Chapter 16 knee note

when treating an MCL and LCL injury what is the timeline for recovery?

-limited and mobilization with R O M and P W B for 2 weeks -protection with functional hinged brace for another 2 to 3 weeks -Athletes allowed to RTP when they have rained normal strength, power, flexibility, endurance, and condition

medial meniscus

C-shaped

Acute patellar subluxation or dislocation -MOST IMPORTANT treatment

Knee should be immobilized in the position it is found

Valgus Stress Test is for what ligament?

LCL

In what ligament sprain is pain is greatest in grade 1 and 2 sprains, grade 3 May be painful initially and then subside to a dull ache

LCL ligament

(MCL sprains) with a grade 1 sprain, what are some signs and symptoms?

a few ligament fibers are torn or stretched, joint is stable during valgus stress test little to no joint effusion, maybe some joint stiffness and point tenderness, no effect on APROM

joint contusions following treatment

after swelling has ended athlete is able to return to normal activity with protective padding if needed if swelling is not resolved and within a week and maybe synovitis or bursitis, indicating the need for rest and referral to a physician

The knee is Commonly considered a hinge joint because its two principal movements are flexion and extension, But what makes it not a hinge joint?

because the rotation of the tibia is an essential component of knee movement

joint contusions cause

blow struck against the meniscus crossing the knee joint often involves vastus medialis which is primarily involved in locking the knee in full extension

Valgus is a _______ force

medially directed force

what knee part would you treat like this? RICE athletes should be sent to physician for evaluation surgery may be needed to remove a portion of the *part or may possibly be repaired with sutures non-surgical *part tear should be treated similar to MCL tears that do not require surgery

meniscal injuries

(MCL sprains) grade 2 _____ tearing or partial separation of ligament fibers

moderate

ACL's most commonly seen cause of injuryry

most common seen when athletes decelerates, the foot is planted and internally rotated

what could joint mice be a result of?

osteochondritis ( fragments of bone and cartilage), Fragments from the menisci, pieces of torn synovial tissue or a torn cruciate ligament

Iliotibial Band friction syndrome (Runner's knee) - cause

overuse condition, where asymmetries of the foot and lower leg cause irritation that develops over the lateral femoral Condyle or at the intersection of the ban on the lateral side of the knee where friction is created

(Bursitis cause) the Deep infrapatellar becomes irritated from ...

overuse of the patellar tendon

-signs and symptoms for LCL injuries

pain and tenderness over the ligament joint swelling and effusion some laxity at 30 degrees( If laxity is present in full extension ACL and PCL should B evaluated)

Chondromalacia - signs and symptoms

pain in the anterior aspect of the knee was walking, running, going up and down, stairs or squatting recurrent swelling around the patella and the grading sensation when flexing and extending the knee

patellar tendonitis may occur in _________ tendon On rare occasions, it may completely fail and rupture

patellar or quadricep,

normal patellar tracking cause the patella to move up and down in the femoral Groove between the femoral condyle. Weaknesses in the quadriceps or females (due to the wider pelvis) may have a tendency for the patella to track laterally with the quadriceps contraction and is generally referred to as a _________

patellofemoral syndrome

Chondromalacia - treatment avoiding irritating activities, pain-free isometric ex concentrating primarily on strengthening the ______ If conservative measures fail ______ may be the only alternative

quadriceps, surgery

Osgood-Schlatter disease - cause

rapid growth during adolescence, repeated pull of a patellar tendon at the tibial tubercle

what are joint mice?

repeated trauma to the knee may cause loose bodies to develop within the joint cavity

for joint contusions what is normally the rule of thumb if adequate first aid is provided to the knee the new will typically _____

return to functional use 24 to 48 hours after trauma

(MCL sprains- grade 3) valgus stress testing reveals ______ in full extension insignificant opening at 30 degrees of flexion

some joint opening

For meniscus tears when do the wounds heal naturally and when do they not?

some peripheral meniscus tear do heal when an adequate blood supply is available, but tears within the cartilage failed to heal because lack of adequate blood Supply

how do you treat joint mice?

surgical removal

Bursitis signs and symptoms - what happens and where

swelling above the knee that is similar to a balloo, occurs outside the joint and may have redness and increased temperature, may be painful and debilitating due to the swelling

vastus medialis contusions are known by .....

swelling and discoloration did the tearing of muscle tissues in blood vessels

Chondromalacia - the cause

the exact cause is unknown, but is often related to abnormal movements of the patella within the femoral Groove or overuse

These bones form several articulations between what bones in the knee?

the femur and the tibia, the femur and the patella, the femur and the fibula, and the tibia and the fibula

What are the 4 bones that make the knee joint?

the femur, the tibia, the fibula, and the patella

What is the most frequently injured joint because many sports place extreme stress on it?

the knee is injured alot

patellar tendonitis - treatment rest, ice, anti-inflammatories _______ massage bracing / taping (_____)

transverse friction, Pat strap

The patella, or kneecap, moves up and down in a groove between the _____ as the muscle quadriceps group contracts and relaxes

two femoral condyles

How long does an MCL and LCL injury normally take?

typically 1-3 weeks is needed for full RTP

LCL sprain cause

varus Force for internal rotation of the tibia

joint contusions cause - signs and symptoms what produce's all the appearances of a knee sprain including severe pain, loss of movement, and signs of acute inflammation

vastus medialis contusions

The proximal end of the tibia, or the tibial plateau, is like what?

very flat and must articulate with the round condyles of the femur

meniscus injury cause

weight bearing combined with rotational forces while extending or flexing the knee

what does the need Provide stability in?

weight-bearing and mobility in locomotion

Synovial membrane lines the______

inner surface of the joint capsule

what is a Baker's cyst?

is a commonly painless and causes no discomfort or disability but develop swelling because of a problem in the joint not The bursae

What is Chondromalacia?

is softening and deterioration of the articular cartilage on the posterior side of the patella

MCL and LCL sprain long term strengthening treatment

isometric quad strengthening ( quad sets, straight leg raises),and progress to active, resisted, full range exercise as soon as possible athlete May then progress to stationary bike, stair climbing, resisted flexion and extension exercises (may need brace or tape).

medial collateral ligament sprains When compromised there is instability and can result in what injuries?

joint capsule and medial meniscus injury

what is patellar tendonitis caused by?

jumping, kicking, or running and Placing extreme tension on the knee extensor muscle complex. sudden or repetitive forceful / of the knee May begin an inflammatory process that eventually leads to tendon degeneration.

PCL sprain cause

knee hyperflexion with ankle plantar flexion

The distal end of the femur expands into the _______ femoral condyles, which are designed to articulate with the tibia and the patella

lateral and medial

Iliotibial Band friction syndrome (Runner's knee)- signs and symptoms tenderness and Mild swelling with increased warmth and redness all over the _______ Pain increases with _____ or cycling activities

lateral femoral condyle, running

Acute patellar subluxation or dislocation Typically displacement takes place_____ and more is common in females than males due to the wider pelvis

laterally

Varus is a ____ force

laterally directed force

ACL cause of injury

likely to occur with the deceleration, rotation and valgus stress as seen in landing from a jump with a knee is dented instead of flex

Signs and symptoms of joint mice

locking and popping, painful, instable and a feeling that the knee will give way

(MCL sprains) what are the more major signs and symptoms of a grade 2 sprain

loss of PROM and pain in medial aspect with General weakness and instability

(Bursitis cause) the prepatellar Bursa becomes inflamed from the...

continued kneeling or falling generally on the knee

what injuries treatment has compression wraps and anti-inflammmatory medications, rest, stop doing the activit causeing the injury, and if it is chronic or recurrent in the synnovial lining of the joint capsule has thickened, a physician May give a steroid injection?

Bursitis

PCL signs and symptoms swelling developing gradually over _____ joint line pain and loss of motion intermittent locking and giving away pain with squatting and ______ athletes Complaining of inability to perform a full squat or changing direction quickly without pain, sense of knee ___________

48 to 72 hours, obvious muscle atrophy, collapse or popping

Lachman's test is for what ligament?

ACL

when the medial collateral ligament is SPRAINED it often results in _________________ as well

ACL and possibly PCL tears

What kind of ligament sprain has a higher likelihood in females versus males did your hormones, various anatomical factors and levels of conditioning

ACL sprain

Anterior/Posterior Drawer test is for what ligaments?

ACL/PCL

major muscles in the Hamstrings

Biceps Femoris, Semitendinosus, Semimembranosus

What injury could come from this senario, the athlete plants the foot, decelerates and simultaneously Cuts in the opposite direction from the weight bearing foot, the thigh rotates internally while the lower leg rotates externally causing immediately directed valgus Force at the knee. the quadriceps muscle attempts to pull in a straight line and as a result, the patella pulled laterally?

Acute patellar subluxation or dislocation

(MCL sprains) grade 2 no gross instability but slight laxity in full extension, flight or absent swelling, moderate to severe joint tightness with instability to actively extend the knee completely T or F

T

When treating MCL and LCL sprains what kind of treatment is recommended for grade 2/3?

Conservative non-operative treatment is recommended for isolated sprains

The articular surfaces of the knee joint are completely enveloped by the largest joint capsule in the body T or F

T

Bursitis cuse typically prepatellar and deep infrapatellar versa have the lowest incidence of irritation in sports T or F

F (highest)

LCL is much more common than an MCL sprain T or F

F(a lot less common)

MUSCLES INVOLVED WITH MOVEMENTS like Knee Flexion involve which muscles?

Hamstring group (3), Gracilis, Sartorius, Gastrocnemius, Popliteus, Plantaris

how can you treat Iliotibial Band friction syndrome (Runner's knee)?

IT band stretching and reducing inflammation, correction of Foot & Leg alignment problems, ice massage before and after activities, proper warm up and stretching, anti-inflammatories, transverse friction massage

what injury is can be a result from running on a road that is not flat and thus the leg that is on the lower side of a crowned road

Iliotibial Band friction syndrome (Runner's knee)

medial meniscus has a higher incidence of injury than lateral due to its attachment to the Deep portion of the MCL T or F

T

swelling in the back of the knee does not always indicate bursitis but could be a sign of a baker's cyst T or F

T

Varus Stress Test is for what ligament?

MCL

Apley's Compression test is for what ligament?

Meniscus

(MCL sprains- grade 3) ligament integrity

a complete tear of the ligament complete loss of medial stability minimum to moderate swelling, immediate severe pain followed by a dull ache, loss of motion due to effusion and muscle guarding of the hamstrings

lateral meniscus

O shaped

what kind of disease/injury is characterized by ongoing pain at the tubercle

Osgood-Schlatter disease

Godfrey's Posterior Sag test is for what ligament?

PCL

the PCL helps prevent movement where?

Prevents Femur from moving forward with weight bearing

the MCL helps prevent movement where?

Prevents Valgus forces

the LCL helps prevent movement where?

Prevents Varus forces

the ACL helps prevent movement where?

Prevents femur from moving posteriorly

MUSCLES INVOLVED WITH MOVEMENTS like Knee Extension involve which muscles?

Quadriceps (4)

MCL and LCL sprain immediate treatment

RICE for at least 24 hours crutches and knee immobilizer may be needed

Treatment for the ACL

RICE( athletes typically cannot walk without assistance due to severe swelling),Surgery (brace may be needed)

PCL treatment _____ non-operative treatment should focus on _______ strengthening for grade 1 and 2 inconclusive if surgery is more beneficial for grade 3 the athlete has surgery they will typically have ____ of immobilization

RICE, quadriceps, 6 weeks

What is considered one of the most complex joints in the human body?

The Knee

when treating medial collateral ligament sprains what is the most important time to act?

The first minute is crucial in being able to get true results for joint stability before effusion sets in

How does a medial collateral ligament sprains happen?

Valgus force or external rotation of the tibia and the foot planted

Major muscles in the quadriepts

Vastus Medialis Oblique, Vastus Lateralis, Vastus Intermedius, Rectus Femoris

when you have osgood-Schlatter's disease what happens over time?

a bony callus forms and the tubercle and larges. This typically resolved by the time the athlete turns 18 to 19

Acute patellar subluxation or dislocation- signs and symptoms

athletes experience a complete loss of function alongside pain and swelling

patellar tendonitis - signs and symptoms

athletes indicates leg pain and tenderness around the bottom of the patella or on the posterior aspect that worsens with jumping and running activities

PCL signs and symptoms

athletes report feeling a pop in the back of the knee, tenderness in the popliteal fossa, relatively little swelling

signs and symptoms of an ACL sprain

audible pop followed by immediate disability and complaining that the knee feels like it is ¨giving out¨ profuse swelling intense pain initially and then goes away

in what environment is a PCL sprain commonly seen and how

car wrecks (dashboard ligament) femur is stabilized by the car seat and the dashboard pushes the tibia posteriorly

joint contusions beginning standard treatment

compression bandages and ICE for the first 72 hours and rest for the first 24 hours

Acute patellar subluxation or dislocation -common treatment

i c e, referral to physician for reduction, mobilization for four plus weeks and athlete is to use crutches when walking,strengthening of musculature of the knee, thigh and hip, bracing / taping may be beneficial