Knee Lecture Flashcards
Screw Home Mechanism
As knee extends the tibia ER, as the knee flexes the tibia IR
Which muscle will help unlock the knee?
Popliteus
Structures for extension:
Rectus femoris Vastus intermedius Vastus lateralis Vastus medialis Patellar ligament Quadriceps tendon
Structures for flexion:
Biceps femoris SM ST Popliteus Gastroc
Structures stabilizing the knee:
LCL MCL ACL PCL Medial/Lateral meniscus
Chief complaint:
pain click instability stiffness locking
History:
MOI
SINS
Functional Status
Differential Dx:
Anatomy
Biomechanics
Location
Superficial
Anterior/Posterior
Medial/Lateral
Deep
Possible injured structures/pathology
Ligament Articular Bone Bursitis Nerve Musculo-tendinous
Health Condition
Articular Defects Meniscal Tears Ligament Extensor Mechanism ITB Osgood-Schlatter Fx Fat pad/bursa
Differential Dx:
Infection RA DVT Neurogenic Claudication PVD Cancer Med Side Effects Lumbosacral Pathology Thyroid Disorder
Knee Questionnaires:
WOMAC
LEFS
KOOS
Subjective
Current Hx CC (SINS) Social/Environmental PMH Activity Restrictions Participation Limitations
Objective
Anatomical components
Source of pain
Impairments/movements/posture
Examination
Posture Gait Palpation AROM PROM MMT Accessory Flexibility Special Tests Clearing Exam
Postural Analysis:
Tibio-femoral valgus/varum Genu recurvatum Tibial varus Patella alta Patella laterally tilted Edema/swelling Eccymosis Atrophy Skin Callous
Gait Analysis:
Antalgic?
Step length?
Trendelenburg?
Decreased knee extension at TSt
Functional Activities:
SLB, squat (SINS)
Pain?
Movement faults?
ROM limited?
Palpation
Joint line Musculo-tendinous inserts Bursa Ligament Popliteal Cyst Fat Pad
Normal knee ROM
0-150
PROM
Endfeel?
Pain?
Accessory motion (knee)
Tibiofemoral: AP & PA
Patellar glides
ACL special tests
Anterior Drawer @ 90
Lachman’s @ 30
HS tightness, false negative
PCL special tests
Godfrey’s
Posterior Drawer
MCL special tests
Valgus
LCL special tests
Varus
Meniscus special tests
McMurray
Thessaly (gold standard)
pain, audible or palpable catching sensation
MCL
Valgus test
Worst if positive in 0 extension than testing in 30
Why? Joint capsule now compromised
Patellofemoral Compression (LongAQ)
Provocative
(+) pain
What is OA?
Articular cartilage degeneration
Bony hypertrophy & osteophyte formation
*special test
OA: Findings
Joint hypomobility, limited ROM Pain w/ motion & worse w/ compression Mornign stiffness & after being in a static position Muscle weakness Crepitus/grinding Deep, achy pain Insidious onset (hx of prior trauma) c/o knee gives during WB
Meniscal Lesions
c/o pain, clicking, catching, locking MOI: can be traumatic or insidious (degenerative) joint line is tender to palpate McMurray & Thessaly Presentation depends on the tear
ACL: MOI
valgus knee position hyperextension, rotation 70% non-contact deceleration phase cutting, landing "pop" Acute: swelling, laxity, pain Chronic: unstable joint, loss of function
MCL: MOI
valgus force, knee collapse inward
football, soccer, slip, direct blow to lateral knee
injured with medial meniscus/ACL
PCL: MOI
traumatic, hyperflexion injury football, falling onto knees, dashboard excessive tibial post translation c/o weakness, instability HS testing will aggravate
Patellofemoral Pain
tenderness along facets
crepitus
passive patellar compression (QS/LAQ) –> CC
squatting, kneeling, stretch to qudas/ITB may reproduce sx
ITBS
MOI: tightness elicits increase rubbing, athletes with repetitive knee flexion/extension
hip muscle imbalances
Fractures
Patellar & Tibial Plateau most common
MOI: traumatic
ACL: ICF
HC: ACL tear Body function & structure: decreased knee ext Activities: impaired walking tolerance Participation: can't play soccer Environmental: school has stairs Personal: very motivated
