Laurie Stuff
What activity is difficult after a TKA and what activity(ies) are prohibited?
Kneeling
Running, Jumping
What PCL special test should you do before checking other structures, and why?
Posterior Sag
It can confound results-- I.e. anterior drawer could be positive because it moves excessively from it's already posterior position
Which direction does the patella normally dislocate/sublux?
laterally
Briefly describe contact guard (CG), stand by assistance (SBA), verbal guidance (VG)/cue (VC)
Have a discussion about when you would use each.
min: patient does 75% mod: patient does 50% max: patient does 25%
CG: flexor grip on gait belt and one hand on shoulder
SBA: could still have gait belt, but PT stand close enough to be there just in case
Verbal guidance/cues: patient is able to follow independent enough to transfer/ambulate but needs verbal guidance/reminders
What is Graded Motor Imagery, what are the 3 levels of it?
process of training/retraining your brain to help with complex pain syndromes
R/L discrimination
Explicit Motor Imagery
Mirror Therapy
What is the Pittsburg Fx Rule?
recommended imaging if MOI was blunt trauma/fall AND either of the following:
-age <12 or >50
-cannot ambulate WB 4 steps in ED or sideline
What is the common MOI for ACL injury?
valgus+rotation: landing, pivoting, twisting
-hyperextension
What is the MOI for patellar tendon rupture?
sudden deceleration
sports or slipping on wet surface
Define/Describe...
Reciprocal inhibition
Synergistic Dominance
Arthrokinetic Inhibition
Reciprocal inhibition: tight muscles decreases the neural drive to its functional antagonist, compensation patterns/injury I.e. biceps&triceps, quad&hamstrings, gastroc&tib ant
Synergistic Dominance: synergists, stabilizers, and neutralizers take over for a weak or inhibited prime mover i.e. TFL for glut med, hamstrings for glut max
Arthrokinetic Inhibition: a muscle inhibited by joint dysfunction or the capsule that crosses the joint
Common treatment for lateral/medial epicondylalgia?
bracing: changes angle of pull, limits movement of tendons
avoid aggravating activities
Manipulation: mulligans moving mobilization
Support for eccentric activity
Consider the shoulder: if you don't have good control of the shoulder, then the elbow could be compensating
Steroids for short term
Iontophoresis for short term
autologous blood injections/PRP to simulate healing??
surgical??
What are two common ways to fracture the patella?
(types.. describe each and what force would cause them?)
Transverse-- horizontal break, right angle to bone
--> bending force
Comminuted-- results in 3+ fragments
--> compression or impaction force
What should be focussed on strengthening as management of a PCL tear?
Quad-- prevent posterior translation of tibia
What are some predisposing factors to PFS?
quad or proximal weakness (hip ER, core)
hypermobility
decreased quad/hamstring flexibility
increased pronation
alignment
What is the second column of the 4x4 matrix?
1: no resistance, pattern assist (feedback)
2: no resistance (no load)
3: pattern assist and resistance (load+feedback)
4: resistance (load)
Which Knee procedures limit WB afterward?
Meniscal REPAIR (NOT meniscectomy)
Patellar Tendon Repair
Proximal Tibia Fracture
OATS/ACI (articular cartilage repair)
What are two complications with a proximal tibial fracture?
-decreased ROM
-DJD
-Popliteal artery could be damaged
-Tibial/Common Peroneal nerves could be damaged
MCL has good blood supply and can often heal on its own
LCL probably needs surgery, but it is a less common injury
What are the 3 surgical options for articular cartilage injury?
describe them
Microfracture: small fractures into subchondral bone to stimulate new growth of cartilage, fastest recovery but least optimal outcomes
Autologous chondrocyte implantation (ACI): harvest pt's cartilage, new chondrocytes injected under periosteu, PWB to stimulate bone
Osteochondral Autograft Transfer System (OATS): harvest bone plugs from NEW regions and plug into regions of defecits, slow rehab (12-18 mo)
What is the SAID principle and how is it applied?
BONUS...
typical dosing for strength, strength/endurance, & endurance
Specific Adaptation on Imposed Demands;
some muscles function in strength type mode, train them for that... some muscles function in endurance type mode, train them for that (you have to progress exercises)
strength: 2-3sets of 8-10 reps (>90% of 1RM)
strength/endurance: 2-3 sets of 15 reps (~75% 1RM)
endurance: 2-3 sets of 20-30 reps (<65% of 1RM)
Distinguish primary, secondary, and posterior rotator cuff impingement
primary: structural/biomedical/anatomical crowding, d/t bone spurs and DJD... hypomobility... excessive superior migration of humeral head
secondary: mechanical instability impairment of muscle coordination, weakness of scapular stablizers... hypermobility...pathological laxity
posterior: repetitive contact between posterior aspect of humeral head and posterior/superior border of glenoid... pinching of supra/infraspinatus (like pitchers)
ALL are a combo of stiffness of posterior capsule, roughness of subacromial bursa, weakness of rotator cuff
What is the typical recovery in time for...
Tendinitis
Muscle Strain (Grade III)
Ligament Sprain (Grade III)
Ligament Graft
Articular Cartilage Repair
Tendinitis: 3-7weeks
Muscle: 3wks-6mo
Ligament Sprain: 5wks-6mo
Ligament Graft: 2mo-2years
Articular Cartilage Repair: 2mo-2years
Name the normal function of ACL, MCL, LCL, and PCL
ACL: resist anterior translation of the tibia on the femur
MCL: resist valgus stress
LCL: resist varus stress
PCL: resist posterior translation of the tibia on the femur
What is general management for PFS/AKP?
(need to find the cause)
cannot selectively strengthen VMO
surgical management (synovectomy, lateral retinacular release, realignment; not great outcomes overall)
Describe the 6 types of gait, what could be used with them, and when you would use them.
(refer to notes on the descriptions)
3pt: crutches, walker... NWB on one LE, typically short term
3-1pt: crutches, walker... PWB on one LE, typically short term and a progression from 3pt
2pt: Crutches, Loftstrand crutches, bilateral canes... bilateral involvement of LE (neurological), balance assistance, long term
2-1pt: single crutch, single Loftstrand, cane, hemiwalker... unilateral involvement, hemiplegic, balance assistance, long term
4/4-1pt same as 2/2-1pt
What is the pharmacologic treatment for RA? What is the MOA?
Disease Modifying Anti Rheumatic Drugs
-target immune system
-MOA differs per drug, but ultimate regulates immune response (affecting inflammatory mediators, inhibiting lymphocytes)