Knee Bursitis

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WWW.OROFINOPHYSICALTHERAPY.COM HEALTH & FITNESS The Newsletter About Health and Caring For Your Body Knee Bursitis There are 5 major bursa in the knee. (see picture) Bursa’s are fluid filled sacs that pad areas where tendons rub over bone. They help protect the tendons of the knee from blunt trauma and fric- tion, but can often become injured themselves in doing so. Bursitis can result from prolonged kneeling, re- petitive motions (running) or from bumping the knee. When a bursa is injured it will commonly swell up; Common Symptoms swelling can vary to mild to severe. Pain with kneeling As the bursa swells it will be accom- Stiffness/pain with panied with pain, redness and walking warmth resulting in some loss of Swelling motion/strength and use. Treatment Redness consists of controlling the inflamma- Tenderness tion and restoring motion/function Warmth of the leg. If swelling is severe phy- sicians may “drain” the fluid from Goals of Physical Therapy SUCCESS STORY the knee which can immediately de- Education My job requires me to do crease that pain that was being a lot of kneeling. This Controlling pain/inflammation caused by the pressure. To decrease Joint Protection caused my knees to hurt your chances of bursitis, where knee and swell up. Therapy re- Normalizing flexibility and pads if you do a lot of kneeling, strength of leg solved my pain and even make sure you are stretching well if more important, I learned Assessment of work ergonomics you are active and that you have Assess athletic body mechanics what I could do to keep it good footwear and sport mechanics. from coming back. If you have had knee pain that has If you or someone you know is Physical Therapy ended lasted longer than 2 weeks, it is time suffering with pain, call us to learn up being fast and fun. to get additional help to keep things how Orofino Physical Therapy ~S.K. from getting worse. can help! Boise * Eagle *OROFINO Emmett PHYSICAL * Middleton THERAPY * & MountainWELLNESS Home * McCall 375-0666 1005 939 MICHIGAN– 9601 AVENUE 365-5341 OROFINO, 585-6566 IDAHO 83544 587 - 1777208 - 476 - 9365 634- 3555 .

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Knee Pain Prevention
DOCTORS CARE OSTEOARTHRITIS PROGRAM FOR Knee Pain Prevention Our program offers a non-surgical option that is safe and effective What Is Osteoarthritis of the Knee? In most cases osteoarthritis is caused by a slow degenerative process whereby, as we age and become less active, we tend to get tighter joints and weaker muscles. This in turn causes our joints to become dysfunctional and then become inflamed. The inflammation causes decreased blood flow to the joint tissues and thus decreased production of joint fluid. This, in turn, causes wear and tear on the joint which causes more inflammation and even less nutrients to the joint tissues. As a result, range of motion and strength are further decreased causing greater dysfunction Aand Healthy greater Joint inflammation. Left untreated, this will lead to a Medialdownward collateral ligamentspiral of degeneration. Joint capsule Muscles Tendons A Healthy Joint Medial collateral ligament Joint capsule Muscles TendonsBone Cartilage Synovial uid In a healthy joint, the ends of bones are encased in smooth cartilage. Together, they are protected by a joint capsule lined with a Bonesynovial membrane thatCartilage produces synovial uid. e capsule and uid protect the cartilage, muscles, and connective tissues.Synovial uid InA aJoint healthy With joint, theSevere ends of Osteoarthritis bones are encased in smooth cartilage. Together, they are protected by a joint capsule lined with a synovial membrane that produces synovialMedial uid. collateral e capsule ligament and uid protect the cartilage, muscles, and connectiveBone spurs tissues. Muscles A Joint With Severe Osteoarthritis Tendons Medial collateral ligament Bone spurs Muscles TendonsBone Worn-away Cartilage cartilage Synovial uid fragments in uid With osteoarthritis, the cartilage becomes worn away.
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Knee Osteoarthritis
BRIGHAM AND WOMEN’S HOSPITAL Department of Rehabilitation Services Standard of Care: _Osteoarthritis of the Knee Case Type / Diagnosis: Knee Osteoarthritis. ICD-9: 715.16, 719.46 Osteoarthritis/Osteoarthrosis (OA) is the most common joint disease causing disability, affecting more than 7 million people in the United States 1. OA is a disease process of axial and peripheral joints. It is characterized by progressive deterioration and loss of articular cartilage and by reactive bone changes at the margins of the joints and in the subchondral bone. Clinical manifestations are characterized by slowly developing joint pain, stiffness, and joint enlargement with limitations of motion. Knee osteoarthritis (OA) results from mechanical and idiopathic factors that alter the balance between degradation and synthesis of articular cartilage and subchondral bone. The etiology of knee OA is not entirely clear, yet its incidence increases with age and in women. 1 The etiology may have genetic factors affecting collagen, or traumatic factors, such as fracture or previous meniscal damage. Obesity is a risk factor for the development and progression of OA. Early degenerative changes predict progression of the disease. Underlying biomechanical factors, such as varum or valgum of the tibial femoral joint may predispose people to OA. However Hunter et al 2reported knee alignment did not predict OA, but rather was a marker of the disease severity. Loss of quadriceps muscle strength is associated with knee pain and disability in OA. Clinical criteria for the diagnosis of OA of the knee has been established by Altman3 Subjects with examination finding consistent with any of the three categories were considered to have Knee OA.
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Patellar Tendinopathy: Some Aspects of Basic Science and Clinical Management
346 Br J Sports Med 1998;32:346–355 Br J Sports Med: first published as 10.1136/bjsm.32.4.346 on 1 December 1998. Downloaded from OCCASIONAL PIECE Patellar tendinopathy: some aspects of basic science and clinical management School of Human Kinetics, University of K M Khan, N MaVulli, B D Coleman, J L Cook, J E Taunton British Columbia, Vancouver, Canada K M Khan J E Taunton Tendon injuries account for a substantial tendinopathy, and the remainder to tendon or Victorian Institute of proportion of overuse injuries in sports.1–6 tendon structure in general. Sport Tendon Study Despite the morbidity associated with patellar Group, Melbourne, tendinopathy in athletes, management is far Victoria, Australia 7 Anatomy K M Khan from scientiﬁcally based. After highlighting The patellar tendon, the extension of the com- J L Cook some aspects of clinically relevant basic sci- mon tendon of insertion of the quadriceps ence, we aim to (a) review studies of patellar femoris muscle, extends from the inferior pole Department of tendon pathology that explain why the condi- of the patella to the tibial tuberosity. It is about Orthopaedic Surgery, tion can become chronic, (b) summarise the University of Aberdeen 3 cm wide in the coronal plane and 4 to 5 mm Medical School, clinical features and describe recent advances deep in the sagittal plane. Macroscopically it Aberdeen, Scotland, in the investigation of this condition, and (c) appears glistening, stringy, and white. United Kingdom outline conservative and surgical treatment NMaVulli options. BLOOD SUPPLY Department of The blood supply has been postulated to con- 89 Medicine, University tribute to patellar tendinopathy.
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Posterior Cruciate Ligament (PCL): Reconstruction and Rehabilitation
Patient information – PCL reconstruction Posterior cruciate ligament (PCL): reconstruction and rehabilitation Introduction Posterior cruciate ligament reconstruction is an operation to replace your torn posterior cruciate ligament (PCL) and restore stability to your knee joint. This leaflet outlines what happens during and after surgery, outlines the risks and benefits, and gives advice and exercises to help you recover if you decide to go ahead with the operation. Posterior (back) view Anterior (front) view The PCL is the largest ligament in the knee and stops the shin bone from moving too far backwards, relative to your thigh bone. It is commonly injured by a significant blow to the front of the knee/upper shin. Most athletic PCL injuries occur during a fall onto the flexed (bent) knee. Hyperextension (‘over straightening’) and hyperflexion (‘bending too far’) of the knee can also cause a PCL injury and the PCL is often involved when there is injury to multiple ligaments in a knee dislocation. Not everyone who has a PCL injury will require surgery as most isolated tears (no other ligaments involved) can heal just with the early application of an appropriate splint/brace. If the ligament does not heal or there are other ligaments involved, some people can notice a ‘looseness’ and an occasional feeling of giving way. This requires a reconstruction (replacement) operation. Posterior cruciate ligament (PCL) reconstruction, August 2020 1 Posterior cruciate ligament (PCL) reconstruction Reasons for not operating To undertake this major reconstruction, you must have appropriate symptoms of instability. This is not an operation for pain. An operation is not recommended if there is any active infection in or around the knee or when there is a lot of other disease, such as arthritis, within the joint.
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ANTERIOR KNEE PAIN Home Exercises
ANTERIOR KNEE PAIN Home Exercises Anterior knee pain is pain that occurs at the front and center of the knee. It can be caused by many different problems, including: • Weak or overused muscles • Chondromalacia of the patella (softening and breakdown of the cartilage on the underside of the kneecap) • Inflammations and tendon injury (bursitis, tendonitis) • Loose ligaments with instability of the kneecap • Articular cartilage damage (chondromalacia patella) • Swelling due to fluid buildup in the knee joint • An overload of the extensor mechanism of the knee with or without malalignment of the patella You may feel pain after exercising or when you sit too long. The pain may be a nagging ache or an occasional sharp twinge. Because the pain is around the front of your knee, treatment has traditionally focused on the knee itself and may include taping or bracing the kneecap, or patel- la, and/ or strengthening the thigh muscle—the quadriceps—that helps control your kneecap to improve the contact area between the kneecap and the thigh bone, or femur, beneath it. Howev- er, recent evidence suggests that strengthening your hip and core muscles can also help. The control of your knee from side to side comes from the glutes and core control; that is why those areas are so important in management of anterior knee pain. The exercises below will work on a combination of flexibility and strength of your knee, hip, and core. Although some soreness with exercise is expected, we do not want any sharp pain–pain that gets worse with each rep of an exercise or any increased soreness for more than 24 hours.
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ACR Appropriateness Criteria® Chronic Knee Pain
Revised 2018 American College of Radiology ACR Appropriateness Criteria® Chronic Knee Pain Variant 1: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography knee Usually Appropriate ☢ Image-guided aspiration knee Usually Not Appropriate Varies CT arthrography knee Usually Not Appropriate ☢ CT knee with IV contrast Usually Not Appropriate ☢ CT knee without and with IV contrast Usually Not Appropriate ☢ CT knee without IV contrast Usually Not Appropriate ☢ MR arthrography knee Usually Not Appropriate O MRI knee without and with IV contrast Usually Not Appropriate O MRI knee without IV contrast Usually Not Appropriate O Bone scan knee Usually Not Appropriate ☢☢☢ US knee Usually Not Appropriate O Radiography hip ipsilateral Usually Not Appropriate ☢☢☢ Variant 2: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph negative or demonstrates joint effusion. Next imaging procedure. Procedure Appropriateness Category Relative Radiation Level MRI knee without IV contrast Usually Appropriate O Image-guided aspiration knee May Be Appropriate Varies CT arthrography knee May Be Appropriate ☢ CT knee without IV contrast May Be Appropriate ☢ US knee May Be Appropriate (Disagreement) O Radiography hip ipsilateral May Be Appropriate ☢☢☢ Radiography lumbar spine May Be Appropriate ☢☢☢ MR arthrography knee May Be Appropriate O MRI knee without and with IV contrast Usually Not Appropriate O CT knee with IV contrast Usually Not Appropriate ☢ CT knee without and with IV contrast Usually Not Appropriate ☢ Bone scan knee Usually Not Appropriate ☢☢☢ ACR Appropriateness Criteria® 1 Chronic Knee Pain Variant 3: Adult or child greater than or equal to 5 years of age.
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Patellar Instability
Females are at higher risk of having patellar instability. “YOUNG ATHLETES SUFFER PATELLAR DISLOCATIONS MORE COMMONLY THAN ANY OTHER AGE GROUP” 2 Patellar Instability PATELLAR INSTABILITY A PATIENT INFORMATION GUIDE The knee joint is made up of 3 bones: the femur for patellar instability. Some patients also have a (thigh bone), the tibia (shin bone) and the patella congenital condition in which the trochlear groove is (kneecap). Usually, the patella sits in the trochle- more “shallow”. In this situation, there is a loss of the ar groove, which is a groove at the distal end of the bony restraint to help hold the patella in place which femur. This forms the patellofemoral joint(figure 1). makes patellar dislocation more likely. There is also a Patellar instability is a condition that occurs when the tendency for patellar dislocation to run in families. kneecap comes out of the trochlear groove. Patellar When the patella dislocates, the soft tissue on subluxation occurs when the patella only partially the inner side of the patella may be stretched or torn, moves out of the trochlear groove. Dislocation of the including a ligament known as medial patellofemoral patella occurs when the patella moves completely out ligament (MPFL) which usually helps to hold the pa- of the trochlear groove. tella in place. Up to half of people who dislocate their Patellar dislocations are typically laterally where- patella will have further dislocations. They may also by the patella moves out of the groove towards the feel that the patella is unstable, even if it does not outer side of the knee joint.
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Osteoarthritis of the Knee
DR. THOMAS COMFORT OSTEOARTHRITIS OF THE KNEE What is osteoarthritis? Osteoarthritis, also known as degenerative (wear and tear) arthritis, is the most common type of arthritis. It is frequently a slowly progressive joint disorder. Osteoarthritis is the loss or breakdown of cartilage which is the protective covering on the ends of each bone where two or more bones come into contact to form a joint. One analogy of osteoarthritis is to compare it to parts of an orange. The orange peel is like healthy cartilage that protects the fruit and the underlying fruit is your bone. As the protective orange peel (cartilage) thins and is lost, it exposes the underlying fruit (bone). Healthy intact cartilage allows bones to glide over one another pain free since it does not have pain receptors. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down exposing the underlying bone which has pain receptors. Cartilage loss allows bones in the joint to rub together, causing pain, stiffness, swelling and loss of motion. Over time the joint may lose its normal alignment and change in size. Exposed bones rubbing on each other can cause extra bone formation called osteophytes or bone spurs. Bone spurs are like your skin developing calluses when chronic pressure has been applied, and the tissue thickens and hardens. How did I get osteoarthritis? Osteoarthritis develops over time and likely you didn’t do anything to cause it. With osteoarthritis being a breakdown of cartilage, it is more common in people over 50, and in people who are overweight.
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PCL Injury Management: a Review of Current Literature
Spencer Edgerton PHYT 875 Final Paper 12/6/18 PCL Injury Management: A Review of Current Literature Historically, the posterior cruciate ligament (PCL) of the knee has been less extensively studied relative to other knee ligaments. In recent years, however, better understanding of the biomechanical and anatomical function of the PCL has led to increased controversy over the management of injury involving this ligament.1,2 PCL injury, rare in isolation, typically occurs with concomitant ligament injury (46% anterior cruciate ligament [ACL], 31% medial collateral ligament [MCL], and 62% with posterolateral corner [PLC]).1 In fact, up to 95% of PCL injury occurs as part of a multi-ligament injury.2 Traditionally, lower grade PCL injury has been treated conservatively due to the intrinsic healing capacity of the ligament, with more severe injury and multi-ligament injury treated surgically.1–4 Although positive clinical outcomes are commonly achieved through conservative management, with the presence of more recent research that implicates PCL-deficiency in knees as contributing to increased joint laxity, increased incidence of arthrosis, and less favorable long-term outcomes, further attention and controversy has surfaced regarding the recommended treatment for PCL injury.2,3 Recent research has focused on determining indications for conservative or surgical management, which surgical technique is preferred, and implications for short and long-term outcomes. Therefore, the purpose of this research paper is to present recent evidence discussing
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Lateral Knee Pain: Iliotibial Band Syndrome
Lateral Knee Pain: Iliotibial Band Syndrome *Are you experiencing pain at the outside of your knee when you run? *Does the outside of your knee ache after sitting or climbing stairs? Iliotibial Band Syndrome (ITB syndrome) is one of the leading causes of lateral knee pain in runners, bikers and athletes in all sports that involve a lot of running yes, this includes soccer! The ITB is a broad thick band of fascia that extends from the top edge of pelvis, over the outside hip and along the outer thigh to attach just below the knee the longest tendon in the body. ITB Syndrome is typically considered an inflammatory condition that is due to friction (rubbing) of this band over the outer bony region of the knee. Inflammation of this fascia causes pain, a thickening of the tissue, and possibly restrictions to motion around the knee and hip. Symptoms ● Typically described as lateral (outer) knee pain. It can however progress along the entire outer leg when severe, or cause pain at the lateral hip or into the kneecap. ● Individuals may feel a snapping of this fascia when the knee is flexed and extended. ● Pain often occurs midway through an event and lingers afterward, especially if running on hills or climbing out of the saddle. ● When the condition becomes more severe, pain may be present with sitting or stair climbing tasks. ● Prolonged or progressive symptoms commonly lead to poor patella (kneecap) tracking, a condition known as Patellofemoral Syndrome. Common Causes of injury ITB syndrome can occur from poor training habits or from poor biomechanical alignment during exercise.
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Iliotibial Band Syndrome: a Common Source of Knee Pain RAZIB KHAUND, M.D., Brown University School of Medicine, Providence, Rhode Island SHARON H
Iliotibial Band Syndrome: A Common Source of Knee Pain RAZIB KHAUND, M.D., Brown University School of Medicine, Providence, Rhode Island SHARON H. FLYNN, M.D., Oregon Medical Group/Hospital Service, Eugene, Oregon Iliotibial band syndrome is a common knee injury. The most common symptom is lateral knee pain caused by inflammation of the distal portion of the iliotibial band. The iliotibial band is a thick band of fascia that crosses the hip joint and extends distally to insert on the patella, tibia, and biceps femoris tendon. In some athletes, repetitive flexion and extension of the knee causes the distal iliotibial band to become irritated and inflamed resulting in diffuse lateral knee pain. Iliotibial band syndrome can cause significant morbidity and lead to cessation of exercise. Although iliotibial band syndrome is easily diagnosed clinically, it can be extremely challenging to treat. Treatment requires active patient participation and compliance with activity modifica- tion. Most patients respond to conservative treatment involving stretching of the iliotibial band, strengthening of the gluteus medius, and altering training regimens. Corticosteroid injections should be considered if visible swelling or pain with ambulation persists for more than three days after initiating treatment. A small percentage of patients are refractory to conservative treatment and may require surgical release of the iliotibial band. (Am Fam Physician 2005;71:1545-50. Copyright© American Academy of Family Physicians.) See page 1465 for liotibial band syndrome is a common it slides over the lateral femoral epicondyle strength-of-evidence knee injury that usually presents as lat- during repetitive flexion and extension of labels.
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Runsmart Iliotibial Band Syndrome “Runners' Knee”
SISTER KENNY® SPORTS & PHYSICAL THERAPY CENTER RunSMART Iliotibial Band Syndrome “Runners’ Knee” The following are general recommendations for runners and are only appropriate for those who are healthy and cleared to exercise by their doctor. What is iliotibial band (ITB) syndrome? ITB syndrome is the most common cause of lateral knee pain in runners and a problem of over usage experienced by bicyclists, runners and long distance walkers. The ITB is a long tendon that attaches to a short muscle at the top of the pelvis called the tensorfascia lata. The ITB runs down the side of the thigh and connects to the outside edge of the tibia, just below the middle of the knee joint. You can feel the tendon on the outside of your thigh when you tighten your leg muscles. The ITB crosses over the side of the joint, giving added stability to the knee. When the knee is bent and straightened, the tendon glides across the edge of the femoral condyle. A bursa is a fluid-filled sac that cushions body tissues from friction. Normally, this bursa lets the tendon glide smoothly back and forth over the edge of the femoral condyle as the knee bends and straightens. Continued irritation may provoke increased amounts of pain on the outside of the knee just above the joint. The pain may become so bothersome that it limits active individuals from participation in activities. Some recent studies have suggested that ITB syndrome may be more of a compression syndrome of the fat deep to the ITB and of the fibrous bands connecting the ITB to the femur versus a friction syndrome of the band.
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