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)
insertion of gracilis
tibia via the pes anserinus tendon
origin is lower half of pubic symphysis and upper half of pubic arch
innervated by the obturator nerve (L3-4)
insertion of sartorius
tibia via the pes anserinus
origin is the anterior superior iliac spine
femoral nerve (L2-3)
origin of plantaris
femur
inserts posterior part of the calcaneous along with the achilles tendon
inn. tibial nerve
what three muscles insert into the pes anserinus?
sartorius
gracilis
semitendinosus
What is pes anserine bursitis?
It is an inflammatory condition of the medial (inner) knee at the anserine bursa, a sub muscular bursa, just below the pes anserinus.
Origin and insertion of popliteus muscle
Origin is the lateral condyle of femur and Insertion is proximal tibial shaft
Tibial nerve (L4, S1)
unlocks and flexes the knee , assists in media rotation of the tibia
anterior view of adductor magnus
posterior view of adductor magnus
What is the Q angle?
It is a measurement of the angle between the Quadriceps (Rectus Femoris is usually used) and the patella tendon.
It is a predictor of biomechanical abnormality throughout the lower limb.
Normal range 18-22 degrees
What happens if the Q angle is outside of normal range?
A precursor for patellar pain and subluxation
The patella’s ability to track straight in the trochlear groove is determined by the quadriceps’ angle of pull. When the Q angle is greater, the quadriceps pull the patella in a more lateral direction
Can also contribute to anterior cruciate ligament sprains and anterior knee pain.
What is the name of degeneration of the cartilage on the underside of the patella?
chondromalacia
What are patellar tracking disorders?
Problems associated with the patella and its correct movement during flexion and extension
Apart from >> Q angle, what else can cause patella tracking disorders?
An imbalance in tightness between the vastus lateralis and vastus medialis muscles.
Weaker muscles must also be strengthened. It is common that laterally positioned fibres of the Vastus medialis known as VMO (vastus medialis oblique) are weak
knock knees is also known as….
Genu valgum
(valgus knees)
Diagram of MCL and LCL
Diagram of lateral collateral ligament
- mostly covered by the tendon of the biceps femoris
Diagram of the medial collateral ligament
Anterior cruxiate ligament
(posterior view)
Anterior view
- inside the knee joint but outside the synovial membrane
Posteror cruxiate ligament
- limit anterior and posterio displacement
Palpation of medial meniscus
Location of comon peroneal nerve
Popliteus muscle
What is the function of the popliteus muscle?
Extended knee - internal rotation of the tibia to ‘unlock’ an unextended knee. Thus it aids in knee flexion.
What is the screw home mechanism?
The action that when a knee reaches full extension and just as the knee locks into hyperextension, the knee externally rotates a few degrees.
What is the function of the screw home mechanism?
It has the effect of putting most of the weight through the menisci, cartilage and bones of the joint and giving a rest to the thigh and calf muscles.
What is another name for chrondomalacia?
patellofemoral syndrome
Palpating the medial condyle of the femur (diagram)
when moving posteriorly the tibia is difficult to locate due to medial collateral ligament
What is the most prominent structure on the medical aspect of the knee (femur)
And what attaches to it?
the medical epicondyle
adductor magnus and the medial collateral ligament
(also called the adductor tubercle)
What nerve is located on the medial aspect of the knee, and it’s location is quite variable?
Saphenous nerve (branch of femoral nerve).
Difficult to palpate
Diagram of palpating for medial collateral ligament.
How wide is it at the knee joint?
3-4 cm
posterior border of MCL is where the joint space can be palpated again. At this point the ligament has its closest connection to the medial meniscus.
where does the MCL attach?
8cm distally and anteriorally from the joint space. It merges with the periosteum on the medial surface of the tibia, underneath the pes anserinus.
What is the primary job of the MCL given it’s strength?
primary decelerator for lateral rotation of the joint
Diagram of the four muscles of the pes anserinus
Sartorius
Gracilis
Semi-membranosus
semitendinosus
