Knee Flashcards
Tibiofemoral Joint
- Modified hinge joint with 2 dg of freedom
- -Convex Femur
- -Concave Tibia
- Resting Position: 25 dg flexion
- Closed: Full extension, ER of the tibia
- Capsular Pattern: Flexion, extension
Patellofemoral Joint
- Modified plane joint
- Resting position: full extension
- Closed: full flexion
- Capsular pattern: flexion > extension
Patella
- Sesamoid bone within the patellar tendon
- Thickest layer of cartilage
- 5 facets: Superior, inferior, medial, lateral, and odd
- Improves efficiency of extension during last 30 dg of extension
- Bony shield for the articular cartilage of the femoral condyles
- Biomechanical function
- -Improve moment arm
- -Reduce tibiofemoral shear stress
Patella Palpation
- Supine or long-sitting
- trace all edges
- Move the patella medial, lateral, superior, and inferior
- When lateral, attempt to palpate the lateral facet
- When medial, attempt to palpate the medial/odd facet (smaller than lateral)
Patella Tracking Palpation
- Sitting w/ knee bent
- With fingers on the medial and lateral aspect of the patella, ask patient to slowly extend and bend knee
- Note tracking and/or crepitis
Tibial Tuberosity Palpation
- Distal end of patellar tendon, may have excessive overgrowth due to Osgood-Schlatter
- -Disease-overgrowth of the bone that can lead to pain -> large tibial tuberosity
Tibial Plateaus Palpation
Sharper edges superior and lateral from the tibial tuberosity
Femoral Condyles Palpation
Easier with knee bent, palpate the medial and lateral condyles just medial/lateral to the patella.
Trochlear Groove Palpation
Highest point of the femoral condyles, superior to patella and should feel depression of the trochlear groove between condyles
Lateral Tibial Plateau Palpation
- Distal from lateral epicondyle and across the joint line
- May feel “sharp”
Lateral Tubercle of Tibia Palpation
- Lateral to the infrapatellar tendon and immediately below tibial plateau
- Attachment site for ITB
Fibular Head Palption
- Approximately the same level as the tibial tuberosity on the lateral aspect of the knee
- Attachment site for LCL and biceps femoris
- Can use this to help with DF
Medial Epicondyle Palpation
- Superior aspect of the medial condyle
- Level with the base of the patella
Adductor Tubercle Palpation
- Most superior and posterior aspect of the medial condyle
- Attachment site for adductor magnus
Medial Tibial Plateau Palpation
- Inferior to soft tissue depression made in the sitting position
- Attachment site for medial meniscus
Quadriceps Palpation
- Palpate as a whole group and as individual muscles
- Note difference between VM and VL
- Both location and ability of contraction
- Check to make sure both are contraction
- Cannot palpate intermedius due to overlapping rectus
Infrapatellar Ligament (Patellar Tendon) Palpation
- Trace from apex of patella to tibial tuberosity
- Above patella=quad tendon
Infrapatellar Fat Pad Palpation
- May be palpable immediately medial/lateral to patellar tendon
- Irritation here is called Hoffa’s Syndrome
Medial (Tibial) Collateral Ligament Palpation
- Between medial tibial plateau and femur
- Part of joint capsule and attached to medial meniscus
Medial Hamstrings
- Semimembranosus is more medial and flatter
- Semitendinosus is more posterior and tendon-like [Don’t confuse with gracilis and sartorius]
Medial Meniscus
- Superior to medial tibial plateau
- Palpated deeper within the joint space
- Tibial IR can make it more prominent
- Coronoid lig is usually what is tender
Pes Anserine Palpation
From Superior to Inferior (Anterior to Posterior)
- Sartorius =More muscular vs tendon
- Gracilis= Contracts more with tibial internal rotation
- Semitendinosus= Most posterior and inferior tendon
Bursa is located here and can be a source of pain
Lateral (Fibular) Collateral Ligament Palpation
- Between the femoral condyle and fibular head
- Best palpated with leg in “guy” crossed leg position
Lateral Meniscus
- Superior to lateral tibial plateau
- Best palpated with knee in slight flexion
Iliotibial Band (ITB)
- Inserts onto the lateral tibial tubercle
- Best palpated with knee in extension
Biceps Femoris Tendon
- Inserts onto the fibular head
- Resist flexion to feel it contract
Common Peroneal Nerve
- Inferior to biceps femoris insertion
- Crosses neck of fibula
- Common site of compression or stretch-especially seen with casts
Medial and Lateral Heads of Gastrocnemius
- Attach to medial/lateral femoral condyles
- Stretch=extend knee
- Have patient PF to feel contract
- -Or resist going into DF
Soleus
- Deep to and broader than gastrocnemius
- Palpate distally near where gastrocnemius turns into Achilles
- Stretch= flex knee
Popliteal Fossa Borders
- Superior Lateral Border: Biceps femoris tendon
- Superior Medial Border: Semitendinsus and Semimembranosus
- Inferior Medial Border: Medial head of gastrocnemius
- Inferior Lateral Border: Lateral head of gastrocnemius
Poplital Fossa Contents
Superifical to Deep:
- Posterior Tibial Nerve
- Popliteal Vein
- Popliteal Artery
Knee Flexion ROM
- Normal: 150 dg
- End Feel: Soft -tissue approximation
- F= Lat. epicondlye of femur
- S=Midline of femur [greater trochenter]
- M=midline of fibula
- Test in prone=ML test of rectus femoris
- Test in supine=bring heel to butt—get more range
- Test in sitting=hit table
- Eli Test-does the hip rise up? In supine and passively flex knee (look at RF)
Knee Extension ROM
- Normal: 0 dg
- End Feel: Firm-posterior capsule and ligaments
- F= lat. epicondyle of femur
- S= midline of femur
- M=midline of fibula
- Lay on back—towel under ankle and measure knee
- Sitted position=muscle activation test-passively place them into extension = passive length instead of MMT
ML Test for Hamstrings
- “90/90”, “Popliteal Angle”
- Pt supine with hip flexed to 90 deg
- Passively extend knee as straight as possible
- Look for compensation at hip joint: Hip extension
- To quantify the ML measure the amount of knee flexion contracture is taken
- Traditionally performed passively, however, can be done actively
ML Test for Rectus Femoris
- “Ely’s Test”
- Pt prone
- Passively flex the pt’s knee by bringing the heel as close to buttocks.
- Look for compensation at the hip joint: Hip flexion or Hip rotation
-To quantify the muscle length measure the amount of knee flexion that occurs
Knee Flexion MMT
- Pt prone with knee bent to approximately 45°
- -Will see it more commonly performed sitting in the clinic
- PT standing next pt
- -One hand stabilizes thigh & palpates hamstrings
- -Other hand pulls knee into extension
- Can perform as one whole muscle group or:
- -Medial HS Test: Perform with tibial IR
- -Lateral HS Test: Perform with tibial ER
Grade 2
Completes ROM in side-lying with leg supported by PT
Knee Extension MMT
- Pt short sitting over edge of table
- PT next to patient
- Resistance hand contacts distal leg just proximal to ankle
- Other hand on posterior surface of distal thigh [Will see it on top of thigh in clinic]
-Grade 2: Completes ROM in side-lying with leg supported by PT
Knee Extension MMT Compensations
- Leaning back
- Locking the knee into full/hyper extension.
- Hip coming off of table
Knee Circumferential Measurements
Take measurements at:
- Joint Line
- Suprapatellar line
- Infrapatellar line
