Knee Flashcards
Movement analysis of knee extension
- Movement occurring and joint
- Knee extension in tibiofemoral joint
- Superior glide in patellofemoral joint
- Axis and Plane
- Sagittal axis about frontal plane
- Range of joint movement
- 0°
- 0-10° - hyperextension
• Main muscles involved
• Quadriceps femoris
○ Prime mover - rectus femoris
• Type of muscle work
• Isotonic (dynamic) muscle work; concentric muscle work where the agonist (rectus femoris) shortens bringing the attachments (AIIS - base of patella, tibial tuberosity) closer, resulting in a swelling of the muscle belly. Internal force > external force
• Range of muscle work - inner/middle/outer
• Muscles involved as synergists/fixators/antagonists
• Synergist - none in open chain; gluteus maximus in closed chain. Muscle that ensures quality of movement by preventing unwanted movement in the associates joints and adjacent joints
• Antagonist - hamstrings, popliteus, gastrocnemius, gracilis, sartorius. Muscle that opposes direction of agonist, e.g. as agonist (rectus femoris) concentrically contracts the antagonist (biceps femoris) reciprocally lengthens.
• Fixators - rectus abdominis; muscles that stabilise the base and proximal attachment of the agonist (AIIS)
• Measurement
• AROM/PROM
○ Goniometry - most accurate
○ Measurement of bony landmarks
○ Visual estimate
• Muscle strength:
○ Oxford scale
§ 0 = no movement
§ 1 = flicker of movement
§ 2 = full ROM with gravity counterbalanced
§ 3 = full ROM against gravity
§ 4 = full ROM against weak resistance
§ 5 = full ROM against strong resistance
○ Dynamometry
• Limiting factors
• Bony opposition of tibia and femur
• Posterior capsule (ACL, PCL, MCL, LCL, Oblique popliteal ligament)
• Tension in antagonists - hamstrings, gastrocnemius, popliteus, gracilis, sartorius
• Other - insufficiency/reciprocal inhibition
• Active insufficiency - rectus femoris; unable to sufficiently shorten to produce full ROM of knee extension and hip flexion simultaneously.
• Passive insufficiency
○ Hamstrings - unable to sufficiently lengthen to produce full ROM of knee extension and hip flexion simultaneously
○ Sartorius - unable to sufficiently lengthen to produce full ROM of knee extension and hip ADD/extension/MR simultaneously
○ Gracilis - unable to sufficiently lengthen to produce full ROM of knee extension and hip ABD simultaneously
○ Gastrocnemius - unable to sufficiently lengthen to produce full ROM of knee extension and ankle dorsiflexion simultaneously
• Reciprocal inhibition - as agonist (rectus femoris) concentrically contracts the antagonist (biceps femoris) reciprocally lengthens; involuntary lengthening
Movement analysis of knee flexion
• Movement occurring and joint
• Knee flexion in tibiofemoral joint
• Inferior glide in patellofemoral joint
• Axis and Plane
• Sagittal axis about frontal plane
• Range of joint movement
+/- 135 degrees
• Main muscles involved
• Hamstrings
○ Prime mover - biceps femoris/semitendinosus/semimembranosus
• Type of muscle work
• Isotonic (dynamic) muscle work; concentric muscle work where the agonist (biceps femoris) shortens bringing the attachments (inferomedial aspect of ischial tuberosity, lateral lip linea aspera, lateral supracondylar ridge - head of fibula) closer, resulting in a swelling of the muscle belly. Internal force > external force
• Range of muscle work - inner/middle/outer
• Muscles involved as synergists/fixators/antagonists
• Synergist - popliteus, gastrocnemius, gracilis, sartorius. Muscle that ensures quality of movement by preventing unwanted movement in the associates joints and adjacent joints
• Antagonist - quadriceps femoris - rectus femoris , vasti. Muscle that opposes direction of agonist, e.g. as agonist (biceps femoris) concentrically contracts the antagonist (rectus femoris) reciprocally lengthens.
• Fixators - rectus abdominis; muscles that stabilise the base and proximal attachment of the agonist (ischial tuberosity)
• Measurement
• AROM/PROM
○ Goniometry - most accurate
○ Measurement of bony landmarks
○ Visual estimate
• Muscle strength:
○ Oxford scale
§ 0 = no movement
§ 1 = flicker of movement
§ 2 = full ROM with gravity counterbalanced
§ 3 = full ROM against gravity
§ 4 = full ROM against weak resistance
§ 5 = full ROM against strong resistance
○ Dynamometry
• Limiting factors
• Limited by soft tissue apposition - rectus femoris and abdominals
• Patellar tendon
• PCL
• Other - insufficiency/reciprocal inhibition
• Active insufficiency
○ Hamstrings; unable to sufficiently shorten to produce full ROM of knee flexion and hip extension simultaneously
○ Sartorius - unable to sufficiently shorten to produce full ROM of knee flexion and hip ABD/fexion/LR simultaneously
○ Gracilis - unable to sufficiently shorten to produce full ROM of knee flexion and hip ADD simultaneously
○ Gastrocnemius - unable to sufficiently lengthen to produce full ROM of knee flexion and ankle plantar flexion simultaneously
* Passive insufficiency - Rectus femoris - unable to sufficiently lengthen to produce full ROM of knee flexion and hip extension simultaneously * Reciprocal inhibition - as agonist (biceps femoris) concentrically contracts the antagonist (rectus femoris) reciprocally lengthens; involuntary lengthening
Movement analysis of knee LR
• Movement occurring and joint
• Knee lateral rotation in tibiofemoral joint
○ Only occurs in in 90° flexion knee joint
• Tilt in patellofemoral joint?
• Axis and Plane
• Transverse plane about a vertical axis
• Range of joint movement
30-40 degrees
• Main muscles involved
Prime mover - biceps femoris
• Type of muscle work
• Isotonic (dynamic) muscle work; concentric muscle work where the agonist (biceps femoris) shortens bringing the attachments (inferomedial aspect of ischial tuberosity, lateral lip linea aspera, lateral supracondylar ridge - head of fibula) closer, resulting in a swelling of the muscle belly. Internal force > external force
• Range of muscle work - inner/middle/outer
• Muscles involved as synergists/fixators/antagonists
• Synergist - ?. Muscle that ensures quality of movement by preventing unwanted movement in the associates joints and adjacent joints
• Antagonist - semitendinosus, semimembranosus, gracilis, sartorius, popliteus. Muscle that opposes direction of agonist, e.g. as agonist (biceps femoris) concentrically contracts the antagonist (semitendinosus) reciprocally lengthens.
• Fixators - rectus abdominis; muscles that stabilise the base and proximal attachment of the agonist (ischial tuberosity)
• Measurement
• AROM/PROM
○ Goniometry - most accurate
○ Measurement of bony landmarks
○ Visual estimate
• Muscle strength:
○ Oxford scale
§ 0 = no movement
§ 1 = flicker of movement
§ 2 = full ROM with gravity counterbalanced
§ 3 = full ROM against gravity
§ 4 = full ROM against weak resistance
§ 5 = full ROM against strong resistance
○ Dynamometry
• Limiting factors
• Tension in MR antagonists - semitendinosus, semimembranosus, sartorius, popliteus, gracilis
• Other - insufficiency/reciprocal inhibition
• Active insufficiency
○ Biceps femoris; unable to sufficiently shorten to produce full ROM of knee LR and hip extension simultaneously
• Passive insufficiency ○ Semitendinosus/semimembranosus - unable to sufficiently lengthen to produce full ROM of knee LR and hip flexion simultaneously ○ Sartorius - unable to sufficiently lengthen to produce full ROM of knee LR and hip extension simultaneously ○ Gracilis - unable to sufficiently lengthen to produce full ROM of knee LR and hip ABD simultaneously • Reciprocal inhibition - as agonist (biceps femoris) concentrically contracts the antagonist (semitendinosus) reciprocally lengthens; involuntary lengthening
Movement analysis of knee MR
• Movement occurring and joint
• Knee medial rotation in tibiofemoral joint
○ Only occurs in in 90° flexion of knee joint
• Tilt in patellofemoral joint?
• Axis and Plane
• Transverse plane about a vertical axis
• Range of joint movement
20-30 degrees
• Main muscles involved
Prime mover - semitendinosus, semimembranosus
• Type of muscle work
• Isotonic (dynamic) muscle work; concentric muscle work where the agonist (semitendinosus) shortens bringing the attachments (inferomedial aspect of ischial tuberosity - anteromedial aspect of proximal tibia at pes anserine tendon) closer, resulting in a swelling of the muscle belly. Internal force > external force
• Range of muscle work - inner/middle/outer
• Muscles involved as synergists/fixators/antagonists
• Synergist - popliteus, gracilis, sartorius. Muscle that ensures quality of movement by preventing unwanted movement in the associates joints and adjacent joints
• Antagonist - biceps femoris. Muscle that opposes direction of agonist, e.g. as agonist (semitendinosus) concentrically contracts the antagonist (biceps femoris) reciprocally lengthens.
• Fixators - rectus abdominis; muscles that stabilise the base and proximal attachment of the agonist (ischial tuberosity)
• Measurement
• AROM/PROM
○ Goniometry - most accurate
○ Measurement of bony landmarks
○ Visual estimate
• Muscle strength:
○ Oxford scale
§ 0 = no movement
§ 1 = flicker of movement
§ 2 = full ROM with gravity counterbalanced
§ 3 = full ROM against gravity
§ 4 = full ROM against weak resistance
§ 5 = full ROM against strong resistance
○ Dynamometry
• Limiting factors
• Tension in lateral rotator antagonist - biceps femoris
• Other - insufficiency/reciprocal inhibition
• Active insufficiency
○ Semitendinosus/semimembranosus; unable to sufficiently shorten to produce full ROM of knee MR and hip extension simultaneously
○ Sartorius - unable to sufficiently shorten to produce full ROM of knee MR and hip ABD/flexion/LR simultaneously
○ Gracilis - unable to sufficiently shorten to produce full ROM of knee MR and hip ADD simultaneously
• Passive insufficiency ○ Biceps femoris - unable to sufficiently lengthen to produce full ROM of knee MR and hip flexion simultaneously • Reciprocal inhibition - as agonist (semitendinosus) concentrically contracts the antagonist (biceps femoris) reciprocally lengthens; involuntary lengthening
