Chapter 12: The Knee Flashcards
1
Q
It is the largest joint in the body. It is bends to remove his shoes and stockings and note a ginglymus (modified hinge) joint, and as such provides a fairly wide range of motion.
A
knee
2
Q
True or False:
The knee is not protected by layers of fat or muscle, its exposure, both environmentally and anatomically, contributes to its high incidence of injury.
A
True
3
Q
What is the first way of inspecting the knee?
A
Analyzing the patient’s gait
4
Q
When asking the client to remove his clothing from the waist down (the un- derwear need not be removed). and while he is in the process of undressing, watch carefully when he bends to remove his shoes and stockings. You inspect the knee for what?
A
Any abnormal movement used to compensate for pain or stiffness in the knee joint.
5
Q
Bursal swelling is more frequently found over the patella. Known as:
A
Prepatellar bursitis
6
Q
Bursal swelling is more frequently found over the tibial tubercle. Known as:
A
infrapatellar bursitis
7
Q
What are factors that precipitate generalized swelling which affects the entire knee?
A
Intra-articular hemorrhage irritation of the synovium (synovitis) causing secretion of synovial lfuid, or synovial thickening
8
Q
Inspection of symmetry of the muscle contours above the knee is done to identify what condition?
A
Any visible muscular atrophy, particularly at the point where the muscles approach the knee.
9
Q
What muscle often atrophies secondary to knee surgery?
A
vastus medialis
10
Q
________ - refers to the bone distal to the joint, which in the knee is the tibia. Also refers to as “lateral”
A
Valgus
11
Q
Excessive valgus is known as:
A
knock-knees or varus (bowlegs)
12
Q
What are the common deformities of the knee joints?
A
Genu Varum ( Bowed Legs )
Genu Valgum ( knock knee )
Genu Recurvatum ( Back knee)
13
Q
To inspect the knee , have the patient stand straight, with knees extended fully; the patellas should be symmetrical and level. From the side, note that the knee should be fully extended when the patient is standing. What area of the knee is involve in the inspection?
A
anterior aspect of the knee
14
Q
What is the position of the patient in bony palpation of the knee?
A
Sitting position
15
Q
The knee is easier to palpate when it is _______ , when the skin stretches tautly over the bones and makes the skeletal landmarks more distinct.
A
flexed
16
Q
When the knee is flexed, the muscles, tendons, and ligaments around the joint become relaxed in the flexed, non-weight-bearing position, making it much easier to palpate the ______________ and the ________ .
A
bony prominences
joint margins
17
Q
What are the medial aspect of the knee?
A
Medial Tibial
Plateau Tibial Tubercle
Medial Femoral Condyle
Adductor Tubercle
18
Q
Depressions that serve as central points of orientation for the palpation of the medial aspect of the knee joint.
A
Soft tissue depressions on either side of the infrapatellar tendon
19
Q
As you move your thumb upward, you will find the medial femoral condyle , part of which is palpable immediately medial to the patella. More accessible to palpation if the knee is flexed more than 90°. What medial aspect of the knee is being palpated?
A
Medial Femoral Condyle
20
Q
Palpation of Medial Tibial Plateau: True or False
Push your thumb inferiorly into the soft tissue depression until you can feel the sharp upper edge Medial Tibial Plateau.
A
True
21
Q
It serves as one point of attachment for the medial meniscus.
A
Medial Tibial Plateau
22
Q
The upper, nonarticulating edge of the plateau is palpable __________ to the junction of the tibial plateau and the femoral condyle and ____________ to the infrapatellar tendon.
A
posteriorly
anteriorly
23
Q
Follow the infrapatellar tendon distally to where it inserts into the tibial tubercle. Just medial to the tubercle lies the subcutaneous surface of the tibia, below the flare of the tibial plateau . This area is of clinical significance because of the pes anserine insertion and bursa. What medial aspect of the knee is being palpated?
A
Tibial Tubercle
24
Q
The condyle is also palpable along its sharp medial edge, proximally as far as the _________ portion of the patella and ________ to the junction of the tibia and femur.
A
superior
distally
25
\_\_\_\_\_\_\_\_\_ - are often palpable in individuals with osteoarthritis of the knee.
Osteophytes - Small excrescences of bone
26
Return to the medial surface of the medial femoral condyle , and move further posteriorly until you locate the ___________ in the distal end of the natural depression between the vastus medialis and hamstring muscles.
Adductor tubercle
27
It is the point of orientation for palpation of the bony prominences of the lateral aspect of the knee joint.
soft tissue depression just lateral to the infrapatellar tendon
28
Push down with your thumb into the soft tissue depression until you feel the upper edge of the lateral tibial plateau Palpate it along its sharp edge (lateral joint line) to the junction of the tibia and femur. What lateral aspect of the knee is being palpated?
Lateral Tibial Plateau
29
It is the large prominence of bone immediately below the lateral tibial plateau. Palpate it as you again palpate the infrapatellar tendon and the tibial tubercle.
Lateral Tubercle
30
Return to the soft tissue depression and move upward and laterally onto the sharp edge of the lateral femoral condyle . It is palpable along its smooth surface as far as the junction of the tibia and femur. What lateral aspect of the knee is being palpated?
Lateral Femoral Condyle
31
\_\_\_\_\_\_\_\_\_\_\_\_\_ - lies lateral to the lateral femoral condyle
Lateral Femoral Epicondyle
32
From the lateral femoral epicondyle, move your thumb inferiorly and posteriorly across the joint line. It is situated at about the same level as the tibial tubercle . What lateral aspect of the knee is being palpated?
Head of the Fibula
33
True or False:
Since much of it is covered by the patella, the lateral femoral condyle has less surface available for palpation than the medial femoral condyle. If the knee is flexed past 90°, however, more of the condylar articulating surface becomes palpable.
True
34
The track in which the patella glides, is covered by articular cartilage but does not articulate with the tibia. After placing your thumbs over the medial and lateral joint lines, move upward along the two femoral condyles to the highest point of the pa- tella .Then, above the patella, palpate toward the midline. What lateral aspect of the knee is being palpated?
trochlear groove
35
It is fixed in the trochlear groove in flexion and mobile in extension. Thus, the medial and lateral portions are much more accessible to palpation when the knee is extended.
Patella
36
True or False:
It is easier to push the patella laterally than medially.
False
* it is easier to push the patella medially than laterally.
37
What are the four clinical zones of Soft tissue palpation ?
Zone: I - the anterior aspect - Quadriceps
II - the medial aspect
III - the lateral aspect
IV - the posterior aspect
38
What is the position of the patient when doing Soft tissue palpation?
To facilitate palpation of the soft tissue structures of the knee, have the patient sit on the end of the examining table, with his knees flexed to 90°. Then sit on a stool facing him.
39
What are the two quadriceps group?
vastus medialis
vastus lateralis
40
The quadriceps tendon then crosses over the patella to form the _______________ , which inserts into the ____________ .
infrapatellar tendon
tibial tubercle
41
Vastus medialis and vastus lateralis are become prominent upon:
isometric contraction
42
Palpate both thighs simultaneously, comparing the quadriceps for symmetry of definition and noting any defects such as ________ and _______ .
ruptures
tears
43
True or False:
Defects are most often found distally in the rectus femoris or the vastus intermedius just proximal to the patella. They may present as transverse defects which feel softer than the normally firm quadriceps muscles.
True
44
What to assess in soft tissue palpation of quadriceps tendon?
1. Any signs of atrophy, particularly in the vastus medialis 2. Any difference in girth
45
This tendon runs from the inferior border of the patella, and is palpable to its insertion into the tibial tubercle. This site of insertion is often tender in young individuals .
Infrapatellar Tendon
46
What happen when the infrapatellar tendon has been avulsed from its insertion?
it no longer feels rigid; instead, a palpable defect develops, along with extreme tenderness in the area of the tibial tubercle.
47
What are the bursae situated in the anterior clinical zone ( zone I )?
prepatellar Bursa
Superficial Infrapatellar Bursa
Deep Infrapatellar Bursa
Pes Anserine Bursa
48
The infrapatellar fat pad lies immediately posterior to the infrapatellar tendon at the level of the joint line, and tenderness elicited here may be evidence of:
hypertrophy or contusion of the fat pad
49
Bursa that lies in front of the infrapatellar tendon, and can become inflamed as a result of excessive kneeling.
Superficial Infrapatellar Bursa
50
Bursa that overlies the anterior portion of the patella. It is subject to inflammation as a result of the combination of excessive kneeling and leaning forward (housemaid's knee).
Prepatellar bursa
51
Bursa located between the tendons of the sartorius, gracilis, and semitendinosus muscles and the upper medial aspect of the tibia, just medial to the tibial tubercle. It is not palpable. However, if it becomes inflamed, you may be able to feel some effusion and thickening.
Pes Anserine Bursa
52
Beginning at the medial soft tissue depression, move your thumb medially and posteriorly along the upper edge of the tibial plateau, until you find the junction of the tibia and femur. What is the clinical zone?
Zone II— Medial Aspect
53
What are the ligaments and muscles in the Medial clinical zone ( zone II )?
Medial Meniscus
Medial Collateral Ligament
Sartorius, Gracilis, and Semitendinosus Muscles
54
\_\_\_\_\_\_\_\_\_\_\_\_ - is attached to the upper edge of the plateau by small coronary ligaments.
Medial Meniscus
55
True regarding palpation of Medial Meniscus.Except:
1. The anterior margin of the medial meniscus itself is just barely palpable deep within the joint space.
2. The meniscus is somewhat mobile, and when the tibia is internally rotated, its medial edge becomes more prominent and palpable.
3. Conversely, upon external rotation of the tibia, the meniscus retracts and become palpable.
Except: 3
* the meniscus retracts and is not palpable.
56
The area of the medial joint line becomes tender to palpation. It is results from what condition?
When the meniscus has been torn.
57
True or False:
Tears are much more common in the medial meniscus than they are in the lateral meniscus.
True
58
A broad, fan-shaped ligament, joins the medial femoral epicondyle and the tibia. The ligament has both a deep and a superficial portion.
Medial Collateral Ligament
59
The deep portion of medial collateral ligament inserts directly into the edge of the ____________ and meniscus , while the superficial portion inserts, more distally, onto the flare of the \_\_\_\_\_\_\_\_.
tibial plateau
tibia
60
To palpate the anatomic region of the ________________ (the ligament itself is not distinctly palpable), first relocate the medial joint line. As you move medially and posteriorly along the joint line, the ligament lies directly under your fingertips.
medial collateral ligament
61
What causes medial collateral ligament to torn?
frequently torn in valgus stress injuries, such as clipping injuries in football.
62
Palpate the area of the medial collateral ligament from origin to insertion for ___________ and _____________ .
tenderness
interruption in continuity
63
True or False:
1. If it is avulsed from the medial epicondyle, the ligament may elevate a small bony fragment with it, in which case the point of origin becomes tender to palpation.
2. If the ligament is torn at its midpoint, the tendon andoverlying soft tissue may be shredded.
3. In the event torn and avulsed ligament, the defect becomes palpable and there is tenderness at the level of the medial joint line.
True
64
On the posteromedial side of the knee, the tendons of these muscles form a visible ridge that crosses the knee joint before they insert into the lower portion of the medial tibial plateau. They help support the knee's medial side. What muscles are they?
Sartorius, Gracilis, and Semitendinosus Muscles
65
True or False:
To palpate the tendons of these muscles(Sartorius, Gracilis, and Semitendinosus), stabilize the patient's leg by holding it securely with your own legs. This frees your hands for palpation. In addition, you are in a position to offer resistance against knee flexion, which makes the tendons prominent. Cup your fingers around the knee and feel the tautness of the tendons.
True
66
Of this tendinous group (Sartorius, Gracilis, and Semitendinosus), What is the most posterior and inferior tendon you can feel on palpation?
semitendinosus
67
\_\_\_\_\_\_\_\_\_\_ - lies slightly anterior and medial to the semitendinosus. It becomes even more prominent if you offer resistance to internal rotation of the leg.
Gracilis
68
The tendons of the _____________ and gracilis muscles are round and should not be confused with the deeper semimembranosus tendon, which remains muscular to its insertion.
semitendinosus
69
\_\_\_\_\_\_\_\_\_\_ - The wide, thick band of the muscle just above the gracilis tendon. Since it is not as tendinous this tendon is more difficult to palpate.
Sartorius
70
\_\_\_\_\_\_\_\_\_\_\_\_ - is rarely pathologically involved except in cases of massive trauma to the knee. It is sometimes utilized as a muscle transplant to reinforce the knee's medial side. At the common insertion of these muscles lies the pes anserine bursa, which may become inflamed and cause pain during motion.
semimembranosus
71
What is the insertion of the semimembranosus muscle?
lies deep to the tendinous group on the posterior aspect of the tibia.
72
Where to palpate semimembranosus muscle?
you can palpate it by thrusting your fingers between the semitendinosus and the gracilis tendons
73
The following are located in what aspect and included in what clinical zone?
Lateral Meniscus
Lateral Collateral Ligament
Anterior Superior Tibiofibular Ligament
Biceps Femoris Tendon
Iliotibial Tract
Common Peroneal Nerve
Lateral Aspect: Zone III
74
\_\_\_\_\_\_\_\_\_\_\_\_ - is best palpated when the patient's knee is in slight flexion, for it usually disappears within the joint upon full extension. It is secured to the edge of the tibial plateau by coronary ligaments, which, when torn, can cause the meniscus to become detached. In such a case, the area is tender to palpation.
lateral meniscus
75
\_\_\_\_\_\_\_\_\_\_\_\_ - is a stout cord that joins the lateral femoral epicondyle and the fibular head. It exists independently from the joint capsule. The ligament stands away from the joint itself, and lies laterally and posteriorly along the joint line .
Lateral Collateral Ligament
76
True regarding palpaton of Lateral Meniscus. Except:
1. If you probe firmly into the lateral joint space with your thumb, you may be able to feel the anterior margin of the lateral meniscus.
2. The meniscus is attached to the popliteus muscle and not to the lateral collateral ligament. It is therefore more mobile than the lateral collateral ligament.
3. Perhaps because of its mobility, the lateral meniscus is seldom torn.
Except: 2
* The lateral meniscus is more mobile than the medial meniscus.
77
It is palpable as a firm, tender mass. It results will to tenderness of the area of the lateral joint line on palpation.
A cyst of the lateral meniscus that develops at the joint line.
78
To palpate it, have the patient cross his legs so that his ankle rests upon the opposite knee. When the knee is flexed to 90° and the hip is abducted and externally rotated. the iliotibial tract relaxes and makes the ligament easier to isolate. What is the ligament being palpated?
Lateral Collateral Ligament
79
Lateral Collateral Ligament: True or False.
The ligament be torn in certain knee joint injuries, but the incidence of such tearing is not as high as for the medial collateral ligament. When it is torn, it becomes tender to palpation. Occasionally, this ligament is congenitally absent.
True
80
This ligament lies in the crevice between the tibia and the fibular head. If you move anteriorly and medially from the head of the fibula, you can feel where this ligament crosses the tibia/fibula articulation. Palpate the ligament for purposes of anatomic definition since it is rarely pathologically involved. What is this ligament?
Anterior Superior Tibiofibular Ligament
81
When the knee is flexed, this tendon becomes prominent where it crosses the knee joint before inserting into the fibular head. It should be palpated near its insertion for any defects that may be present. The tendon is rarely torn, but can be avulsed from the fibula upon a severe trauma to the knee. What is this tendon?
Biceps Femoris Tendon
82
The biceps femoris muscle and tendon should not be confused with the __________ .
iliotibial tract
83
It is situated more anteriorly on the lateral aspect of the knee. It is palpable to the point where it inserts into the lateral tibial tubercle. It is neither a muscle nor a tendon, but rather a long, thick band of fascia. The anterior border immediately lateral to the superior pole of the patella is the portion most available for palpation
iliotibial tract
84
True or False:
The iliotibial tract is more conveniently palpable when the knee is extended and the leg raised or when, against resistance, the knee is flexed. Contractures in its substance are often a cause of knee deformity in paralytic cases such as poliomyelitis and meningomyelocele.
True
85
\_\_\_\_\_\_\_\_\_\_\_\_\_ - is palpable where it crosses the neck of the fibula. The nerve can be rolled gently between the tip of your finger and the neck of the fibula, slightly inferior to the insertion of the biceps femoris muscle.
Common Peroneal Nerve
86
What is the result of applying excessive pressure on palpation of common peroneal nerve?
It causes injury and cause foot drop
87
The following are posterior aspect of the knee. What clinical zone they are included?
1. Popliteal Fossa
2. Gastrocnemius Muscle
Zone IV
88
\_\_\_\_\_\_\_\_\_\_\_ - is defined by the prominent biceps femoris tendon. The tendons of the semimembranosus and the semitendinosus muscles form the superior medial border, while the inferior borders are formed by the two heads of the gastrocnemius muscles where they emerge from the fossa to enter the calf.
Popliteal Fossa
89
What are the group of significant structures cross the popliteal area?
Posterior Tibial Nerve
Popliteal Vein
Popliteal artery
90
\_\_\_\_\_\_\_\_\_\_ - lies directly under the posterior tibial nerve.
Popliteal Vein
91
\_\_\_\_\_\_\_\_\_\_\_\_ - the deepest structure in the popliteal area, runs flush against the joint capsule.
Popliteal Artery
92
\_\_\_\_\_\_\_\_\_\_\_ - a branch of the sciatic nerve, is the most superficial structure crossing the popliteal area
Posterior Tibial Nerve
93
True or False:
When the knee is extended, the fascia covering the fossa is pulled tight and the structures underlying it are difficult to palpate. However, the fascia and muscles relax in flexion, and the deeper areas of the fossa become accessible to palpation.
True
94
True or False:
Because the popliteal artery is covered by the fascia, the nerve, and the vein, it may be difficult to feel the popliteal pulse. Absence of this pulse may be due to vascular occlusive disease at a higher level in the extremity.
True
95
A discrete swelling in the fossa may indicate cyst. This type of cyst is usually a painless, mobile swelling appearing on the medial side of the fossa, and is more readily palpable when the patient's knee is extended.
popliteal cyst, or Baker's cyst (commonly a distention of the gastrocnemius—semimembranosus bursa)
96
The two heads of this muscle are palpable at their origin on the posterior femoral surface just above the medial and lateral condyles when the patient flexes his knee against resistance.
Gastrocnemius Muscle
97
True or False:
The gastrocnemius heads are not as distinctly palpable as the hamstring muscle tendons just above them. If is torn, you may be able to feel a small defect in the belly of the muscle; however, more often than not, palpation of the muscle reveals only slight tenderness.
True
98
What is the positions of the patient on testing for Joint stability of Collateral Ligaments?
lie supine on the table with one knee flexed
99
To test , secure the patient's ankle with one hand and place the other hand around the knee so that your thenar eminence is against the fibular head. Then, push medially against the knee and laterally against the ankle in an attempt to open the knee joint on the inside ( valgus stress ). What is the ligament being tested?
medial collateral ligament
100
If present the medial collateral ligament is not supporting the knee properly.The medial joint line is palpated for what?
Gapping
101
Medial Collateral Ligament: True or False:
When stress on the injured joint is relieved, you can feel the tibia and femur "clunk" together as they close.
True
102
To test for stability, reverse the position of your hands, and push laterally against the knee and medially against the ankle to open the knee joint on the lateral side (varus stress). What aspect of the knee is being tested?
lateral aspect of the knee
103
True or False:
If your fingers are too short to reach around the knee to palpate the joint lines, secure the patient's foot between your arm and body (in the axilla) so that your hands are free to palpate the joint line. In this way, your body acts as a lever on the foot and applies varus and valgus stress to the knee joint.
True
104
True or False:
Since the medial collateral ligament is critical to stability, an isolated tear of this ligament leads to joint instability, whereas a similar defect in the lateral collateral ligament may have little effect either way. Most ligamentous injuries around the knee occur on the medial side.
True
105
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - are instrumental in preventing anterior and posterior dislocation of the tibia on the femur. These ligaments are intracapsular, originating on the tibia and inserting into the inner sides of the femoral condyles.
Anterior and posterior cruciate ligaments
106
To test the integrity of the anterior cruciate ligament, what is the position of the patient?
the patient lie supine on the examination table with his knees flexed to 90° and his feet flat on the table.
107
True or False:
Cup your hands below the patient's knee, with your fingers on the area of insertion of the medial and lateral hamstrings and your thumbs on the medial and lateral joint lines.
False
* Cup your hands around the patient's knee
108
Draw the tibia toward you if it slides forward from under the femur, the anterior cruciate ligament may be torn. This sign is called:
Positive anterior draw sign
109
True or False:
When you do find a positive anterior draw sign, it is important not to repeat the maneuver with the patient's leg in internal and external rotation.
False
* It is important to repeat the maneuver with the patient's leg in internal and external rotation.
110
\_\_\_\_\_\_\_\_\_\_ rotation of the leg tightens the postero- medial portion of the joint capsule.
External
111
\_\_\_\_\_\_\_\_\_\_ rotation tightens the structures on the posterolateral side of the knee.
Internal
112
Normally, there should then be reduced forward movement of the ________ on the femur , even if the anterior cruciate ligament is torn.
tibia
113
Normally, there should be reduced movement when the leg is pulled _________ , even if the anterior cruciate ligament is torn.
forward
114
If forward movement with the leg ________ rotated is equal to forward movement with the leg in the ________ position, both the anterior cruciate ligament and the posteromedial portion of the joint capsule (and possibly the medial collateral ligament) may be damaged.
externally
neutral
115
If the amount of forward movement of the tibia on the femur in ________ rotation is equal to that in the _______ position, both the anterior cruciate ligament and the posterolateral portion of the joint capsule may be torn.
internal
neutral
116
The anterior cruciate ligament may be torn in association with:
Tears of the medial collateral ligament
117
True or False:
The anterior draw sign is more common than the posterior sign, since the incidence of damage to the anterior cruciate is much higher than to the posterior cruciate. In fact, an isolated tear of the posterior cruciate ligament is rare.
True
118
Test the posterior cruciate ligament in a similar manner. Stay in the same position and push the tibia posteriorly. If it moves backward on the femur, the posterior cruciate ligament is probably damaged. This is called:
positive posterior draw sign
119
What are the three basic movements ( range of motion ) of the knee joint?
(1) flexion (associated with glide)
(2) extension (associated with glide)
(3) internal and external rotation.
120
\_\_\_\_\_\_\_\_ and __________ - are primarily the result of movement between the femur and the tibia. In- ternal and external rotation involve displacement of the menisci on the tibia, as well as movement between the tibia and the femur.
Flexion
extension
121
Extension is performed by the quadriceps, while flexion is performed by the __________ and gravity.
hamstrings
122
Internal and external rotation (which take place when the knee is slightly flexed) are performed by the reciprocal action of the ______________ , _____________ , gracilis, and sartorius on the medial side, and the _______ on the lateral side.
semimembranosus
semitendinosus
biceps
123
Test active range of motion: Ask the patient to squat in a deep knee bend. He should be able to flex both knees symmetrically. What range of motion is being tested?
Flexion
124
Test active range of motion: Instruct the patient to stand up from the squatting position, and take careful notice of whether he is able to stand straight, with knees in full extension, or whether one leg is relied upon more than the other during the procedure. What range of motion ?
Extension
125
The arc of motion from flexion to extension should be smooth. On occasion, a patient may be unable to extend the knee through the last 10° of motion and may be able to finish extension only haltingly, and with great effort. It frequently accompanies quadriceps weakness. This is referred to as:
extension lag
126
True or False:
Note that the leg can be extended fully without some amount of external tibial rotation on the femur because of the physical configuration of the knee joint and its cruciate ligaments.
True
127
The medial femoral condyle is approximately a half-inch longer than the ________________ . Therefore, as the tibia moves on the femoral condyles into full extension, it uses all available articulating surface on the __________ , while leaving about a half inch on the medial side.
lateral femoral condyle
lateral side
128
To use the remaining articular surface on the medial side and reach full extension, the medial side of the tibia must rotate _________ around the ______________ . This allows the medial femoral condyle to complete its extension, and, in effect, "locks the knee joint home" in the full extension position.
laterally
lateral femoral condyle
129
The final locking movement allows the patient to maintain the knee in extension over prolonged periods of stand- ing without relying on his muscles. This is commonly called:
"screw home" motion
130
When testing screw home motion, Draw one dot on the midpoint of the _______ and another over the tibial tubercle while the patient's knee is ______ . The dot over the __________ should line up with the dot on the midpoint of the patella.
patella
flexed
tibial tubercle
131
When testing screw home motion, ask the patient to extend his leg fully. The tibial tubercle should rotate _________ from under its dot, indicating that the tibia has rotated ___________ on the femur. The tibial tubercle has also turned slightly lateral to the dot over the midpoint of the patella.
laterally
externally
132
\_\_\_\_\_\_\_\_\_\_\_\_\_ - may prevent screw home motion and block full extension of the knee.
Torn meniscus
133
To test Range of motion. Instruct your patient to rotate his foot medially and laterally, to test the knee's range of rotation. Under normal circumstances, he should be able to rotate the foot about 10° to either side. What knee range of motion is being tested?
Internal and External rotation
134
Testing Passive Range of Motion: What is the normal end point of knee flexion?
The normal end point of knee flexion for adults is approximately 135° from an extended position.
135
Testing Passive Range of Motion: What is the position of the patient?
The patient may lie either prone or supine on an examining table, or he may sit on the very edge of the table with the popliteal fossa away from it and his legs dangling free.
136
To test, Grasp one leg at the ankle joint and place your other hand in the popliteal fossa to act as a fulcrum and to unlock the knee. Then, flex the leg as far as it will go, noting the distance between heel and buttock. With younger patients, it is relatively easy to flex the leg all the way so that the heel almost touches the buttock. What range of motion of the knee is being tested?
Passive range of motion
137
To test, Maintain your hands in position on the patient's ankle and knee and extend his knee. The arc of motion from flexion to ex- tension should be smooth, and the knees should extend bilaterally to at least what degree 0° or beyond and into a few degrees of hyperextension. What passive range of motion is being tested?
Extension
138
To test, Place your hand on the patient's thigh just above the knee to stabilize the femur, grasp his heel with your free hand, and rotate the tibia. At the same time, palpate the tibial tubercle to ensure that it is moving. Normally, there should be approximately 10° of rotary motion to each side of the leg. What passive range of motion is being tested?
Internal and external rotation
139
What is the normal end point of knee internal and external rotation?
Internal Rotation - 10°
External Rotation - 10°
140
In muscle testing of knee, What is the primary extensor muscle?
Quadriceps
141
Muscle Testing: To perform the manual test, stabilize the thigh by placing one hand just ______ the knee. Then, instruct the patient to fully extend his knee. Once the knee is fully extended, offer resistance to extension just above the ___________ . Palpate the quadriceps with your stabilizing hand during this test.
above
ankle joint
142
What is the innervation of Quadriceps muscles ?
Femoral nerve, L2, L3, L4
143
In muscle testing of knee, What is the primary flexor?
Hamstrings
144
What are the three muscle group of Hamstring?
Semimembranosus
Semitendinosus
Biceps Femoris
145
What is the innervation of semimembranosus and semitendinosus?
tibial portion of sciatic nerve - L5
146
What is the innervation of biceps femoris?
tibial portion of sciatic nerve - S1
147
To test the hamstrings as a group, What is the position of the patient?
The patient lie supine on the examining table and sta- bilize his thigh just above the knee.
148
While you resist the motion at the back of his ankle joint. What is the position of patient's knee?
The patient knee is flexed.
149
To bring the biceps femoris into greater activity during the test. What is the position of the leg?
The patient leg should be rotated externally
150
To bring the semimembranosus and semitendinosus muscles into greater activity during the test. What is the position of the leg?
The patient leg should be rotated internally
151
True or False:
The muscles that allow internal and external rotation in the knee cannot be isolated for clinical testing. However, their strength has been tested earlier, in conjunction with the muscle tests for flexion and extension.
True
152
Sensation Testing: True or False
Those nerves taking origin from roots in the lumbar and sacral spines provide sensation to the skin over the knee and surrounding areas. The areas supplied by each particular neurologic level define broad bands, or dermatomes, which cover certain areas of the skin.
True
153
Roughly, the sensory dermatomes of the knee region run in long, oblique bands as follows: Except.
1) L4 crosses the anterior portion of the knee, continuing down the medial side of the leg.
2) L3 spans the anterior thigh immediately at and above the knee joint.
3) L2 crosses the anterior portion of the middle of the thigh.
4) S1 outlines a strip down the midline of the posterior thigh and the popliteal fossa.
Except: 4
* S2 outlines a strip down the midline of the posterior thigh and the popliteal fossa.
154
\_\_\_\_\_\_\_\_\_\_\_\_ - is the only sensory branch of the femoral nerve that continues into the leg. Its infrapatellar branch is often cut during knee surgery, particularly during the surgical removal of the medial meniscus.
saphenous nerve
155
What are the sensory dermatomes of the knee that supplied by femoral nerve?
L3 and L2
156
What is the sensory dermatomes of the knee that supplied by the posterior femoral cutaneous nerve of the thigh?
S2
157
\_\_\_\_\_\_\_\_\_\_\_\_\_ - is a deep tendon reflex, mediated through nerves emanating from the L2, 3, and 4 neurologic levels, but predominantly from L4.
patellar relfex or knee jerk
158
True or False:
For clinical application, the patellar reflex is to be considered an L4 reflex. However, even if the L4 nerve root is pathologically involved, the reflex may still be present, since it is innervated by more than one neurologic level. While the patellar reflex may be significantly diminished, it is rarely totally absent.
True
159
What is the position of the patient so infrapatellar tendon is stretched and primed?
sitting position at the edge of the examining table with his legs dangling
160
Reflex Testing of Patellar reflex: To locate the tendon accurately, palpate the soft tissue depression on either side of the ___________ tendon . Elicit the reflex by tapping the tendon with a neurologic hammer at the level of the knee joint, using a short, smart wrist action.
infrapatellar
161
What instrument is used to elicit the reflex by tapping the tendon at the level of the knee joint, using a short, smart wrist action?
neurologic hammer
162
True or False:
If the Patellar reflex is difficult to obtain, reinforce by having the patient clasp his hands and attempt to pull them apart as you tap the tendon.
True
163
What are the special test used in neurologic examination of the knee?
1. McMurray Test
2. Apley's compression and distraction Tests ( Compression or Grinding Test and Distraction Test )
3. Reduction Click
4. " Bounce home" Test
5. Patella Femoral Grinding Test
6. Apprehension Test for Patellar Dislocation And Subluxation
7. Tinel test
8. Knee Joint effusion Tests
164
During knee flexion and extension, a torn meniscus may produce a palpable or audible "clicking" in the region of the joint line. Tenderness elicited in palpation of the joint line on either side suggests the possibility of a torn meniscus. Posterior meniscal tears are difficult to identify, What is the test that was originally developed to assist in this difficult diagnosis?
McMurray Test
165
During McMurray test, What is the position of the patient?
The patient to lie supine with his legs flat and in the neutral position. With one hand, take hold of his heel and flex his leg fully.
166
Statement regarding Mcmurray Test. True or False:
1. Place your free hand on the knee joint with your fingers touching the medial joint line and your thumb and thenar eminence against the lateral joint line, and rotate the leg internally and externally to loosen the knee joint . Push on the lateral side to apply valgus stress to the medial side of the joint, while, at the same time, rotating the leg externally
True
167
McMurray Test: If this maneuver causes a palpable or audible "click" within the joint, there is a probable tear in the __________ , most likely in its posterior half.
medial meniscus
168
This is another procedure designed to aid in the diagnosis of a torn meniscus. Where in the patient is lie prone on the examining table with one leg flexed to 90°.
Compression or Grinding Test
169
True or False:
Gently kneel on the back of the patient's thigh to stabilize it while leaning hard on the heel to compress the medial and lateral meniscus between the tibia and the femur. Then, rotate the tibia internally and externally on the femur as you maintain firm compression.
True
170
Compression or Grinding Test: If this maneuver elicits pain, there is probably meniscal damage. Ask your patient to describe the location of his pain as accurately as possible. Pain on the medial side indicates a damaged ___________ ; pain on the lateral side suggests a ____________ tear.
medial meniscus
lateral meniscal
171
Test that helps to distinguish between meniscal and ligamentous problems of the knee joint. This test should follow the compression test in logical progression.
Distraction Test
172
Remain in the same position described for the compression test, and maintain your stabilization of the posterior thigh. Apply traction to the leg while rotating the tibia internally and externally on the femur .This maneuver reduces pressure on the meniscus and puts strain upon the _________ and _____________ structures.
lateral and medial ligamentous
173
Distraction Test: If the _________ are damaged, the patient will complain of pain; if the ________ alone is torn, the test should not be painful for him.
ligaments
meniscus
174
This procedure is applicable to those patients having a locked knee due to a torn, dislocated, or "heaped up" meniscus. The objective procedure is to reduce the displaced or torn portion of the meniscus by clicking it back into place.
Reduction Click
175
This test is designed to evaluate a lack of full knee extension, most often secondary to a torn meniscus, a loose body within the knee joint, or an intracapsular joint swelling.
" Bounce home" Test
176
This test is designed to determine the quality of the articulating surfaces of the patella and the trochlear groove of the femur. The patient should be supine on the examining table with his legs relaxed in the neutral position.
Patella Femoral Grinding Test
177
This procedure is designed to determine whether or not the patella is prone to lateral dislocation. If you suspect that your patient has a recurrent dislocating patella, you should attempt to dislocate it manually while observing his face as he reacts to this test.
Apprehension Test for Patellar Dislocation And Subluxation
178
Reduction Click: To do this, flex the knee while it is rotated both ________ and _________ . Then rotate and extend the leg until the meniscus slips back to its proper position and you hear a characteristic "click."
internally
externally
179
" Bounce home" Test: The knee should _____________ , or "bounce home," into extension with a sharp end-point.
extend completely
180
Patella Femoral Grinding Test: First, push the patella ________ in the trochlear groove .Then instruct the patient to tighten his ________ and palpate and offer resistance to the patella as it moves under your fingers.
distally
quadriceps
181
Patella Femoral Grinding Test: True or False:
The movement of the patella should be smooth and gliding; any roughness in its articulating surfaces causes a palpable crepitation when the patella moves.
True
182
What indicates that Patella femoral grinding test is positive?
If the test is positive, the patient usually complains of pain or discomfort. Clinically, patients most often complain of pain when they climb stairs or get up from a chair.
183
Apprehension Test for Patellar Dislocation And Subluxation:
What is the position of the patient during the test?
The patient lie supine on the examining table, with his legs flat and the quadriceps relaxed.
184
What are the other conditions that results the roughened undersurface of the patella forced against the trochlear groove that causes pain?
chondromalacia patellae
osteochondral defects
degenerative changes
185
Apprehension Test for Patellar Dislocation And Subluxation:
If you suspect that the patella may dislocate laterally, press against the __________ of the patella with your thumb. If everything is in order, this will produce little reaction; however, if the patella begins to _______ , the expression on the patient's face will become one of apprehension and distress.
medial border
dislocate
186
Test that can refer either to the elicitation of pain from tapping for neuromata on the end of a cut nerve, or to the provocation of pain on the leading edge of a regenerating nerve. In the case of the knee, the testing concerns the area around the medial side of the tibial tubercle where the infrapatellar branch of the saphenous nerve runs.
Tinel test
187
These tests are designed to document suspected effusion in the knee joint. (Major Effusion and Minor Effusion)
Knee Joint effusion Tests
188
Tinel test:
In knee surgery, __________ nerve is frequently cut, particularly during removal of the medial meniscus. If a neuroma has developed, tenderness can be elicited over the ________ of the severed nerve.
saphenous
bulbous end
189
Test for Major Effusion:
When the joint is distended by a ___________ , carefully extend the patient's knee and instruct him to relax the quadriceps muscles. Then, push the ________ into the trochlear groove and quickly release it.
large effusion
patella
190
Test for Major Effusion: The large amount of fluid lying under the patella is first forced to the sides of the joint, and then flows back to its former position, forcing the patella to rebound. This is referred as: ______________ .
ballotable patella
191
In these case, there is not enough fluid to ballot the patella. To test, keep your patient's knee in extension, and then "milk" the fluid from the suprapatellar pouch and lateral side into the medial side of the knee. What effusion is being tested?
Test for Minor Effusion
192
Test for Minor Effusion:
When the fluid has been forced to the \_\_\_\_\_\_\_\_, gently tap the joint over the fluid, which will traverse the knee to create a fullness on the __________ .
medial side
lateral side
193
Examination of the knee and its related Areas: True or false.
1. The joints both above and below the knee should be examined in a truly comprehensive examination of the knee joint.
2. A herniated disc in the lumbar spine or osteoarthritis of the hip both can refer pain to the knee.
3. Less often, foot problems such as ligamentous sprains or infections may occasionally manifest in the knee
True
