Knee Flashcards
Largest sesamoid in the body
Patella
Fibrocartilage disks that make the rounded femoral condyles fit to support the joint and cushion the knee joint
Menisci
Death of bone tissue due to lack of blood supply
Avascular necrosis
Prevents tibia from moving forward and femur back
Anterior cruciate ligament
Prevents tibia from sliding back and femur forwards
Posterior cruciate ligament
Stabilized knee and protects from valgrus force
Medial collateral ligament
Resists varus force applied to medial surface of knee
Lateral collateral ligament
Cushion the front of the knee
Fat pads
Knock knees, tension on medial aspect
Genu valgum
Bow legs, tension on the lateral aspect
Genu varum
Blood in the joint
Hemarthrosis
Soft tissue diagnosis tool
MRI
Anterior gliding of the tibia
Translation
Valgus stress test
Place one hand on the lateral aspect of the knee and the other on the medial aspect of the ankle. Apply a valgus force to the knee at 0 and 30 degrees.
Positive test for Valgus stress test
Pain and laxity at the MCL
LCL special test
Varus stress test
What is the varus stress test
Place one hand on the medial aspect of the knee and the other on the lateral ankle. Apply a varus force to the knee at 0 and 30 degrees.
Varus positive test
Pain/laxity at LCL
What is the special test for the ACL
Lachmans and anterior drawer
What is the lachmans test
Firmly grasp the distal femur and the proximal tibia. With the knee in slight flexion pull the tibia anteriorly
Lachmans positive test
Laxity compared to uninsured side
What is the anterior drawer test
Put the athlete in knee flexion. Place hands in the superior aspect of the gastrocnemius and pull anteriorly
When is the anterior test positive
Pain and the tibia moves forward
Knees are designed to:
Provide stability and mobility
The knee is the most ______ joint in the body
Complex
The knee is a _______ joint
Hinge
Stability depends on the
Ligaments, joint capsule and muscles
The knee is unstable in which directions
Laterally and medially
How many bursae are around the knee?
2 dozen
The ______ fat pad is the largest
Infrapatellar
What is the purpose of the fat pad?
Cushions the front of the knee and separates the patella tendon from the joint capsule
Tibial nerve supplies the
Semitendinosis, semimembranosus, and gastrocnemius
Peroneal nerve supplies the
Biceps femoris
Femoral nerve supplies the
Quadriceps
_______ artery stems from the femoral artery
Popliteal
Leg alignment questions
Are the patellas level? Patellas facing forward? Can the athlete touch the medial femoral condyles and medial malleoli together? Are the knees fully extended? Are both knees equally extended?
Genu valgum
Knock knees
Symptoms of knock knees (genu valgum)
Pronated feet
Tension on ligaments
Compression of lateral aspects
Abnormal tightness of IT band
Genu varum
Bow legs
Genu varum (bow legs) symptoms
Tension on ligaments on lateral surface of knee/IT band
Supinated foot
Genu recurvatum
Hyperextended knees and
Symptoms of genu recurvatum (hyperextended knees)
Compensation for lordosis
Stretching of hamstring muscles
Produces anterior pressure on knee, posterior ligaments and tendons
What is the Q angle?
When lines are drawn from the middle of the patella to the anteriorsuperior spine of the illium and from the tubercle of the tibia through the center of the patella
What is a normal Q angle?
10 degrees for males, 15 for females
If you have a Q angle greater than 20 what does it mean
It is considered excessive and could lead to knee pain and injuries
How do you measure the Q angle?
With the knee fully extended and flexed at 30 degrees
Longest and strongest bone
Femur
Sesamoid: bone within tendon
Shock absorber
Patella
Primary weight bearing bone in lower leg
Tibia
Bears no weight, attachment site for muscles
Gives stability to ankle
Fibula
Protects from valgus (medial) displacement
Medial collateral ligament
Protects from varus (lateral) displacement, taut during knee extension
Lateral collateral ligament
Most frequently ruptured, protects from anterior tibia motion, made of three twisting bands
Anterior cruciate ligament
Protects from posterior displacement, stronger than ACL
Posterior cruciate ligament
Most common injured ligament in the knee
MCL
Valgus stress, lateral blow w/ foot fixation, serve twist that causes swelling, limited ROM, pain, LOF, and instability
MCL injury
Mild ligament fibers torn or stretched but joint is stable with mild or no swelling, mild pain, stiffness and joint tenderness
MCL grade 1
Tearing of the capsule, partial tear of MCL, moderate instability, swelling, joint stiffness
MCL grade 2
Complete tear of MCL and supporting ligaments, complete loss of medial stability, severe pain and swelling, LOF and hear a pop
MCL grade 3
Varus stress, medial blow with pain, inflammation, instability and LOF
LCL sprain
Torsion, (foot fixation with twisting) or a blow. Typically happens in female soccer players and they hear a pop, then rapid swelling and pain
ACL sprain
Severe hyperextension, or a fall w/knee flexed to 90 degrees
Symptoms: feeling a pop in back of knee, tenderness, little swelling, instability and pain
PCL injury
PCL special tests
Posterior drawer and posterior sag
Posterior drawer procedure
W/athlete in knee flexion push posteriorly on tibia
Positive test for posterior drawer
Laxity compared bilaterally
Posterior sag procedure
Athlete lies supine with knees and hips flexed to 90. Hold the tibias at 90 and look for sagging of the proximal tibia
Positive test for posterior sag
Sagging of proximal tibia
C-shaped, attached to medial facet tibia
Medial meniscus
O-shaped, attached to lateral aspect of tibia
Lateral meniscus
What are the three zones
Red, red-white, and white-white
Two oval fibrocartilages that deepen the articulation and cushion any stresses placed on the knee joint
Meniscus
Red zone:
Outer 1/3, good vascular supply
Red-white zone
Middle 1/3, has minimal blood supply
White-white zone:
Inner 1/3 is avascular
Higher incidence of injury, it attaches to tibia and capsular ligament
Meniscus injury
Firm foot fixation with rotary force (torsion) while the knee is extended or flexed, cutting motion, squatting
Meniscus injury
What are the symptoms for a meniscus injury
Swelling, discoloration
Pain along the joint, loss of ROM, locking, clicking, buckling
Cutting with foot fixation in younger athletes
Bucket handle
Torsion
Parrot beak
Forced flexion
Loose body
Types of meniscus injuries
Bucket handle
Parrot beak
Loose body
How do you treat a meniscus injury
MRI, surgery, ice, rom,
Anterior thigh (quadriceps)
Vastus intermedius, rectus femoris, vastus lateralis, vastus medialis
What is the movement of the quadriceps
Knee extension
Posterior thigh (hamstrings)
Semimembranosus, semitendinosis, biceps femoris
What is the movement of the hamstrings
Knee flexion
Medial thigh (groin)
Adductor longus, brevis, magnus, gracilis, pectineus
What is the movement of the medial thigh
Hip adduction
Lateral thigh
Tensor fasciae latae, gluteus medius
Lateral thigh movement
Hip abduction
Lower leg
Gastrocnemius
Lower leg movement
Knee flexion
Compression force, blow to the soft tissue of the thigh with inflammation, discoloration, and loss of ROM
Quad contusion
Sudden stretching contraction (jumping, kicking) with pain, spasm, loss of function
Quad strain
Muscle fatigue, faulty posture, leg length discrepancy, tight hamstrings, improper form with discoloration, pain, LOF, swelling
Hamstring strain
Continued kneeling or falling directly on the knee with localized swelling and redness
Bursitis
Jumping, kicking, or running may place extreme tension on the knee with vague tenderness and pain
Patellar tendinitis (jumpers knee)
When an athlete plants the foot, decelerates, and simultaneously cuts in an opposite side from the weight beating foot
Patella dislocation
Rapidly growing immature adolescent knee, repeated pull of the patella tendon at tibial tubercle
Osgood-schlatter disease
Overuse condition in runners or cyclists with tenderness, mild swelling, increased warmth, and redness over the lateral femoral condyle
IT band tendinitis (runners knee)
When can an athletic trainer go on the field for an injury in lacrosse
When the ref stops play and allows you on
What are the offense positions in lacrosse
1st, 2nd, 3rd home, and 2 attack wings
What are the defense positions in lacrosse
Center, 2 wings, point, cover point, 3rd man and goalie
During a track meet, what locations will injuries most likely occur?
Pole vault, finish line and over hurdles
Return to play criteria
Full ROM
Full strength
Pain free
Functional activities
Walking
Jogging
Running
Spiriting
What is the long term goal of rehab
To return the injured athlete to practice or competition as quickly and safely as possible
Short term goals of rehab
Maintain or improve flexibility, restore or increase strength, reestablish neuromuscular control, and maintain level of cardiovascular fitness
Rehab goals
To prevent de-conditioning and to restore the injured part to a pre-injury status
Phase 1 rehab
Heel slides Quadriceps contractions Knee extension (no weight) Pilates (clams, 90/90) Balancing Bike workout Hamstring curls (no bridge) 4 way hip exercises Stretching
