Knee Joint Flashcards
objective exam parts
observation movement analysis ROM assessment strength assess flexibility neurological joint accessory motion special test
subjective exam parts
MOI
Differencial considerations
Signs and Symptoms
MOI
Mechanism of Injury
May not be very specific
differential considerations
medial management (surgery vs. conservative rehab)
age, sex, occupation
PMH
Signs and Symptoms
Location
SINS
Aggravating and Easing positions
Sings and Symptoms Parts
- Pain (severity location better/worse)
- Laxity (lig injury, carti injury, arthritis/m. weakness)
- Locking (menisal lesion/patellofemoral dysfunction)
- Effusion (TRUE lesion, Infection)
Observation/Posture
Knee stability and movement coordination impair
movement analysis
functional movement testing
gait assessment
WHAT MOTION BRINGS OUT PAIN
Knee ROM
Tibiofemoral joint (TFJ) Normal 135-140 flexion, 0 extension
Closed Pack Position
full extension and ER
Resting position
25-45 of flexion
strength assessment
quad, hamstring, hip, foot/ankle
prox stabilizers
glut max/med, TFL, adductors
prime movers
quads, hamstrings, popliteus
distal stabilizers
gastroc, soleus, posterior tibialis
flexibility assessment
important walking, lifting, stepping normally
ROM affected by flexibility (condition joint itself, muscle, CT around joint)
joint accessory testing
movement WITHIN joint and surrounding tissue that are necessary for full ROM–performed actively
osteokinematic motion
arthorkine motion
Pediatric Knee Conditions
Osteochondritis dissecans
osgood-schlatter
larsen-johansson
Traumatic injuries
fracture, lig injury, meniscal lesion, chondral injury
Complication of Fracture
- loss of knee movment
- non-union or failure of fracture to unite
- arthritis of knee joint
- infection
- deep vein thrombosis
Testing Fractures
- PROM
- Percussion
- Palpation
ACL Resists
Anterior tibial translation
flex/ext
frontal, axial motion
ACL antagonist
quads
Injury to ACL
sudden stop of direction
twist or pivot
hyperextensive movement of knee
Sign and symptoms of ACL injury
- Pop or Snap sound
- Unstable in WB over knee
- self-limiting activity
- Loss of knee motion in WB
- Knee feels like its falling apart/ giving way
- IMMEDIATE LACK OF FUNCTION
PCL Resists
posterior tibial translation
extension (ant lateral bundle)
frontal, axial motion
PCL antagonist
hamstrings
PCL injury
- primary passive external force
- force applied to extended knee
- extremem hyperextension movement of knee
PCL sing and symptoms
- rarely audible sound at injury
- moderate swell and stiff
- resume activity after hurting it
- decrease knee motion (extension limited)
MOI PCL
fall with weight to ANT part of knee with knee bent
knee bend and foot plantar flexed
hard blow to anterior lower leg with KNEE FLEXED
Tenderness POP fossa
posterior laxity to functional
ACL Special tests
Lachman’s
anterior drawer test
lachman’s test
best for ACL test on field
+ result will have mushy or empty end-feel
- result (tibia is IR, femur not properly stabalized)
Anterior drawer
+ result increase anteiro tibial tranltion
- only if acl torn, swelling or hamstring spasm
false + result posterior sag sign present
Medial Collateral Lig
More common
valgus or twisting force (foot in neutral/ER)
HIGH risk for meniscus involvement
Lateral Collateral Lig
varus or twisting force
unstable knee at risk
less risk for meniscus injury
RISK peroneal nerve involvement
MCL ROM
both fibers taut in full extension
anterior fibers taut in flexion
posterior fibers taut in mid range
Valgus Stress test
assess medial instability
0* (MCL super and deep, Post oblique lig, post med capsule)
30* (MCL superficial, post oblique lig, PCL, post med capsule)
LCL ROM
taut in extension loose flexion (especially after 30* of flexion)
Injury LCL
varus forces (ADDUCTED and tibia IR)
Varus Stress Test
assess lcl instability
0* (lol, pcl, arcuate complex, pcl/acl)
30* (lcl, post lat capsule, arcuate complex)
Meniscal movement
extension=anterior movement
flexion=posterior movement
meniscal lesions
increase medial due to valgus stress attach capsule and MCL
Swelling in POP fossa secondary to injury within joint
Baker’s cyst
MOI meniscal
compression rotational force valgus force combination of forces degenerative changes (>30, Po PMHX)
Cartilage Clinical Presentation
history pain CATCHING giving way/buckling joint stiffness antalogic gait joint line pain effusion (baker cyst) clicking during rom pain with varus/valgus/squating test
Meniscal testing
IR Tibia=lateral meniscus
ER=Medial meniscus
McMurray
Thessaly’s
McMurray’s
+ result from pop, clicking, locking of knee
pain/ reproduction of symptoms
proceedure mcmurray
- flex knee
- rotate tibia on femur
- extend knee
- click and compiant
- repeat
- detect flap from meniscal tear
Thessaly’s Test
early detection of meniscal tear
- parallel bend knee
- rotate with support
- return to center
- repeat other side
Overuse syndrome patellofemoral pain
poor patellar tracking chondromalacia fatpad impingement patellar tendonitis and tendinosis pes anserinus endinitis/bursitis ITB syndrome
IRB syndrome
chornic irritation
weak gluteal musculature and genu valgrum
oseoarthritis
most common
increase risk with activities that stress joints
blood test can rule out other diagnosis
Imflammatory/Systemic Condition
Arthritis (osteo, rheumatoid, spetic) bursitis tendonitis synovitis osteomyelitis pseuedogout
knee locking
meniscal lesion
knee won’t straighten
meniscal/lig
gives out going down
cruciate lig
