THE KNEE Flashcards by Millie Dean

Palpate the patella

patient supine
identify bade of patella - palpate border
continue down lateral aspect to apex
then up medial aspect

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palpate the tibial tubercle

patient supine
palpate apex
slide fingers distally to the tibia - approx 4cm
palpate full extent

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palpate head of fibula

knee in flexion - follow hamstring tendons - palpate 2cm from line
palpate full extent

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palpate the knee joint line

patient crook lying - foot fixed
find gap between femoral and tibial condyles
medial joint line - from the patella to the medial tibial condyle - use lateral counter pressure
lateral joint line - from the patella apex to lateral tibial condyle

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what is the classifcation of the knee joint

biaxial, complex, modified hinge joint

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demonstrate full ROM for knee flexion

patient supine

bring heel to buttock

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demonstrate full ROM for knee extension

patient supine

static quad contraction to lift heel off plinth

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demonstrate full ROM for knee medial rotation

patient sitting over edge of plinth

dorsiflex foot - turn feet out

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demonstrate full ROM for knee lateral rotation

patient sitting over edge of plinth

dorsiflex foot - turn feet in

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what is normal ROM for knee flexion

0-135

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what is normal ROM for knee extension

0-5 - very variable

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what is normal ROM for knee medial rotation

0-40

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what is normal ROM for knee lateral rotation

0-25

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what is the limiting factors for knee flexion

contact of calf with posterior thigh

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what is the limiting factors for knee extension

MCL, PCL, LCL and ACL all taught

extent of articular surfaces

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what is the limiting factors for knee medial rotation

cruciate ligaments - particularly PCL

what is the limiting factors for knee lateral rotation

cruciate ligaments - particularly ACL

how to carry out circumferential muscle bulk test - calf

half laying
measure 5cm below tibial tubercle
repeat 3 times

how to carry out circumferential muscle bulk test - thigh

half lying
measurre 10cm and 15cm above base of patella
repeat 3 times

how to carry out valgus stress test

patient supine
leg between forearm and waist
support thigh with LATERAL hand
support calf with MEDIAL hand just above ankle
push ankle laterally and thigh medially

repeat with knee extended and at 30 degree flexion

how to carry out varus stress test

patient supine

leg between forearm and waist
support thigh with MEDIAL hand
support calf with LATERAL hand just above ankle
push ankle medially and thigh laterally

repeat with knee extended and at 30 degree flexion

how to carry out Lachmann’s test

patient supine
pillow under knee (ensures hamstrings relaxed)
grasp lower anterior femur to stabilise
cup posterior upper calf
pull tibia upwards with counter pressure on thigh

how to carry out posterior draw test

70 degree flexion - patient supine
sit on foot
grasp upper tibia with thumbs on tibial tubercle
push tibia backwards

CHECK TIBIAL PLATAU FIRST FOR RUPTURE

how to carry out McMurrays test

patient supine
hold under heel, knee flexion
for MEDIAL meniscus - turn foot outwards and palpate posteromedial joint line - extend knee
for LATERAL meniscus - turn foot inwards - palpate posterolateral joint line and extend the knee

what is the circumferential muscle bulk test looking for?

differential measurements for loss of bulk

what is the valgus test looking for?

defect in MCL | - excessive joint gapping

what is the varus test looking for?

defect in LCL | - excessive joint gapping

what is the Lachmann's test looking for?

defect in ACL | - excessive anterior displacement of tibia

what is the posterior draw test looking for?

defect in PCL | - excessive posterior displacement of tibia - more than 1cm

what is the McMurrays test looking for?

defect in menisci - pain or apprehension during extension - clicks over joint line diagnosis must be alongside history of giving way, looking or recurrent effusions

how to perform AP tibia

- Patient lying supine with pillow under knee - Plinth at mid thigh height - Web space over proximal anterior tibia - Push down into the bed

how to perform PA tibia

- Prone lying with pillow under knee - Plinth at mid thigh height - Webspace over proximal posterior tibia - Push down into the bed

how to perform AP femur

- Supine lying with pillow under knee - plinth at mid thigh height - face patients head - place webspaces over distal anterior femur - press down –ensure not to compress the PFJ.

how to perform caudad of PFJ

o Place heel of hand over base of patella with wrist extended o Place other hand over patella to stabilise and guide it o Apply pressure towards the foot o This increases knee FLEXION

how to perform cephlad of PFJ

o Place heel of hand over apex of patella with extended wrist o Place other hand over patella to guide and stabilise o Oscillatory movement towards the patients head o Increases knee EXTENSION

how to perform medial transverse movement of PFJ

o Place both thumbs on lateral border of patella | o Oscillatory movement by pushing patella medially – use fingers to guide

how to perform lateral transverse movement of PFJ

o Move to opposite side of bed to the side that is being mobilised o Place thumbs on medial border of patella o Move patella laterally.

what is the benefit of transverse movement of PFJ

Useful for patients with anterior knee pain – generalised stiffness and pain in the PFJ