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Test and Measures > Knee > Flashcards

Knee Flashcards

1
Q

Tibiofemoral Joint

A
  • 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
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2
Q

Patellofemoral Joint

A
  • Modified plane joint
  • Resting position: full extension
  • Closed: full flexion
  • Capsular pattern: flexion > extension
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3
Q

Patella

A
  • 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
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4
Q

Patella Palpation

A
  • 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)
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5
Q

Patella Tracking Palpation

A
  • 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
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6
Q

Tibial Tuberosity Palpation

A
  • 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
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7
Q

Tibial Plateaus Palpation

A

Sharper edges superior and lateral from the tibial tuberosity

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8
Q

Femoral Condyles Palpation

A

Easier with knee bent, palpate the medial and lateral condyles just medial/lateral to the patella.

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9
Q

Trochlear Groove Palpation

A

Highest point of the femoral condyles, superior to patella and should feel depression of the trochlear groove between condyles

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10
Q

Lateral Tibial Plateau Palpation

A
  • Distal from lateral epicondyle and across the joint line

- May feel “sharp”

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11
Q

Lateral Tubercle of Tibia Palpation

A
  • Lateral to the infrapatellar tendon and immediately below tibial plateau
  • Attachment site for ITB
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12
Q

Fibular Head Palption

A
  • 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
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13
Q

Medial Epicondyle Palpation

A
  • Superior aspect of the medial condyle

- Level with the base of the patella

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14
Q

Adductor Tubercle Palpation

A
  • Most superior and posterior aspect of the medial condyle

- Attachment site for adductor magnus

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15
Q

Medial Tibial Plateau Palpation

A
  • Inferior to soft tissue depression made in the sitting position
  • Attachment site for medial meniscus
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16
Q

Quadriceps Palpation

A
  • 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
17
Q

Infrapatellar Ligament (Patellar Tendon) Palpation

A
  • Trace from apex of patella to tibial tuberosity

- Above patella=quad tendon

18
Q

Infrapatellar Fat Pad Palpation

A
  • May be palpable immediately medial/lateral to patellar tendon
  • Irritation here is called Hoffa’s Syndrome
19
Q

Medial (Tibial) Collateral Ligament Palpation

A
  • Between medial tibial plateau and femur

- Part of joint capsule and attached to medial meniscus

20
Q

Medial Hamstrings

A
  • Semimembranosus is more medial and flatter

- Semitendinosus is more posterior and tendon-like [Don’t confuse with gracilis and sartorius]

21
Q

Medial Meniscus

A
  • 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
22
Q

Pes Anserine Palpation

A

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

23
Q

Lateral (Fibular) Collateral Ligament Palpation

A
  • Between the femoral condyle and fibular head

- Best palpated with leg in “guy” crossed leg position

24
Q

Lateral Meniscus

A
  • Superior to lateral tibial plateau

- Best palpated with knee in slight flexion

25
Q

Iliotibial Band (ITB)

A
  • Inserts onto the lateral tibial tubercle

- Best palpated with knee in extension

26
Q

Biceps Femoris Tendon

A
  • Inserts onto the fibular head

- Resist flexion to feel it contract

27
Q

Common Peroneal Nerve

A
  • Inferior to biceps femoris insertion
  • Crosses neck of fibula
  • Common site of compression or stretch-especially seen with casts
28
Q

Medial and Lateral Heads of Gastrocnemius

A
  • Attach to medial/lateral femoral condyles
  • Stretch=extend knee
  • Have patient PF to feel contract
  • -Or resist going into DF
29
Q

Soleus

A
  • Deep to and broader than gastrocnemius
  • Palpate distally near where gastrocnemius turns into Achilles
  • Stretch= flex knee
30
Q

Popliteal Fossa Borders

A
  • 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
31
Q

Poplital Fossa Contents

A

Superifical to Deep:

  • Posterior Tibial Nerve
  • Popliteal Vein
  • Popliteal Artery
32
Q

Knee Flexion ROM

A
  • 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)
33
Q

Knee Extension ROM

A
  • 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
34
Q

ML Test for Hamstrings

A
  • “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
35
Q

ML Test for Rectus Femoris

A
  • “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

36
Q

Knee Flexion MMT

A
  • 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

37
Q

Knee Extension MMT

A
  • 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

38
Q

Knee Extension MMT Compensations

A
  • Leaning back
  • Locking the knee into full/hyper extension.
  • Hip coming off of table
39
Q

Knee Circumferential Measurements

A

Take measurements at:

  • Joint Line
  • Suprapatellar line
  • Infrapatellar line

Test and Measures (8 decks)

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