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Lower Extremity Evaluation Lecture > Knee > Flashcards

Knee Flashcards

1
Q

Femur

A
  • Longest and strongest bone in body
  • Distal portion forms medial and lateral condyles & epicondyles
  • Features Linea Aspera
    ~ Posterior and serves as attachment
    site
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2
Q

Tibia

A
  • Proximal portion forms medial and
    lateral Tibial Plateaus
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3
Q

Fibula

A
  • Fibular head serves as attachment site
    for numerous soft tissue structures
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4
Q

Patella and its purpose

A
  • Classified as Sesamoid bone due its
    shape
  • Improves mechanical function of quads
    ~ Acts as a pully
  • Protects anterior portion of knee
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5
Q

Bursae

A
  • Act as padding and reduce friction
  • Suprapatellar
  • Prepatellar: On top of Patella
  • Infrapatellar (2)
  • Pretibial: On top of Tibia
  • Popliteal
  • Anserine: Medial
  • Iliotibial: Lateral
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6
Q

Tibiofemoral Joint

A
  • Articulation between condyles of femur
    and tibial plateaus
  • Condyles are covered with articular
    (hyaline) cartilage
  • Tibial plateaus are covered by medial
    and lateral menisci
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7
Q

Menisci and purpose

A
  • Made of fibrocartilage
  • Act as shock absorbers, increase joint
    congruency (bones fit better = stability),
    and decrease friction
  • Gets most of its resources from Synovial
    Fluid
    ~ Not supplied by blood very well; outer
    1/3 has the best blood supply and
    therefore better at healing
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8
Q

Tibiofemoral Joint Movements During Functional Loading/Pronation

A
  • Sagittal: Flexion
  • Frontal: Abduction
  • Transverse: Internal Rotation
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9
Q

Tibiofemoral Joint Movements During Functional Unloading/Supination

A
  • Sagittal: Extension
  • Frontal: Adduction
  • Transverse: External Rotation
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10
Q

What bone is relative to what bone at the Tibiofemoral Joint?

A

Tibia is relative to Femur

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11
Q

Patellofemoral Joint

A
  • Articulation between the patella and the
    medial and lateral condyles of femur
  • Both surfaces are covered by articular
    cartilage
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12
Q

Patellofemoral Joint Movements

A
  • Gliding along femoral condyles during functional loading and functional unloading of knee
  • During extension the patella rests superior to femoral groove (out of joint)
  • During flexion the patella enters the femoral groove (20-30 degrees)
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13
Q

When is the Patella most stable?

A

During flexion (loading): there’s no room for injury

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14
Q

Superior Tibiofibular Joint & Its Movements

A
  • Articulation between tibia and head of fibula
  • Movements:
    ~ Superior/Inferior Gliding
    ~ Anterior/Posterior Gliding
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15
Q

What Muscles Move the Knee?

A
  • Vastus Lateralis
  • Vastus Medialis
  • Vastus Intermedius
  • Rectus Femoris
  • Sartorius
  • Gracilis
  • Semitendinosus
  • Biceps Femoris
  • Semimembrabosus
  • Popliteus
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16
Q

Pes Anserine contains what Muscles?

A
  • Common tendon formed by Sartoius, Gracilis, and Semitendinosus
  • Insertion: Superior aspect of medial surface of Tibia near Tibial Tuberosity
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17
Q

Vastus Lateralis

A
  • Origin: Lateral lip of Linea Aspera &
    Intertrochanteric Line
  • Insertion: Lateral Border of Patella
  • Nerve: Femoral
  • Action: Knee Extension
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18
Q

Vastus Medialis

A
  • Origin: Medial lip of Linea Aspera &
    Intertrochanteric Line
  • Insertion: Medial Border of Patella
  • Nerve: Femoral
  • Action: Knee Extension
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19
Q

Vastus Intermedius

A
  • Origin: Superior 2/3 of anterior and
    lateral surfaces of femur
  • Insertion: Superior Border of Patella
  • Nerve: Femoral
  • Action: Knee Extension
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20
Q

Rectus Femoris

A
  • Origin: Anterior Inferior Illiac Spine &
    Superior to Acetabulum (Socket)
  • Insertion: Superior Border of Patella
  • Nerve: Femoral
  • Action: Knee Extension & Hip Flexion
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21
Q

Quadriceps Function: During functional loading at the Knee, the Quadriceps muscles…

A

Decelerate Flexion, Internal Rotation, & Abduction

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22
Q

Sartorius

A
  • Origin: Anterior Superior Iliac Spine
  • Insertion: Pes Anserine
  • Nerve: Femoral
  • Action: Knee Flexion; External Rotation &
    Flexion of the Hip
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23
Q

Gracilis

A
  • Origin: Inferior Ramus of Pubis & Ramus
    of Ischium
  • Insertion: Pes Anserine
  • Nerve: Obturator
  • Action: Flexion & Internal Rotation of
    Knee; Adduction of Hip
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24
Q

Semitendinosus

A
  • Origin: Ischial Tuberosity
  • Insertion: Pes Anserine
  • Nerve: Tibial
  • Action: Flexion & Internal Rotation of
    Knee; Hip Extension
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25
Q

Semimembranosos

A
  • Origin: Ischial Tuberosity
  • Insertion: Medial Condyle of Tibia
  • Nerve: Tibial
  • Action: Flexion & Internal Rotation of
    Knee; Hip Extension
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26
Q

Biceps Femoris

A
  • Origin: Ischial Tuberosity (long) & Linea
    Aspera (short)
  • Insertion: Head of Fibula
  • Nerve: Tibial
  • Action: Flexion & External Rotation of
    Knee; Hip Extension
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27
Q

Biceps Femoris Function: During functional loading at the knee, the Biceps Femoris…

A

Decelerates Internal Rotation

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28
Q

Popliteus

A
  • Origin: Lateral Condyle of Femur
  • Insertion: Posterior, Proximal Tibia
  • Nerve: Tibial
  • Action: Internal Rotation of Knee
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29
Q

Tibialis Posterior Function: During functional loading at the knee, the Tibialis Posterior…

A

Decelerates Flexion

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30
Q

Soleus Function: During functional loading at the knee, the Soleus…

A

Decelerates Flexion

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31
Q

What should be noticed during Anterior Inspection?

A
  • Knee Alignment
  • Patella Position
  • Quadriceps Girth and Contour
  • Patellar Tendon
  • Tibial Tuberosity
  • Edema or Effusion?
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32
Q

Knee Alignment & What structures get more stress due to these alignments?

A
  • Genu Valgum (“Knock Knee”)
    ~ Knees touch, ankles don’t
    ~ Lateral meniscus, MCL, and ACL get
    more stress
  • Genu Varum (“Bowleg”)
    ~ Knees apart with ankles touching
    ~ Medial meniscus and LCL get more
    stress
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33
Q

Patella Position

A
  • Normal should be in the middle
  • Grasshopper Eye: Tilt Outward
  • Squinting Eye: Tilt Inward
  • Patella Alta: High Position
  • Patella Baja: Low Position
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34
Q

Edema vs. Effusion

A
  • Edema
    ~ Swelling that’s all over and outside the
    joint
  • Effusion
    ~ Swelling that’s localized and inside the
    joint
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35
Q

Sweep/Brush/Stroke Test: Edema vs. Effusion Test

A
  • Positive test indicated by observation of
    fluid movement from lateral to medial
    ~ Indicates Effusion
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36
Q

Patellar Tap/Ballotable Patellar Test: Edema vs. Effusion Test

A
  • Positive test indicated by behavior of
    patella:
    ~ If patella sinks = Edema
    ~ If patella rebounds = Effusion
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37
Q

Fluctuation Test: Edema vs. Effusion Test

A
  • Positive test indicated by fluid passing
    from superior to inferior
    ~ Indicates Effusion
38
Q

What should be noticed during lateral inspection?

A
  • Knee Alignment
    ~ Genu Recurvatum (“Hyperextended
    Knee”)
    > Needs to be seen bilateral to be
    normal
39
Q

What should be noticed during posterior inspection?

A
  • Knee Alignment
  • Calf Girth and Contour
  • Hamstring Girth and Contour
  • Popliteal Fossa
40
Q

ROM Testing

A
  • AROM
    ~ Depends on muscle girth and body
    size
    ~ Flexion: 135-145 degrees
    > Pt. needs to be supine to take
    Rectus Femorus out of the equation
    ~ Extension: 0 degrees
    > Pt. needs to be supine to take
    Rectus Femorus out of the equation
    > Leg slightly elevated to allow knee
    to fully push down
  • PROM
  • RROM
41
Q

Neurological Assessment

A
  • Very important due to orientation of the nerves around the knee and the possibility of nerve injury along with other soft tissue injury
  • Nerve injuries follow the MOI of ligaments
  • Common Peroneal: Sensory & Motor
  • Tibial: Sensory & Motor
  • Saphenous: Sensory
42
Q

Ligamentous and Capsular Testing: Tibiofemoral Joint

A
  • Joint Capsule
    ~ Fibrous connective tissue capsule
    which surrounds the circumference of
    knee joint
  • Medial & Lateral Collateral Ligaments
43
Q

Medial Collateral Ligament

A
  • Provides medial stability & resists
    valgus
  • Originates just below the Adductor
    Tubercle, crosses the medial joint line
  • Inserts 7-10 cm below joint line
    (Junction of Tibiofemoral Joint)
  • Strong and thick because it’s used all day, every day
44
Q

Medial Collateral Ligament Test

A
  • Valgus Stress Test
    ~ Positive test indicated by increased
    laxity at the medial joint line
    > Full Extension = MCL & Medial Joint
    Capsule
    > 25 degrees of Flexion = MCL
45
Q

Lateral Collateral Ligament

A
  • Provides lateral stability & prevents Varus
  • Originates from lateral femoral epicondyle, crosses the lateral joint line
  • Inserts on the Fibular head
  • Small and wimpy because it’s not used all the time. The knees natural reaction is to go into Varus and not Valgus
46
Q

Lateral Collateral Ligament Test

A
  • Varus Stress Test
    ~ Positive test indicated by increased
    laxity at the lateral joint line
    ~ Full Extension = LCL & Lateral Joint
    Capsule
    ~ 25 degrees of Flexion = LCL
47
Q

Medial Collateral Ligament Signs & Symptoms

A
  • Pain medially
  • Will hear/feel a pop
  • A lot of effusion
  • Instability
48
Q

Lateral Collateral Ligament Signs & Symptoms

A
  • Pain laterally
  • Will hear/feel a pop
  • Effusion or Edema or both
  • Instability
49
Q

Anterior Cruciate Ligament (ACL)

A
  • Origin: Anteromedial intercondylar
    eminence of Tibia, runs superior
    & lateral
  • Insertion: Medial wall of lateral femoral
    condyle
  • Provides stability in all 3 planes:
    ~ Abduction
    ~ Anterior tibial translation
    ~ Internal Rotation
  • Anterior Bundle: Tightest at full Flexion
  • Posterior Bundle: Tightest at full
    Extension
50
Q

ACL Tests

A
  • Anterior Drawer Test (easier)
    ~ Positive test indicated by increased
    anterior translation of Tibia relative to
    Femur
    ~ Determines grade: 1-3
    ~ False negatives can occur due to
    hamstrings muscle guarding
    > hamstrings need to be relaxed
    and no extension
  • Lachman’s Test (favored)
    ~ Positive test indicated by increased
    anterior translation of Tibia
    ~ Hamstrings aren’t able to muscle
    guard
51
Q

Segond Fracture

A
  • Piece of bone off of Tibia
  • High correlation to ACL injury and same
    MOI
  • Thought to be due to excess Internal
    Rotation
  • Appears to be an avulsion fracture,
    possibly associated with tension on
    posterlateral capsule, or LCL
52
Q

Posterior Cruciate Ligament (PCL)

A
  • Origin: Posterior aspect of Tibia, runs
    superior and medial
  • Insertion: Lateral wall of medial femoral
    condyle
  • Works with Popliteus to prevent
    posterior translation and external
    rotation of Tibia on Femur
  • Anterior Bundle: Tightest between
    40-120 degrees
  • Posterior Bundle: Tightest beyond 120
    degrees
53
Q

PCL Tests

A
  • Posterior Drawer Test
    ~ Positive test indicated by increased
    posterior translation of Tibia
    ~ Will appear normal, once posterior
    force is applied, will look abnormal
  • Godfrey’s Test
    ~ Positive test indicated by unilateral
    posterior displacement of Tibial
    Tuberosity
    ~ Knees flexed in air, gravity will make
    Tibial Tuberosities appear unilateral
    ~ Quads need to be relaxed
  • Posterior Sag Test
    ~ Positive test indicated by unilateral
    posterior displacement of Tibial
    Tuberosity
    ~ Knees flexed with feet on table, gravity
    will make Tibial Tuberosities appear
    unilateral
54
Q

The Anterior & Posterior Tibiofibular Ligaments support…

A

The Proximal Tibiofibular Joint: head of Fibula against Tibia

55
Q

Proximal Tibiofibular Joint Ligament Tests

A
  • Tibiofibular Translation Test
    ~ Positive test indicated by increased
    movement of Fibula on Tibia~ Excess Anterior Translation =
    Posterior Tibiofibular Ligament
    ~ Excess Posterior Translation =
    Anterior Tibiofibular Ligament
56
Q

Meniscus Tear and S&S

A
  • Often paired with ligament injury
    ~ Any MOI that causes ligament tear
  • Impingement of meniscus between
    Femoral Condyles and Tibial Plateau
  • Remember! Meniscus’ main job is
    stability
  • S&S:
    ~ Not much swelling due to lack of
    blood supply, unless severe
    ~ Pain
    ~ Clicking, locking, & popping
57
Q

Meniscus Tear Tests

A
  • McMurray’s Test (best for posterior)
    ~ Positive test indicated by popping,
    clicking, or locking of knee
    ~ Positive with Internal Rotation =
    Lateral Meniscus posteriorly
    ~ Positive with External Rotation =
    Medial Meniscus posteriorly
  • Apley’s Compression Test (not that good)
    ~ Positive test indicated by pain during
    compression and not during
    distraction
    > If pain with distraction indicates
    other structure
58
Q

Anterolateral Rotary Instability

A
  • Describes the direction the Tibia
    translates on Femur as a result of injury
    ~ Anterior & Lateral
  • Possible injury to ACL and any
    combination of Anterolaterl/
    Posterolateral Capsule, and or LCL
59
Q

Why is instability worse than laxity?

A
  • Instability requires surgery
  • Laxity is rehabilitatable
60
Q

Anterolateral Rotary Instability Tests

A
  • Slocum 1 Drawer Test
    ~ Internal Rotation
    ~ Positive test indicated by increased
    amount of anterior tibial translation
    relative to straight drawer
  • Lateral Pivot Shift Test
    ~ Internal Rotation
    ~ Positive test indicated by anterolateral
    subluxation of Tibia at around 20
    degrees & reduction greater than 30
    degrees
  • Slocum Anterolateral Rotary Instability
    Test
    ~ Internal Rotation
    ~ Positive test indicated by
    anterolateral subluxation of Tibia
    ~ Can be used for ACL and Capsule
61
Q

Anteromedial Rotary Instability

A
  • Possible injury to ACL and any
    combination of Anteromedial/
    Posteromedial capsule, and or MCL
62
Q

Anteromedial Rotary Instability Test

A
  • Slocum 2 Drawer Test
    ~ External Rotation
    ~ Positive test indicated by increased
    amount of anterior Tibial translation
    relative to straight drawer
63
Q

What does excess laxity internally, externally, or the same internally and externally indicate?

A
  • Excess laxity internally = LCL
  • Excess laxity externally = MCL
  • Excess laxity internally & externally = ACL
64
Q

Posterolateral Rotary Instability

A
  • Possible injury to PCL and Posterolateral
    Capsule and or LCL
65
Q

Posterolateral Rotary Instability Tests

A
  • Hughston’s Posterolateral Drawer Sign Test
    ~ External Rotation
    ~ Positive test indicated by increased
    posterior translation of Tibia relative
    to straight drawer
  • External Rotation Recurvatum Test
    ~ External Rotation
    ~ Positive test indicated by
    hyperextension of knee & external
    rotation of Tibia
66
Q

Posteromedial Rotary Instability

A
  • Possible injury to PCL and Posteromedial
    Capsule and MCL
67
Q

Posteromedial Rotary Instability Test

A
  • Hughston’s Posteromedial Drawer Sign Test
    ~ Internal Rotation
    ~ Positive test indicated by increased
    posterior translation of Tibia relative to
    straight drawer
68
Q

Plica Syndrome and Cause

A
  • Normal fold in joint capsule that’s
    enlarged and becomes inflamed
    ~ Usually medial and superior to patella
    ~ Can also be superior, inferior, or
    lateral
  • Can be due to trauma or anatomical
    variation
69
Q

Plica Syndrome Signs, Symptoms, and Management

A
  • S&S:
    ~ Snapping and/or locking with knee
    Flexion/Extension
    > occurs due to patellar movements
    ~ Minimal swelling
    ~ Appears the same as Meniscus tear
    > Pt. will say weird MOI for Meniscus
    tear
  • Management:
    ~ RICE
    ~ NSAIDS
    ~ Surgical Excision
    > Last resort; needs to be severe
    > Causes scar tissue
70
Q

Plica Syndrome Tests

A
  • Mediopatellar Plica Test
    ~ Positive test indicated by pain with
    medial movement of patella
  • Plica “Stutter” Test
    ~ Positive test indicated by jerking
    motion of patella during knee
    extension
    > Jerking is caused by patella getting
    stuck and will forcefully glide
71
Q

Osgood-Schlatter’s Disease

A
  • Apophysitis at Tibial Tubercle
    ~ Causes prominent bump at Tibial
    Tubercle
  • Common in boys and girls between 8-15
    years old
72
Q

Sinding-Larsen Johansson’s Disease

A
  • Apophysitis at Infrapatellar pole (patellar
    tendon attachment site)
    ~ Causes prominent bump at patellar
    tendon attachment site
  • Common in boys and girls between 8-15
    years old
73
Q

Osgood-Schlatter & Larsen-Johansson Diseases Cause, Signs, Symptoms, & Management

A
  • Cause:
    ~ Excess stress or tension on bony
    attachment
    ~ Age; Adolescents
  • S&S:
    ~ Pain just below attachment
    ~ Swelling over attachment
  • Management:
    ~ Decrease activity level
    ~ RICE
    ~ Patellar Tendon Strap
    > Changes angle of tendon pull (bows
    in and cheats)
    > Not a fix, but helps
    ~ Time
74
Q

Patellar Tendonitis (“Jumpers Knee”)

A
  • Chronic inflammation due to overuse
  • Common in sports requiring explosive
    movements involving Flexion/Extension
    of Knee
75
Q

Patellar Tendon Rupture

A
  • Excess tension of patellar tendon
  • Usually preceded by Tendonitis or
    Osgood’s
  • Not common in adolescents
76
Q

Patellar Tendon Rupture Signs, Symptoms, & Management

A
  • S&S:
    ~ Complaint of sudden snap/pop
    ~ Swelling = Edema
    ~ Tenderness
    ~ Discoloration
    ~ Deformity
    ~ Diminished/absent active knee
    Extension
  • Management:
    ~ Splint/brace to immobilize
    ~ Crutches (non-weight bearing)
77
Q

Patellofemoral Joint: Soft Tissue that keep Position Maintenance

A
  • Bony Geometry
    ~ Patella is built and set up to stay in
    femoral groove
  • Retinaculum
    ~ Medial: originates from Vastus
    Medialis and Patella and inserts on
    Tibia
    ~ Lateral: originates off of Vastus
    Lateralis and Patella and inserts on
    Tibia
  • Patellofemoral & Patellotibial Ligaments
  • Muscles
    ~ Vastus Medialis
    ~ Vastus Lateralis
    ~ Vastus Intermedius
    ~ Rectus Femoris
78
Q

Knee Conidtions

A
  • Patella Femoral Stress Syndrome
    ~ Normal activity can cause it so ask if
    any trauma to knee, if no suspect this
  • Chondromalacia Patellae
    ~ Caused by Patella Femoral Stress
    Syndrome
    ~ Breakdown of patella
  • Patellar Subluxation/Dislocation
    ~ Easy to see
79
Q

Patellar Subluxation/Dislocation Test

A
  • Patellar Apprehension Test
    ~ Positive test indicated by patient
    apprehension
    ~ Subluxation usually goes lateral and
    this test mimics that
80
Q

Neurovascular Injury

A
  • Emergent
  • Usually as a result of a Subluxation
  • Same force of soft tissue MOI can injure
    nervous and vascular structures
  • Nerves involved
    ~ Tibial: Dislocation or hyperextension
    ~ Common Peroneal: LCL
    ~ Saphenous: MCL
81
Q

Tibial Nerve (Posterior)

A
  • Sensory
    ~ Back of thigh
    ~ Lateral lower leg
    ~ Sole of foot
  • Muscles Innervated
    ~ Soleus
    ~ Gastrocnemius
    ~ Tibialis Posterior
    ~ Flexor Hallicus Longus
    ~ Flexor Digitorum Longus
    ~ Hamstrings
82
Q

Common Peroneal Nerve

A
  • Split from the Sciatic Nerve
  • Splits into Deep and Superficial after
    crossing the knee
83
Q

Common Peroneal: Deep Peroneal (Anterior)

A
  • Sensory
    ~ 1st web of foot
  • Muscles Innervated
    ~ Tibialis Anterior
    ~ Peroneus Tertius
    ~ Extensor Hallicus Longus
    ~ Extensor Digitorum Longus
84
Q

Common Peroneal: Superficial Peroneal (Lateral)

A
  • Sensory
    ~ Lateral lower leg
    ~ Lateral portion of dorsum of foot
  • Muscles Innervated
    ~ Peroneal Longus
    ~ Peroneal Brevis
85
Q

Saphenous Nerve (Medial)

A
  • Split from Femoral Nerve
  • Sensory
    ~ Medial knee
    ~ Lower leg
86
Q

Signs of Vascular Injury

A
  • Expanding hematoma
  • Absent distal pulse
    ~ Dislocation can cause an artery to tear
  • Cold and pale limb
87
Q

Why is a Vascular injury worse than a Neurological injury?

A
  • A vascular injury causes the lack of blood
    flow to tissue resulting in tissue death
  • It’s very important to call EMS and refer
    immediately if suspected
88
Q

Q-Angle

A
  • Angle of hips relative to lower leg
    ~ Abduction/Valgus
  • Women have larger Q-Angle due to
    having wider hips
  • Larger Q-Angle predisposes you to ACL,
    MCL, and Lateral Mensicus tear
89
Q

Obturator Nerve

A

Innervates the upper/medial thigh

90
Q

What does NSAIDs stand for?

A

Non Steroidal Anti Inflammatory Drugs

91
Q

Patellar Bursitis “Housemaid’s Knee”

A
  • Patellar Bursa becomes too inflamed due
    to excess friction

Lower Extremity Evaluation Lecture (8 decks)

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