past 90, no crossing legs, no leg IR Ant - Avoid Ext-ADD-ER Post - Avoid FADDIRSpecific number goals for TKA Max - Knee flex _____ deg, knee ex __________, regain quad strength (at least 3/5) Mod - Full knee ext, knee flex _______ deg, regain quad/ hamstring strength (at least 4/5) Min - back to functional90, 110Legg-Calve-Perthes disease is an idiopathic avascular necrosis of the femoral head in children, mainly _______ (boys/ girls), b/w 4-8. This form of osteochondrosis may have patients presenting w/ a Trendelenburg sign, an _____(out/in) -toeing of the involved extremity, and decreased hip _____/______ with pain.Legg-Calve-Perthes disease is an idiopathic avascular necrosis of the femoral head in children (mainly boys) b/w 4-8. This form of osteochondrosis may have patients presenting w/ a Trendelenburg sign, an out-toeing of the involved extremity, and decreased hip ABD/IR with pain.SCFE is an _______ (ant/post) displacement of the femoral neck from the capital femoral epiphysis while the head remains in the acetabulum. It can be stable or unstable, and presents w/ a limp w/ ER and the _________ hip capsular pattern. It is mostly seen in Polynesians and African Americans and at 12 yrs old for girls and 14 for boys.SCFE is an ant displacement of the femoral neck from the capital femoral epiphysis while the head remains in the acetabulum. It can be stable or unstable, and presents w/ a limp w/ ER and the FAME hip capsular pattern. It is mostly seen in Polynesians and African Americans and at 12 yrs old for girls and 14 for boys.Some DD for LCPD includes...Sagging Rope sign Insidious onset of limp w/ hip/ knee pain Mainly limited ABD/ER Abnormal fem head shapeSome DD for SCFE includes...Radiographs Klein's Line (line should cross the superior femoral epiphysis if normal) Steel's Metaphyseal Blanc Sign (crescent shaped) Limited FAME (Flex > ABD > IR > ER) Stable or UnstableA patient has a life-threatening delayed diagnosis of an impairment, and refuses to walk because she has severe pain and leg spasms. She presents w/ a rigid leg in flexion and ER. What pathology could she have? a. septic arthritis b. congenital hip dislocation c. SCFE d. transient synovitisa. septic arthritisBabies in the breech position are more likely to have hip instability than babies in a normal womb position and have an increased risk of this pathology.Congenital Hip DislocationChildren 2-12 years old w/ this pathology present w/ an antalgic gait and a low grade fever.Transient SynovitisIn LCPD, children bw _____ (age) tend to be _______ (shorter/ overweight), have a ___________(deformity/ displacement) of the femoral _______(head/neck) , and primarily need __________ (conservative/ operative) treatment. Surgery for these patients may involve a ________________femoral osteotomy/ internal fixation).In LCPD, children bw 4-8 tend to be shorter, have a deformity of the femoral head, and primarily need conservative treatment. Surgery for these patients may involve a femoral osteotomy.In SCFE, children bw _____ (age) tend to be _______ (shorter/ overweight), have a ___________(deformity/ displacement) of the femoral _______(head/neck) , and primarily need __________ (conservative/ operative) treatment. Surgery for these patients may involve a ________________femoral osteotomy/ internal fixation)In SCFE, children bw 10-15 tend to be overweight, have a displacement of the femoral neck, and primarily need operative treatment. Surgery for these patients may involve a internal fixation.Some conservative treatments of LCPD include...- Atlanta-Scottish-Rite Hospital Orthosis - Petrie cast - PTSome surgical treatments of LCPD include...ADD tenotomy, CPO, valgus or varus femoral osteomyYou could have complications with femoral head shape and congruence, limited joint function, DJD, and/or gait dysfunction with (LCPD/SCFE).LCPDYou could have avascular necrosis, chrondrolysis, impingement, fixation failure, or a bone growth cessation w/ (LCPD/SCFE).SCFE

MSK 2 Exam 2

Students also viewed

Other sets by this creator

Verified questions

Recommended textbook solutions

Clinical Reasoning Cases in Nursing

Pharmacology and the Nursing Process

Planning, Implementing, and Evaluating Health Promotion Programs

Medical Language for Modern Health Care