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Client Assessment 2-3 > Chapter 12: The Knee > Flashcards

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

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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

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3
Q

What is the first way of inspecting the knee?

A

Analyzing the patient’s gait

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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.

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5
Q

Bursal swelling is more frequently found over the patella. Known as:

A

Prepatellar bursitis

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6
Q

Bursal swelling is more frequently found over the tibial tubercle. Known as:

A

infrapatellar bursitis

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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

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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.

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9
Q

What muscle often atrophies secondary to knee surgery?

A

vastus medialis

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10
Q

________ - refers to the bone distal to the joint, which in the knee is the tibia. Also refers to as “lateral”

A

Valgus

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11
Q

Excessive valgus is known as:

A

knock-knees or varus (bowlegs)

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12
Q

What are the common deformities of the knee joints?

A

Genu Varum ( Bowed Legs )

Genu Valgum ( knock knee )

Genu Recurvatum ( Back knee)

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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

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14
Q

What is the position of the patient in bony palpation of the knee?

A

Sitting position

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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

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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

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17
Q

What are the medial aspect of the knee?

A

Medial Tibial

Plateau Tibial Tubercle

Medial Femoral Condyle

Adductor Tubercle

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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

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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

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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

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21
Q

It serves as one point of attachment for the medial meniscus.

A

Medial Tibial Plateau

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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

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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

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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

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25
Q

_________ - are often palpable in individuals with osteoarthritis of the knee.

A

Osteophytes - Small excrescences of bone

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26
Q

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.

A

Adductor tubercle

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27
Q

It is the point of orientation for palpation of the bony prominences of the lateral aspect of the knee joint.

A

soft tissue depression just lateral to the infrapatellar tendon

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28
Q

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?

A

Lateral Tibial Plateau

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29
Q

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.

A

Lateral Tubercle

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30
Q

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?

A

Lateral Femoral Condyle

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31
Q

_____________ - lies lateral to the lateral femoral condyle

A

Lateral Femoral Epicondyle

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32
Q

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?

A

Head of the Fibula

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33
Q

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.

A

True

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34
Q

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?

A

trochlear groove

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35
Q

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.

A

Patella

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36
Q

True or False:

It is easier to push the patella laterally than medially.

A

False

  • it is easier to push the patella medially than laterally.
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37
Q

What are the four clinical zones of Soft tissue palpation ?

A

Zone: I - the anterior aspect - Quadriceps

II - the medial aspect

III - the lateral aspect

IV - the posterior aspect

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38
Q

What is the position of the patient when doing Soft tissue palpation?

A

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.

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39
Q

What are the two quadriceps group?

A

vastus medialis

vastus lateralis

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40
Q

The quadriceps tendon then crosses over the patella to form the _______________ , which inserts into the ____________ .

A

infrapatellar tendon

tibial tubercle

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41
Q

Vastus medialis and vastus lateralis are become prominent upon:

A

isometric contraction

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42
Q

Palpate both thighs simultaneously, comparing the quadriceps for symmetry of definition and noting any defects such as ________ and _______ .

A

ruptures

tears

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43
Q

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.

A

True

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44
Q

What to assess in soft tissue palpation of quadriceps tendon?

A
  1. Any signs of atrophy, particularly in the vastus medialis 2. Any difference in girth
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45
Q

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 .

A

Infrapatellar Tendon

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46
Q

What happen when the infrapatellar tendon has been avulsed from its insertion?

A

it no longer feels rigid; instead, a palpable defect develops, along with extreme tenderness in the area of the tibial tubercle.

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47
Q

What are the bursae situated in the anterior clinical zone ( zone I )?

A

prepatellar Bursa

Superficial Infrapatellar Bursa

Deep Infrapatellar Bursa

Pes Anserine Bursa

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48
Q

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:

A

hypertrophy or contusion of the fat pad

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49
Q

Bursa that lies in front of the infrapatellar tendon, and can become inflamed as a result of excessive kneeling.

A

Superficial Infrapatellar Bursa

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50
Q

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).

A

Prepatellar bursa

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51
Q

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.

A

Pes Anserine Bursa

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52
Q

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?

A

Zone II— Medial Aspect

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53
Q

What are the ligaments and muscles in the Medial clinical zone ( zone II )?

A

Medial Meniscus

Medial Collateral Ligament

Sartorius, Gracilis, and Semitendinosus Muscles

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54
Q

____________ - is attached to the upper edge of the plateau by small coronary ligaments.

A

Medial Meniscus

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55
Q

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.
A

Except: 3

  • the meniscus retracts and is not palpable.
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56
Q

The area of the medial joint line becomes tender to palpation. It is results from what condition?

A

When the meniscus has been torn.

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57
Q

True or False:

Tears are much more common in the medial meniscus than they are in the lateral meniscus.

A

True

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58
Q

A broad, fan-shaped ligament, joins the medial femoral epicondyle and the tibia. The ligament has both a deep and a superficial portion.

A

Medial Collateral Ligament

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59
Q

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 ________.

A

tibial plateau

tibia

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60
Q

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.

A

medial collateral ligament

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61
Q

What causes medial collateral ligament to torn?

A

frequently torn in valgus stress injuries, such as clipping injuries in football.

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62
Q

Palpate the area of the medial collateral ligament from origin to insertion for ___________ and _____________ .

A

tenderness

interruption in continuity

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63
Q

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.
A

True

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64
Q

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?

A

Sartorius, Gracilis, and Semitendinosus Muscles

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65
Q

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.

A

True

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66
Q

Of this tendinous group (Sartorius, Gracilis, and Semitendinosus), What is the most posterior and inferior tendon you can feel on palpation?

A

semitendinosus

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67
Q

__________ - lies slightly anterior and medial to the semitendinosus. It becomes even more prominent if you offer resistance to internal rotation of the leg.

A

Gracilis

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68
Q

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.

A

semitendinosus

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69
Q

__________ - 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.

A

Sartorius

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70
Q

____________ - 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.

A

semimembranosus

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71
Q

What is the insertion of the semimembranosus muscle?

A

lies deep to the tendinous group on the posterior aspect of the tibia.

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72
Q

Where to palpate semimembranosus muscle?

A

you can palpate it by thrusting your fingers between the semitendinosus and the gracilis tendons

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73
Q

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

A

Lateral Aspect: Zone III

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74
Q

____________ - 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.

A

lateral meniscus

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75
Q

____________ - 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 .

A

Lateral Collateral Ligament

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76
Q

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.
A

Except: 2

  • The lateral meniscus is more mobile than the medial meniscus.
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77
Q

It is palpable as a firm, tender mass. It results will to tenderness of the area of the lateral joint line on palpation.

A

A cyst of the lateral meniscus that develops at the joint line.

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78
Q

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?

A

Lateral Collateral Ligament

79
Q

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.

A

True

80
Q

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?

A

Anterior Superior Tibiofibular Ligament

81
Q

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?

A

Biceps Femoris Tendon

82
Q

The biceps femoris muscle and tendon should not be confused with the __________ .

A

iliotibial tract

83
Q

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

A

iliotibial tract

84
Q

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.

A

True

85
Q

_____________ - 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.

A

Common Peroneal Nerve

86
Q

What is the result of applying excessive pressure on palpation of common peroneal nerve?

A

It causes injury and cause foot drop

87
Q

The following are posterior aspect of the knee. What clinical zone they are included?

  1. Popliteal Fossa
  2. Gastrocnemius Muscle
A

Zone IV

88
Q

___________ - 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.

A

Popliteal Fossa

89
Q

What are the group of significant structures cross the popliteal area?

A

Posterior Tibial Nerve

Popliteal Vein

Popliteal artery

90
Q

__________ - lies directly under the posterior tibial nerve.

A

Popliteal Vein

91
Q

____________ - the deepest structure in the popliteal area, runs flush against the joint capsule.

A

Popliteal Artery

92
Q

___________ - a branch of the sciatic nerve, is the most superficial structure crossing the popliteal area

A

Posterior Tibial Nerve

93
Q

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.

A

True

94
Q

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.

A

True

95
Q

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.

A

popliteal cyst, or Baker’s cyst (commonly a distention of the gastrocnemius—semimembranosus bursa)

96
Q

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.

A

Gastrocnemius Muscle

97
Q

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.

A

True

98
Q

What is the positions of the patient on testing for Joint stability of Collateral Ligaments?

A

lie supine on the table with one knee flexed

99
Q

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?

A

medial collateral ligament

100
Q

If present the medial collateral ligament is not supporting the knee properly.The medial joint line is palpated for what?

A

Gapping

101
Q

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.

A

True

102
Q

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?

A

lateral aspect of the knee

103
Q

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.

A

True

104
Q

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.

A

True

105
Q

________________ - 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.

A

Anterior and posterior cruciate ligaments

106
Q

To test the integrity of the anterior cruciate ligament, what is the position of the patient?

A

the patient lie supine on the examination table with his knees flexed to 90° and his feet flat on the table.

107
Q

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.

A

False

  • Cup your hands around the patient’s knee
108
Q

Draw the tibia toward you if it slides forward from under the femur, the anterior cruciate ligament may be torn. This sign is called:

A

Positive anterior draw sign

109
Q

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.

A

False

  • It is important to repeat the maneuver with the patient’s leg in internal and external rotation.
110
Q

__________ rotation of the leg tightens the postero- medial portion of the joint capsule.

A

External

111
Q

__________ rotation tightens the structures on the posterolateral side of the knee.

A

Internal

112
Q

Normally, there should then be reduced forward movement of the ________ on the femur , even if the anterior cruciate ligament is torn.

A

tibia

113
Q

Normally, there should be reduced movement when the leg is pulled _________ , even if the anterior cruciate ligament is torn.

A

forward

114
Q

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.

A

externally

neutral

115
Q

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.

A

internal

neutral

116
Q

The anterior cruciate ligament may be torn in association with:

A

Tears of the medial collateral ligament

117
Q

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.

A

True

118
Q

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:

A

positive posterior draw sign

119
Q

What are the three basic movements ( range of motion ) of the knee joint?

A

(1) flexion (associated with glide)
(2) extension (associated with glide)
(3) internal and external rotation.

120
Q

________ 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.

A

Flexion

extension

121
Q

Extension is performed by the quadriceps, while flexion is performed by the __________ and gravity.

A

hamstrings

122
Q

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.

A

semimembranosus

semitendinosus

biceps

123
Q

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?

A

Flexion

124
Q

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 ?

A

Extension

125
Q

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:

A

extension lag

126
Q

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.

A

True

127
Q

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.

A

lateral femoral condyle

lateral side

128
Q

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.

A

laterally

lateral femoral condyle

129
Q

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:

A

“screw home” motion

130
Q

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.

A

patella

flexed

tibial tubercle

131
Q

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.

A

laterally

externally

132
Q

_____________ - may prevent screw home motion and block full extension of the knee.

A

Torn meniscus

133
Q

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?

A

Internal and External rotation

134
Q

Testing Passive Range of Motion: What is the normal end point of knee flexion?

A

The normal end point of knee flexion for adults is approximately 135° from an extended position.

135
Q

Testing Passive Range of Motion: What is the position of the patient?

A

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
Q

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?

A

Passive range of motion

137
Q

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?

A

Extension

138
Q

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?

A

Internal and external rotation

139
Q

What is the normal end point of knee internal and external rotation?

A

Internal Rotation - 10°

External Rotation - 10°

140
Q

In muscle testing of knee, What is the primary extensor muscle?

A

Quadriceps

141
Q

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.

A

above

ankle joint

142
Q

What is the innervation of Quadriceps muscles ?

A

Femoral nerve, L2, L3, L4

143
Q

In muscle testing of knee, What is the primary flexor?

A

Hamstrings

144
Q

What are the three muscle group of Hamstring?

A

Semimembranosus

Semitendinosus

Biceps Femoris

145
Q

What is the innervation of semimembranosus and semitendinosus?

A

tibial portion of sciatic nerve - L5

146
Q

What is the innervation of biceps femoris?

A

tibial portion of sciatic nerve - S1

147
Q

To test the hamstrings as a group, What is the position of the patient?

A

The patient lie supine on the examining table and sta- bilize his thigh just above the knee.

148
Q

While you resist the motion at the back of his ankle joint. What is the position of patient’s knee?

A

The patient knee is flexed.

149
Q

To bring the biceps femoris into greater activity during the test. What is the position of the leg?

A

The patient leg should be rotated externally

150
Q

To bring the semimembranosus and semitendinosus muscles into greater activity during the test. What is the position of the leg?

A

The patient leg should be rotated internally

151
Q

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.

A

True

152
Q

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.

A

True

153
Q

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.

A

Except: 4

  • S2 outlines a strip down the midline of the posterior thigh and the popliteal fossa.
154
Q

____________ - 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.

A

saphenous nerve

155
Q

What are the sensory dermatomes of the knee that supplied by femoral nerve?

A

L3 and L2

156
Q

What is the sensory dermatomes of the knee that supplied by the posterior femoral cutaneous nerve of the thigh?

A

S2

157
Q

_____________ - is a deep tendon reflex, mediated through nerves emanating from the L2, 3, and 4 neurologic levels, but predominantly from L4.

A

patellar relfex or knee jerk

158
Q

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.

A

True

159
Q

What is the position of the patient so infrapatellar tendon is stretched and primed?

A

sitting position at the edge of the examining table with his legs dangling

160
Q

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.

A

infrapatellar

161
Q

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?

A

neurologic hammer

162
Q

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.

A

True

163
Q

What are the special test used in neurologic examination of the knee?

A
  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
Q

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?

A

McMurray Test

165
Q

During McMurray test, What is the position of the patient?

A

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
Q

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
A

True

167
Q

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.

A

medial meniscus

168
Q

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°.

A

Compression or Grinding Test

169
Q

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.

A

True

170
Q

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.

A

medial meniscus

lateral meniscal

171
Q

Test that helps to distinguish between meniscal and ligamentous problems of the knee joint. This test should follow the compression test in logical progression.

A

Distraction Test

172
Q

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.

A

lateral and medial ligamentous

173
Q

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.

A

ligaments

meniscus

174
Q

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.

A

Reduction Click

175
Q

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.

A

” Bounce home” Test

176
Q

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.

A

Patella Femoral Grinding Test

177
Q

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.

A

Apprehension Test for Patellar Dislocation And Subluxation

178
Q

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.”

A

internally

externally

179
Q

” Bounce home” Test: The knee should _____________ , or “bounce home,” into extension with a sharp end-point.

A

extend completely

180
Q

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.

A

distally

quadriceps

181
Q

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.

A

True

182
Q

What indicates that Patella femoral grinding test is positive?

A

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
Q

Apprehension Test for Patellar Dislocation And Subluxation:

What is the position of the patient during the test?

A

The patient lie supine on the examining table, with his legs flat and the quadriceps relaxed.

184
Q

What are the other conditions that results the roughened undersurface of the patella forced against the trochlear groove that causes pain?

A

chondromalacia patellae

osteochondral defects

degenerative changes

185
Q

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.

A

medial border

dislocate

186
Q

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.

A

Tinel test

187
Q

These tests are designed to document suspected effusion in the knee joint. (Major Effusion and Minor Effusion)

A

Knee Joint effusion Tests

188
Q

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.

A

saphenous

bulbous end

189
Q

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.

A

large effusion

patella

190
Q

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: ______________ .

A

ballotable patella

191
Q

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?

A

Test for Minor Effusion

192
Q

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 __________ .

A

medial side

lateral side

193
Q

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
A

True

Client Assessment 2-3 (4 decks)

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