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Kin 2236 Final Exam | All Questions and
Correct Answers | Graded A+ | Verified
Answers | Latest Exam 2025
What are the causes of achilles tendinosis? ---------CORRECT ANSWER-----------------
- may be brought on by the neglect of acute tendinitis
- years of running
- Excessive pronation (increased load on gastrocs/soleus to resupinate)
- Poor flexibility
- Training in cold climate
- Improper footwear Where is tendinosis usually found? ---------CORRECT ANSWER-----------------in the midportion of the achilles What does the diagnosis of achilles tendinosis look like? ---------CORRECT ANSWER------------------ History, FITT, Pain
- usually 2-7 cm from the insertion onto the calcaneus (you have to understand where its sore) Things to observe when diagnosing Achilles tendinosis ---------CORRECT ANSWER-- ---------------- is there swelling (there shouldn't be any swelling, more so a
thickening because its a tissue) and tenderness over a large portion of the tendon?
- Faulty biomechanics (looking to see if they're pronating too far and too fast.
- On STTT, both plantar and dorsiflexion cause pain and crepitus (if paratenon is involved), particularly with loading -- stretch and contract to make it sore
- Nodules/bumps may be palpable What does the treatment of tendinosis look like? ---------CORRECT ANSWER--------- --------- Eccentric strengthening programs provide 60-90% improvement in pain and function -- Level of Evidence A
- Rehabilitative exercises including inversion/eversion to make sure the tendon works. What is an Achilles Rupture? ---------CORRECT ANSWER------------------ The achilles tendon is the most commonly ruptured tendon
- Risk factors include: -- male sex (10:1) -- use of steroids can weaken the achilles -- more likely to rupture one if the other side is already ruptured (contralateral)
- Subjective Report (symptoms) include: -- patient reports pop or snap like someone kicked them -- pain may be immediate then rapidly subsides (usually bc its not attached to anything so there is no tension) --- usually pain only at the site of tear
Tibiofemoral Joint ---------CORRECT ANSWER------------------ articulating surfaces between the medial and lateral condyles of the femur and tibia
- allows transmission of body weight from the femur to the tibia while providing hinge-like, sagittal plane joint rotation along with a small degree of tibial axial rotation -- provide hinge-like motion (flexion + extension in the sagittal plane) Patellofemoral Joint ---------CORRECT ANSWER------------------ is the articulation between the patella and femur
- the patella is the largest sesamoid bone in the body (which helps with the extensor mechanism in the quads)
- referred to as the extensor mechanism
- also works eccentrically during gait Describe the Screw Home Mechanism ---------CORRECT ANSWER------------------ a mechanism where rotation occurs during the last few degrees of extension because the medial femoral condyle is larger than the lateral -- if foot is planted the femur rotates medially -- if the foot is fixed the tibia rotates laterally
- this locks the joint to increase stability -- ensures stability of the knee -- regulates patellar alignment
- the popliteus then must contract to externally rotate the femur on the tibia to unlock the knee
Describe knee stability ---------CORRECT ANSWER------------------ More stable in extension -- help from dynamic stabilizers
- knees have relatively poor bony fit when flexed
- knee has a strong fibrous joint capsule
- need to rely on MCL, LCL, ACL, and PCL and dynamic stabilizers The Capsule of the Knee ---------CORRECT ANSWER------------------ Knee is surrounded by a capsule -- anteriorly to suprapatellar pouch -- inferior to infrapatellar fat pad and bursa -- medially it communicates with the deep fibres of the MCL -- posteriorly covers femoral condyles
- Lined by synovial membranes, except posteriorly where it passes in front of the cruciates What are the 3 layers of the lateral support complex? ---------CORRECT ANSWER--- --------------1. Superficial
- iliotibial band and biceps femoris
- Middle
- patellofemoral ligaments and retinaculum
- Deep
- lateral (tibial) collateral ligament (LCL)
MOI for acute patellar dislocation ---------CORRECT ANSWER------------------ Forceful knee rotation (tibia ER/Femur IR) +/- forceful quads contraction bc it pulls patella up and then twists it
- Knee usually near full extension (out of trochlea)
- +/- laterally directed force Symptoms and Signs of Patellar Dislocation ---------CORRECT ANSWER----------------- Symptoms:
- may report feeling knee "shift", "move or "pop-out"
- Pain ++ until reduced
- fast swelling bc you are tearing out retinaculum Signs:
- loss of knee function (if still dislocated)
- tenderness over medial border of patella -- because they tear out
- positive lateral apprehension test -- slide knee cap laterally to get apprehension because they feel its going to dislocate
- Need to rule out ACL bc they both have hemarthrosis (75% of the time its ACL) What do you do if the patella is dislocated? ---------CORRECT ANSWER-----------------
- Slightly flex the hip and slowly extend the knee
- usually the patella relocates -- if it does not, do not force the patella medial
- there may be some associated fractures (back of the patella, lateral femoral condyle) Facts about the LCL ---------CORRECT ANSWER------------------ LCL Injuries are less common but more complicated secondary to the number of structures
- usually VARUS loading +/- hyperextension
- most contribution at 20-30 degrees of knee flexion
- may include IT band, lateral hamstrings, and/or popliteus
- can be complicated bc usually other tissues tear with it
- injury to the lateral side
- always check the other side bc it supports that side (see if injured) Facts about the MCL ---------CORRECT ANSWER------------------ 40% of all severe knee injuries involve the MCL, making it the most frequently injured knee structure -- get hit a lot from outside which open/stretches inert tissues
- VALGUS force with or without rotation
- Often occurs in isolation Signs and Symptoms of Collateral Ligament Sprains ---------CORRECT ANSWER------ ------------ Reports of pain over structure
- Swelling: Timing
--- 75% sustain meniscal injuries --- 80% have bone bruise on lateral joint line or (segond fracture)
- 2 - 8x higher injury rate in females due to hip and knee angles MOI for ACL injuries ---------CORRECT ANSWER------------------ Valgus after MCL - usually with contact
- Deceleration/Internal Rotation - non-contact
- Protected in box, straight hyperextension should not tear AC: -- can tear ACL in hyperextension but NOT isolation --- if torn, there will be other things that injure as well
- Quads active - anterior tibial translation Quads Active Mechanism in ACL injury ---------CORRECT ANSWER------------------ Main mechanism -- rapid deceleration -- untoward landing
- Shoe- surface interface friction
- Anterior tibial dislocation by quads
- see it more in women bc they use their quads more than hamstring and cutting/landing on straight knee -- quads pull so hard they dislocate anteriorly
- If it was hyperextension, bone bruise would be on front and on top -- why straight hyperextension isn't a mechanism
-- what most people think they are trying to explain but its actually the quads active mechanism --- quads turn on so much that it dislocates and tears it out What independent tendons come together to become one tendon? --------- CORRECT ANSWER-----------------The gastrocnemius and the soleus fuse together approx 5-6 cm proximal to the calcaneal insertion What is proximal to the insertion and between the tendon and calcaneus? --------- CORRECT ANSWER-----------------the retrocalcaneal bursa Facts about the achilles tendon ---------CORRECT ANSWER------------------ it is the thickest and strongest tendon in the body
- has no synovial sheath but is surrounded by the paratenon -- only vascular tendons are surrounded by paratenon What should you consider when having heel pain? ---------CORRECT ANSWER------- ----------- It could be: achilles tendonitis, achilles bursitis or retrocalcaneal bursitis
- you need to decide exactly where the pain is
- true tendon pain is usually only painful ON the tendon itself
-- New shoes/popped out - shoe repair, hammer/pop out shoe so theres more room over the spot What is Tendinitis? ---------CORRECT ANSWER-----------------an inflammation of the tendon and is relatively rare What is paratenonitis? ---------CORRECT ANSWER-----------------Inflammation, pain, and crepitation (creaking feeling) of the paratenon as it slides over the structure How does tendinitis/paratenonitis occur? ---------CORRECT ANSWER------------------ Acute Irritation: -- Too much, Too soon
- External Factors such as: -- Rub from shoe/equipment -- Running down hill -- tibialis anterior -- Rub from laces -- tibialis anterior -- Hyper dorsiflexion -- achilles
- Internal Factors such as: -- Rub over bone --- Cavus or flat/pronating feet
Symptoms and signs of paratenonitis/tendinitis ---------CORRECT ANSWER----------- ------- Pain and/or crepitation (of paratenon) of acute onset
- Red and hot over involved structure (remember itis = red, hot, swollen, painful)
- Usually precipitated by movement around the ankle joint -- too much, too soon!!! Diagnosis of paratenonitis/tendinitis ---------CORRECT ANSWER------------------ Made on the basis of local swelling
- STTT -- ex. plantar/dorsiflexion, moving toes etc. -- tendon is contractile therefore it needs to contract or put it on stretch to see which one it is Rehabilitation of Paratenonitis during the inflammatory destructive phase --------- CORRECT ANSWER------------------ remember during this phase there is red, hot, painful, swelling
- POLICE/PEACE&LOVE
- Heel lift/pad/support Rehabilitation of Paratenonitis during the repair phase ---------CORRECT ANSWER-- ---------------- remember in this phase there is pain, the swelling subsides and there is tissue healing
- Heat
- Idealize ROM by stretching gastroc and soleus
--- usually the lateral joint line point/pain is ACL -- LCL tear is more common in MMA but overall not very common Lateral Collateral Ligament (LCL) ---------CORRECT ANSWER------------------ Round fibrous cord about the size of a pencil
- extends from the lateral epicondyle of the femur to lateral fibular head
- extracapsular -- not gonna have much swelling
- Primary static restraint to varus -- muscles give us majority of support on lateral side (just static restraint) Loading of knee flexion and extension ---------CORRECT ANSWER------------------ Loading response at all angles -- Load at 25-30 degrees greater than at 90 degrees What are the 3 layers of the Medial Support Complex? ---------CORRECT ANSWER-- ---------------1. Superficial
- sartorius and fascia
- Middle
- contains superficial MCL and semimembranosus (hamstring muscle group)
- Deep
- contains deep fibres of MCL and capsule
What does the stability of a Medial Support Complex look like? ---------CORRECT ANSWER------------------ MCL primary stabilizer does most of its work at 25- 30 degrees of flexion -- ACL/PCL secondary vs. valgus
- Muscles help in full extension -- medial hamstrings (sartorius, semimembranosus + semitendinosus_ -- medial head of gastrocs. -- quad muscle (vastus med.)
- Bony structure is tertiary support -- bony support in full extension What is the MCL? ---------CORRECT ANSWER------------------ broad unlike the LCL -- narrow and extracapsular
- A capsular ligament (swells) -- thick capsular effusion in 8 hours
- Has superficial and deep components -- deep portions connect directly to the medial meniscus -- superficial portions run from medial femoral epicondyle to superomedial surface of tibia Knee flexion and extension (medial view) ---------CORRECT ANSWER------------------ Most active resisting valgus loading when knee is 25-30 degrees of flexion
- each part loaded at varying angles
- the wider the ligament turns, the more its on stretch
- Deep MCL = 8%
- Posterior Capsule = 18% What should you check when there is significant MCL injury? ---------CORRECT ANSWER-----------------ALWAYS CHECK THE PCL AND ACL because they are the 2nd line of support against that mechanism Describe what happens during a retrocalcaneal bursitis ---------CORRECT ANSWER-
Anatomy of the ACL ---------CORRECT ANSWER------------------ Runs from the ant. aspect of tibial plateau to post. medial aspect of lateral femoral condyle
- primary restrain to ant. tibial ext.
- greatest translation occurs at 20-30 degrees What are the 2 major bundles that are named for their attachment on the tibia (ACL)? ---------CORRECT ANSWER------------------ Anteromedial -- tighter in flexion
- Posterolateral -- tighter in extension What is the stabilizing role of the ACL? ---------CORRECT ANSWER------------------ weaker of the two cruciate ligaments
-- functions to restrict posterior translation of the femur relative to the tibia during weight bearing -- restricts anterior translation of the tibia during non weight-bearing --- stops tibia from sliding forward
- but if its fixed, stops femur from sliding backwards -- also limits excessive rotation of the tibia --- bad collateral (LCL/MCL) issue, check ACL/PCL bc they are the secondary restraints -- secondary support for valgus and varus with collateral ligament damage
- running from front to back Anatomy of the PCL ---------CORRECT ANSWER------------------ The PCL originates on the lateral aspect of the medial femoral condyle and inserts posteriorly to intercondylar area of tibia
- passes medially to the ACL
- Larger and stronger than the ACL
- primary restraint to posterior tibial translation
- Greatest translation occurs at 20-30 degrees What are the 2 major bundles that are named for their attachment on the tibia (PCL)? ---------CORRECT ANSWER------------------ Anterolateral -- Tight in Flexion
- Posteromedial -- Tight in Extension
