Download Knee Examination: Terms, Tests, and Structures and more Quizzes Health sciences in PDF only on Docsity!
Why is the knee joint complex susceptible to
injury?
not much bony support, relies on femoral condyles sitting on top of menisci and ligamentous attachments TERM 2
Resting position of the knee?
DEFINITION 2 25 degrees flexion TERM 3
Close packed position of the knee?
DEFINITION 3 extension and lateral rotation TERM 4
Capsular pattern of the knee
DEFINITION 4 flexion>extension limitation TERM 5
Functions of menisci?
DEFINITION 5 shock absorbercongruencylubrication and nutritionincrease surface contact area
What kind of bone is the patella?
sesamoid bone -- fully encapsulated within the tendon TERM 7
Functions of the patella
DEFINITION 7 increases the moment arm for knee extensiondecreases friction from the quads or patellar tendoncontrols capsular tension in the knee TERM 8
What connects the menisci to the tibia?
DEFINITION 8 coronary ligaments TERM 9
Lateral directed forces on the patella
DEFINITION 9 IT bandBowstringing force on the patellaLateral patellar retinacular fibers TERM 10
Medial directed forces on the patella
DEFINITION 10 vastus medialis (oblique fibers)medial patella (retinacular fibers)
Area of patellofemoral joint
symptoms
symptoms anywhere around the patella. May also refer inferior to knee, and into popliteal fossa. TERM 17
What other structures may refer pain to the
knee?
DEFINITION 17 Lumbar spine (L2-4) and Hip complex TERM 18
Aggravating factors for a knee injury
DEFINITION 18 walk/run stairs/hills deep squat kneeling TERM 19
Walk/Run
DEFINITION 19 terrain (even vs. uneven, soft vs. hard, incline/decline?), footwear, training level/habits. TERM 20
Stairs/Hills
DEFINITION 20 ascending (concentric loading) vs. descending (eccentric loading = aggressive forces). Joint position and reaction forces.
Deep squat
increased PF and TF Joint forces, prolonged flexion OA at knee. Sitting can also be considered prolonged flexion, but involves decreased joint reaction forces. TERM 22
Kneeling
DEFINITION 22 area of contact important to differentiate between TF and PF joint reaction forces. TERM 23
Questions to ask the patient if not offered
spontaneously
DEFINITION 23 Locking (meniscus) swelling Crepitus (noise is ok but noise with discomfort is bad) giving way (true giving way, or pain inhibition?) TERM 24
Meniscal injuries caused by what?
DEFINITION 24 torsion TERM 25
Valgus force causes injuries to what?
DEFINITION 25 medial structuresACL"terrible triad"
Gradual onset knee injuries may be caused by
what?
Overuse, misuse, disuse, abuse, chronic subclinical disorder Change in activity level (increased/decreased), change in equipment/footwear, change in terrain (treadmill to street or to hills vs. flat terrain) Previous history of knee symptoms whichMay accelerate degenerative process Previous history of lower extremity dysfunction Including hip and ankle/foot complex If history of previous ankle injury produced altered weight bearing and gait, could this potentially led to knee symptoms? TERM 32
Functional position analysis portion of the
observation
DEFINITION 32 Patient to provide a quick reassessment (asterisk) sign relative to their concept of their functional limitation. THEIR demonstration of THEIR functional movements affected by THEIR disorder TERM 33
Observation in
standing
DEFINITION 33 Posture Are the deviations protective or habit? Pelvis: asymmetry Hip: anteversion/retroversion Knee: varus/valgus, recurvatum Ankle: pronation/supination TERM 34
Normal tibiofemoral shaft angle
DEFINITION 34 6 degrees of valgus TERM 35
Miserable malalignment syndrome
DEFINITION 35 increased femoral anteversion anterior pelvic tilt decreased tibiofemoral angle (excessive q-angle) genu recurvatum patella subluxation excessive lateral force lateral tibial torsion foot pronation
What is observed in lateral standing
observation?
genu recurvatum -- hyperextension patella alta -- fat pad camel sign patella baja tilt of inferior patella pole -- may cause fat pad irriation TERM 37
What is observed in posterior standing
observation?
DEFINITION 37 Look for similar findings as in anterior viewAbnormal swellings? Bakers (popliteal) cyst- herniation of synovial tissue through a weakening in the posterior capsule wall TERM 38
Functional Quick Tests
DEFINITION 38 Single Leg Balance Forward/Backward Walking Step Up/Down Squat BalanceBounce in full squat Kneeling in quadruped into full flexion Lumbar Spine Clearing TERM 39
How to clear the
hip?
DEFINITION 39 Perform flexion, IR and flexion/adduction simultaneously to clear the hipif no symptoms, then ok TERM 40
Active ROM in the exam
DEFINITION 40 Compare knee ROM in non-weight bearing to range observed when patient performed squat in standing Knees should extend equally and If not then possible swelling, loose body, meniscal injury, etc Swelling or Ecchymosis -- If swelling is intracapsular, the knee will be positioned in 15-25 flexion (resting position of the knee) intracapsular swelling is evident over the entire jointextracapsular swelling is more localized
Muscles testing for
length
HamstringsHip AbductorsHip AdductorsITBGastrocAll have the ability to effect mobility and/or stability at the knee TERM 47
Static resisted tests
DEFINITION 47 Knee Extension Knee Flexion -- Differentiate between medial and lateral hamstring muscles Dorsiflexion/Plantarflexion -- What is the relationship to the knee with ankle movement? Hip Abd/Add Hip ER TERM 48
Valgus stress test
DEFINITION 48 Examiner applies a valgus stress at the knee while the ankle is stabilized in slight lateral rotation Knee is first in full ext and then flexed 20-30 (true test) (+) test= excessive motion (compared to the other leg) Looks at medial structures TERM 49
Varus stress test
DEFINITION 49 Examiner applies a varus stress at the knee while the ankle is stabilized Test is done with knee in full extension and then flexed 20- If the tib is laterally rotated in full ext, maximal stress is placed on the collaterals (+) test= tib moves away from femur when stress is applied looks at lateral structures TERM 50
Anterior drawer test
DEFINITION 50 Supine, knee flexed to 90; hip flexed to 45 Examiner sits on the patients forefoot; foot is in neutral rotation Examiner places hands around tibia and ensures hamstrings are relaxed Tibia is drawn forward on the femur Looking for ACL stability
Lachman Test
Supine with the involved leg held by the examiner between 0-30 flexion Stabilize femur with one hand Proximal aspect of tibia is moved forward with other hand (+)= mushy or soft end-feel and disappearance of infrapatellar tendon slope Looking for ACL stability TERM 52
Posterior Sag sign
DEFINITION 52 Supine, hip flexed to 45, knee flexed to 90 If the PCL is torn, the tib will drop back or sag back on the femur due to gravity Normally, the medial tibial plateau extends one cm anteriorly beyond the femoral condyle in this position TERM 53
If there is a positive posterior sag sign, then
what test may you perform?
DEFINITION 53 voluntary anterior drawerPatient carefully extends the knee while the examiner holds the hip in 90-100 flexion. The tibial plateau will move or shift forward, indicating that the tibia was previously posteriorly subluxed (+PCL tear) TERM 54
Neural tension
testing
DEFINITION 54 same as hip (SLR) TERM 55
Palpation of the knee
DEFINITION 55 Temperature, Swelling, Inflammation Patella Superficial and Deep Soft Tissue Bony Alignment
Static resisted tests in prone
Hamstring Differentiation IR (Heel Out) vs. ER (Heel In) TERM 62
Lumbar clearing in prone
DEFINITION 62 Posterior Palpation Examination TERM 63
Functional assessment
DEFINITION 63 in addition to the functional quick tests performedchoose activities specific to the patient's requirements/goals running -- straight, stopping (deceleration) vertical jump (single vs. double leg) running and twisting (figure 8) jumping and going into full squat hard cuts, twists, pivots TERM 64
Single leg
hop
DEFINITION 64 for distance <85% asymmetry in distance is abnormal Repeated 3 times alternately on each leg Distance of the affected leg is less than NL leg if instability is evident TERM 65
Single leg
hop
DEFINITION 65 for time Assessed for the time taken to hop 6 m (20 ft) on one leg Uninvolved vs. Involved
Triple Hop
Pt is asked to hop as far as possible, taking 3 hops Uninvolved vs. Involved TERM 67
Crossover Hop
DEFINITION 67 Pt is asked to take 3 consecutive hops on one foot, crossing over the straight line each time Uninvolved vs. Involved TERM 68
Agility Hop
DEFINITION 68 Place cones 6 m apart Pt is timed as he/she hops around the cones Uninvolved vs. Involved TERM 69
Numeric rating systems
DEFINITION 69 Cincinnati Knee Rating System -- pain, swelling, stability and activity level, good for active population Knee Outcome Survey -- ADL's and sports activity subscales knee society lysholm scale -- used for clinical instability and chrondral lesions WOMAC (osteoarthritis index) Knee injury and osteoarthritis outcome score (KOOS) TERM 70
Location of the MCL
DEFINITION 70 posterior aspect of medial tibiofemoral joint
Location of the ACL
Extends superiorly, posteriorly and laterally from tibia to femurTwists on itself as it runs from tibia to femur. TERM 77
Function of ACL
DEFINITION 77 Prevents anterior translation of the tibia on the femur Checks lateral rotation of the tibia in flexion Also checks extension and hyperextension Least amount of stress between 30 and 60 flexion TERM 78
Location of the PCL
DEFINITION 78 Extends superiorly, anteriorly and medially from tibia to femur Strong, stoutest ligament in the knee TERM 79
Function of the PCL
DEFINITION 79 1 stabilizer of the knee against post translation of the tibia on the femur Checks extension and hyperextension Helps to maintain rotary stability Majority of fibers are tight at 30 flex TERM 80
What happens to the cruciate and collateral
ligaments with lateral rotation of the tibia?
DEFINITION 80 collateral ligs become taught and cruciates become relaxed
What happens to the cruciate and collateral
ligaments with medial rotation of the tibia?
collaterals become relaxed, cruciates are taut TERM 82
Structures being tested in a valgus stress test
with the knee in extension
DEFINITION 82 MCL (superficial and deep fibers) Posterior oblique ligament Posteromedial capsule ACL PCL Medial quadriceps expansion Semimembranosus muscle TERM 83
Structures being tested in a valgus stress test
with the knee in 20-30 degrees flexion
DEFINITION 83 MCL Posterior oblique ligament PCL Posteromedial capsule TERM 84
structures being tested in a varus stress test
with the knee in extension
DEFINITION 84 LCL Posterolateral capsule Arcuate-popliteus complex Biceps femoris tendon PCL ACL Lateral gastroc ITB TERM 85
Structures being tested in a varus stress test
with the knee in 20-30 degrees flexion
DEFINITION 85 LCL Posterolateral capsule Arcuate-popliteus complex ITB biceps femoris tendon
Anterior drawer sign: false negative with
isolated ACL tear
other structures limit movement+ hamstring abnormal shortening TERM 92
Anterior drawer sign: false
positive
DEFINITION 92 if PCL torn (+ sag sign) TERM 93
Posterior drawer and sag signs
DEFINITION 93 Normally medial tibial plateau extends beyond the femoral condyleIf this step is lost, the test is positive or a posterior sag is evident TERM 94
Positive posterior drawer and sag signs
DEFINITION 94 following structures may be injured: PCL Arcuate-popliteus complex Posterior oblique ligament ACL If the arcuate-popliteus complex remains intact, a positive posterior drawer sign may not be elicited TERM 95
Posterior drawer and sag signs: support
DEFINITION 95 moderate support
If positive for anterolateral rotary instability,
the following structures may be involved
ACL
Posterolateral capsule Arcuate-popliteus complex LCL PCL ITB TERM 97
If positive for anteromedial rotary instability,
the following structures may be involved:
DEFINITION 97 MCL (especially the superficial fibers) Posterior oblique ligament Posteromedial capsule ACL TERM 98
Slocum test
DEFINITION 98 Used to test for anteromedial and anterolateral instability Supine, hip is flexed to 45, knee is flexed to 80- Foot is first placed in 30 med rotation (ALRI), and then 15 lateral rotation (AMRI) Examiner sits on the pts forefoot and draws the tib forward (+) test= excessive movement related to the unaffected side TERM 99
Lateral Pivot Shift Maneuver (Test of
MacIntosh) support
DEFINITION 99 moderate support TERM 100
Lateral Pivot Shift Maneuver (Test of
MacIntosh)
DEFINITION 100 Primary test to assess anterolateral instability of the knee Also an excellent test for ACL ruptures Protective muscle contraction may lead to false negative Pt lies supine with hip flexed and abd 30 and relaxed in about 20 medial rotation Examiner wraps on arm around LE, uses other hand to medially rotate tibia Slowly extended knee while maintaining rotation at tibia
- test, lateral tibia relocates, audible click possible
