Knee region Flashcards
What’s the best position to palpate the knee
Px sitting on couch with leg dangling over the edge
structures within the popliteal crease
- biceps femoris
- common peroneal nerve
- tibial nerve
- semitendinosus
- semimembraneous
palpation of adductor magnus tendon
Knee compression-rotation test. (KKU Test)
(meniscus test)
Knee compression-rotation test. (KKU Test)
Patient supine knee extended
Practitioner places thumb and index finger on joint line with other hand supporting posterior calcaneus
Practitioner applies cephalic compressive force whilst internally and externally rotating tibia
Practitioner repeats procedure with knee in 30, 60, 90 and 120 degrees of flexion – this compresses different parts of the meniscus.
Pain and/or clicking is considered a positive test
What are the three meniscus tests?
Knee compression-rotation test. (KKU Test)
McMurray’s (McMurrays circumduction) Test
Thassaly test
McMurray’s (McMurrays circumduction) Test
(meniscus test)
Patient supine, practitioner palpates joint line and supports calcaneus.
To test Medial Meniscus: Practitioner passively hyper-flexes involved knee and applies compression, internal tibial rotation and a varus force. Practitioner then extends knee whilst holding knee in compression, internal rotation and a varus position
To test Lateral Meniscus: Practitioner passively hyper-flexes involved knee and applies compression, external tibial rotation and a valgus force. Practitioner then extends knee whilst holding knee in compression, external rotation and a valgus position.
Pain and or clicking is considered a positive test
Thassaly test
(meniscus test)
Load bearing test for meniscii, carried out on well knee first then involved knee
Practitioner supports patient, by holding both their hands, as he/she actively stands on one leg and flexes knee to 5 degrees.
Patient then rotates body medially and laterally 2 or 3 times Test can also be repeated with knee flexed to 20 degrees
Reproduction of symptoms including pain, locking, audible crepitus familiar to the patient is considered a positive test
Three Ligament tests
Anterior Draw Test
Posterior Draw Test
Valgus and Varus stress tests
Valgus & Varus stress tests
(MCL and LCL)
Patient supine with LEX extended
Practitioner stabilizes ankle and applies a lateral to medial force at the knee (valgus test) and then a medial to lateral force (varus test)
Practitioner repeats test with knee slightly flexed (approx 25 degrees)
Pain in the medial knee may indicate a MCL sprain and in the lateral knee a LCL sprain
Increased gapping/joint movement is also considered a positive test for ligamentous laxity which is graded 1 to 4. Grade 1 = 0-5mm, Grade 2 = 5-10mm, Grade 3 = 10-15mm, Grade4=+15m
Clarke’s test
- For chondromalacia patella and patellofemoral pain syndrome
Patient is supine with the knee supported and in 30 degrees of flexion.
Practitioner places one hand superior to the patella & applies gentle posterior force.
Practitioner asks patient to contract the quadriceps muscle while applying a caudal force on the patella
Practitioner repeats test with the knee flexed to 60 degrees
Patellofemoral pain with patient unable to hold the quadriceps contraction is considered positive test
Posterior knee
DIAL Test:
To assess popliteus tendon, arcuate ligament complex and LCL, PCL
Can be performed supine or prone with knees in 30 and 90 degrees of flexion
Prone version:
Patient is instructed to flex knees to 90 degrees whilst keeping their knees together.
Practitioner holds calcaneus of both feet and passively externally rotates tibia, comparing side to side
Test is repeated with patient’s knees at 30 degrees flexion
Results: Increased external rotation and pain at 30 degrees flexion indicates injury to the postero-lateral structures.
Increased external rotation and pain at 30 degrees and 90 degrees may indicate injury to the posterolateral structures and the PCL.
Knee pain guide
What is a posterior fibular head?
What is an anterior fibular head?
Post :One that resists anterior translatory movement
Ant: One that resists posterior translatory movement
What is an MET for a posterior fibular head?
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Vastus medialis
origin - intertrochanteric line and medial lip of linea aspera
I: patella via quadriceps tendon
Inn. Femoral nerve (L2-L4)
Rectus femoris
origin - anterior inferior iliac spine
Inn. Femoral nerve (L2-L4)
Flexes the hip and extends the knee
Vastus lateralis
Origin is the greater trochanter and upper lateral surface of linea aspera
Femoral nerve (L2-4)
Sartorius
origin - anterior superior iliac spine
Inserts - tibia via the pes anserinus
Inn. Femoral nerve (L2-3)
Insertion points of the semimembranosus and sartorius muscles (diagram)
plus MCL underneath
Attachment of biceps femoris
(2 heads)
lateral side of head of fibula.
origin - linea aspera of femur
innervated by the common peroneal nerve (L5-S2)
Semitendinosus insertion
tibia , via the common tendon called the pes anserinus
Originates from the ischial tuberosity, sharing common tendon with semimembranosus and biceps femoris
tibial nerve innervation (L5-S2)
insertion of semi membraneous
medial condyle of the tibia
origin is ischial tuberosity
innervation is tibial nerve (L5-S2)