OSCE 4 - Knee Flashcards
Q angle - normal, how measured, female variation
normal Q angle 15 degrees
measured by creating straight line from ASIS to center of patella and another line through tibial tuberosity and the same point on patella
difference between them forms the Q-angle!
- females typically have increased Q angle
ROM for knee flexion, extension, int/ ext rot.
flexion 145-150
extension 0
int/ext rotation 10
knee flexion muscles and nerves
hamstrings
tibial N L4-5, S1-3
knee extension muscles and nerves
quadriceps
femoral n, L2-4
what innervation tested by patellar reflex
primarily L4
L2-4
dermatomes in leg
L3-5, S2
if the Valgus knee test is also positive with knee fully extended, it indicates
joint capsule injury
+ test for valgus/ varus
increased laxity, soft or absent endpoint or pain
ACL tests
Lachman’s
Anterior Drawer test
Lachman’s test
patient supine, cephaland hand on distal thigh superior to patella
- caudad hand on proximal tibia, flex knee to 15-30, then use caudad hand to pull tibia anteriorly while cephalad hand stabilizes thigh
+ test: increased laxity, soft or absent end point
indicates: ACL insufficiency
position of knee and examiner for anterior and posterior drawer test
90 degree flexion
examiner sitting on patient’s foot grasping proximal tibia with both hands
PCL tests
Reverse Lachman’s test
Posterior Drawer test
Patellar ligament test and positive findings indicate?
Patellar laxity test (graded 1-4 (+1 = 0-25%, +2 25-50%)
patellar apprehension test
- positive previous patellar dislocaiton or severe instability
patellar cartilage test
patellar compression (grind) test patellar glide test
patellar compression/ grind test
grind test - compressive load to patella with one hand while moving patella medial and lateral
+ test = pain with compression
indicates: possible infl., chondromalacia, or injury to patellofemoral articular surfaces
patellar-femoral gliding variation
patella compressed caudally into trochlear groove and patient instructed to tighten quads against resistance
+ findings: crepitation o rpain indicated roughness of articulating surfaces (chondromalacia)
patellar glide test
patient sitting or supine, slowly extending/ flexing the knee, physician notes quality of motion, can place hand lightly over patella to increase sensitivity of test
+ test: palpable or audible crepitus, pain or catching of the patella
indicates: possible damage to articular surface
Meniscus cartilage test
McMurray’s Test
Apley compression (grind) test
apley distraction test
McMurray’s test
medial meniscus: int. rot tibia as knee extended with varus load
lateral meniscus: ext. rot tibia as knee extended with valgus load
+ test: pian/ painful click during extension
indicates: possible meniscus tear
apley compression/ grind test
patient prone, knee flexed to 90
downward force on foot to compress meniscus while rotating foot internally and eternally
+ test: pain w/e rotation, ocmpression
indicates: meniscal injury, collateral ligament injury or both
apley distraction test:
patient prone, knee flexed to 90, examiner uses pulling force on foot to provide distraction on meniscus while rotating foot internally and externally
+ test: pain w/ distraction and rotaiton
indicates: collateral ligament damage
meniscal segments and red/white and what it means
W/W: medial 1/3
R/W: central 1/3
R/R: lateral 1/3
W/W inadequate blood supply, meniscus is shaved
R/R: adequate blood supply, meniscus repaired and allowed to heal
bursa in th eknee
suprapatellar prepatellar superficial infrapatellar infrapatellar - bursa below pes anserine
valgus/ varus tests are testing what at 30 and 0 knee flexion
30 collateral ligament
0 capsule
components of the unhappy triad
ACL
medial meniscus
MCL
Overuse injury Common in adolescents Avulsion of secondary ossification center of tibial tubercle
osgood-schlatter disease
