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BR 3rd Ed > Ch 4 - MSK: Knee Anatomy & Clinical Tests > Flashcards

Ch 4 - MSK: Knee Anatomy & Clinical Tests Flashcards

1
Q

Describe normal ROM of the knee.

A
  • Flexion: 135°
  • Extension: 0°
  • IR: 10°
  • ER: 10°
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2
Q

Describe muscles and innervation of knee extension.

A 
• Quadriceps (femoral n: L2, L3, L4):
 – Rectus femoris
 – Vastus lateralis
 – Vastus intermedius
 – Vastus medialis obliquus
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3
Q

Describe muscles and innervation of knee flexion.

A

• Hamstrings
– Semimembranosus (sciatic n, tibial division: L4, L5, S1, S2)
– Semitendinosus (sciatic n, tibial division: L4, L5, S1, S2)
– Biceps femoris
■ Long head (sciatic n, tibial division: L5, S1, S2)
■Short head (sciatic n, common peroneal division: L5, S1, S2)
• Sartorius (femoral n: L2, L3)
• Gracilis (obturator n: L2, L3, L4)
• Gastrocnemius (tibial n: S1, S2)

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4
Q

Describe muscles and innervation of knee medial rotators.

A
  • Semitendinosus (sciatic, tibial portion: L4, L5, S1, S2)
  • Semimembranosus (sciatic, tibial portion: L4, L5, S1, S2)
  • Sartorius (femoral n: L2, L3)
  • Gracilis (obturator n: L2, L3, L4
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5
Q

Describe muscles and innervation of knee lateral rotators.

A

Biceps femoris
■ Long head (sciatic n, tibial division: L5, S1, S2)
■Short head (sciatic n, common peroneal division: L5, S1, S2)

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6
Q

Describe muscles and innervation of unlocking knee.

A

Popliteus (tibial nerve: L4, L5, S1)

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7
Q

What are the compartments of the knee?

A

Medial femoral–tibial
Lateral femoral–tibial
Patellofemoral

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8
Q

What is the Q angle?

A

Formed by the long axes of the femur and the tibia and reflects the natural valgus attitude of the knee
– Males: 13°
– Females: 18°

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9
Q

What is Knock-kneed?

A

Genu valgum

Excessive valgum of the knees

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10
Q

What is bow-legged?

A

Genu varum

Excessive varum of the knees

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11
Q

What is back-kneed?

A

Genu recurovatum

Hyperextension at the knees

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12
Q

Describe the origin and insertion of the ACL.

A

Origin: medial aspect of the lateral femoral condyle
Travels: anteromedially in intercondylar notch
Insertion: medial tibial eminence

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13
Q

What is the function of the ACL?

A
  • Primary function is to limit anterior tibial translation
  • Prevents posterior translation of the femur and hyperextension
  • Limits IR of femur when the foot is fixed and knee is locked
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14
Q

The ACL tightens with __ and loosens in __.

A

The ACL tightens with full extension/femoral ER and loosens in flexion/IR.

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15
Q

In flexion, the ACL draws the femoral condyles ____>

A

Anteriorly

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16
Q

What does an ACL deficient knee cause?

A

Inc pressure on posterior menisci

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17
Q

Describe the origin and insertion of the PCL.

A

Origin: anterolateral aspect of the medial femoral condyle
Travels: intercondylar notch
Inserts: posterior aspect of tibial plateau

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18
Q

What is the function of the PCL?

A

Restrain posterior tibial translation

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19
Q

PCL is looser in ___ and tighter in ___.

A

PCL is looser in extension and tighter in flexion.

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20
Q

In extension, the PCL pulls the femur __.

A

Posteriorly

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21
Q

What does a PCL deficient knee cause?

A

More force on the patellofemoral joint

22
Q

What causes tension on the MCL?

A

Full extension

Abduction stress in flexion

23
Q

When is there peak stress on the LCL?

A

Adduction when the knee is at 70° flexion

24
Q

What does the posterior capsule restrict?

A

Knee hyperextension

25
Q

What is the origin and insertion of the oblique popliteal ligament?

A

Origin: semimembranosus tendon
Insertion: capsule and lateral meniscus

26
Q

What is the function of the oblique popliteal ligament?

A

Strengthens the fibrous posterior capsule and resists knee extension

27
Q

What is the function of the acuate popliteal ligament complex (APLC)?

A
  • Provides attachment for the posterior horn of the lateral meniscus
  • Reinforces the lateral aspect of the knee and gives posterior lateral rotary stability
  • Restrains posterior tibial translation
28
Q

What can the acuate popliteal ligament complex (APLC) be mistaken for?

A

Rear of the posterior horn of the lateral meniscus on MRI

29
Q

What is the function of the medial and lateral meniscus?

A

Deepen the articular surface area of the tibia to provide more stability for the femoral condyles and increased force dispersion to the tibial plateau

30
Q

Describe the vascularization zones of the menisci.

A
  • Outer 1/3 of the menisci is well vascularized

* Inner 2/3 is poorly vascularized and usually cannot be surgically repaired

31
Q

Describe the the medial meniscus.

A
  • Longer than the lateral meniscus
  • “C” shaped
  • Peripheral border is attached to a portion of the MCL
32
Q

Describe the the lateral meniscus.

A
  • “O” shaped
  • Larger area than the medial meniscus
  • Loined to the medial femoral condyle by the posterior meniscofemoral ligament
33
Q

What are the anterior bursas of the knee?

A

Prepatellar
Suprapatellar
Deep infrapatellar
Superficial or subcutaneous infrapatellar

34
Q

What is the most commonly damaged anterior bursa of the knee?

A

Prepatellar

35
Q

Which anterior bursa of the knee communicates with the joint capsule?

A

Suprapatellar

36
Q

What are the tendons of the Pes anserinus bursa?

A

Sartorius
Gracilis
Semitendonosus

37
Q

Where can a Baker’s cyst be found?

A

Posterior bursa b/w medial gastroc and semimembranosus tendons

38
Q

Describe the McMurray’s test.

A

– Dx posterior meniscal tears
– The patient lies supine with the knee flexed
– The examiner palpates the medial and lateral joint

39
Q

Describe the McMurray’s test for medial meniscus.

A
  • Tibia ER, valgus stress, slowly extend the knee

* (+) torn medial meniscus with audible or palpable click and pain at the medial joint line

40
Q

Describe the McMurray’s test for lateral meniscus.

A
  • Tibia IR, varus stress, slowly extend the knee

* (+) torn lateral meniscus with audible or palpable click and pain at the lateral joint line

41
Q

Describe an Apley’s grind test.

A
  • Dx meniscus tear
  • Prone, knee flexed to 90°
  • Force downward on the heel, compressing the menisci between the femur and tibia, then rotate tibia
  • (+) pain in medial or lateral compartment
42
Q

Describe an Apley’s distraction test.

A
  • Dx MCL or LCL damage
  • Prone, knee flexed
  • Traction force while IR and ER tibia
  • Pressure on the menisci is reduced
  • (+) pain indicates ligamentous damage
43
Q

Describe the Bounce home test.

A
  • Dx dec knee extension
  • Supine, flex knee while holding the heel then passively extend knee
  • (+) full extension not attained, and rubbery resistance is felt
44
Q

Describe the patellofemoral grind test.

A
  • Dx patella articulating surfaces quality
  • Supine, legs neutral
  • Push patella distally and contract the quadriceps against the resistance on the patella
  • (+) pain and crepitation on patella movement
45
Q

Describe the anterior drawer test.

A
  • Dx integrity of ACL
  • Supine, knees flexed to 90°, foot stabilized, grasp knee and draw tibia forward
  • (+) tibia slides from under the femur with no distinct endpoint
46
Q

Why is the anterior drawer test not very sensitive?

A

Hemarthrosis, hamstring spasm, and posterior capsule can limit forward movement of the tibia

47
Q

Describe the Lachman’s test.

A
  • Dx ACL and anterior knee integrity
  • Supine, knee flexed 15° to 30°
  • Stabilize distal femur and apply anterior force to proximal tibia
  • (+) anterior movement with no distinct endpoint
  • Partial ACL tear: soft endpoint
48
Q

What can cause a false negative in anterior drawer test?

A

Hamstring activity

Torn meniscus blocking tibial motion

49
Q

Describe a Pivot shift test.

A
  • Dx anterolateral rotary instability and ACL injury
  • Tibia IR, valgus stress and axial load applied
  • Begin in full knee extension and gently flex the knee
  • (+) Anterolateral subluxation of the lateral tibial plateau
50
Q

Describe the posterior drawer test.

A
  • Dx PCL integrity
  • Supine, knees flexed to 90°, foot stabilized, grasp knee and push tibia backward
  • (+) tibia slides backward on the femur
51
Q

Describe the Sag test.

A
  • Dx PCL integrity
  • Supine, knee flexed 90°, foot on exam table
  • (+) tibia is displaced posteriorly

BR 3rd Ed (92 decks)

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