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kinesiology test > The Knee > Flashcards

The Knee Flashcards

1
Q
  • One of the most injured joints in the body
  • Supported mainly by muscles and ligaments with NO bony stability
  • The largest joint in the body
  • Flexion, extension and rotation as an accessory motion to extension
A

The Knee

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2
Q

Note: the articular surface of the femoral condyles is much larger than the articular surface of the tibia… therefore:
As the knee is going from flexion into extension, the femur must ________posteriorly as it _________s on the tibia (so it does not run out of room to complete extension)

A
  • GLIDE
  • ROLL
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3
Q

Note: the articular surface of the medial condyle is larger than that of the lateral condyle … therefore:

A
  • The medial condyle of the femur must also glide posteriorly to use all of its articular surface
  • This cause the femur to spin medially in the last few degrees of WB extension in closed chain action
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4
Q

In the screw home mechanism in the weight bearing position (closed chain kinetic activity), the femur rotates _________on the tibia as the knee moves into the last few degrees of knee extension

A

medially_

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5
Q

In the non-weight bearing position (open chain kinetic activity), the tibia must rotate ________ on the femur and the last few degrees of extension will LOCK the knee into extension

A

laterally

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6
Q
  • To unlock the knee in an open chain kinetic activity, the femur must rotate laterally on the tibia
  • This accessory motion limits the knee from being a TRUE hinge joint but knee rotation will not be considered a measureable joint motion
A

Screw Home Mechanism

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7
Q

The articulation between the femur and patella is the ______________ joint

A

Patellofemoral Joint

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8
Q

The patella serves to increase the mechanical advantage of the ___________muscle and to protect the knee joint from harm

A

quadriceps

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9
Q

the patella

  • The moment arm is____________ due to the line of pull the patella adds to the quadriceps
    • Remember…the perpendicular distance from the muscle line of action to the joint axis
  • Without the patella, this moment arm would be shorter and the joint would be at a disadvantage
A

lengthened

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10
Q
  • Also known as the Q-angle or the patellofemoral angle is the angle between the patellar tendon and the rectus femoris
  • Determined by drawing a line from the ASIS to the midpoint of the patella and from the tibialtuberosity to the midpoint of the patella
  • Normal ranges are 13-18 degrees and it is measured in knee extension
    • Larger in women due to their *larger by nature* pelvis
    • Patellofemoral pain syndrome (PFPS) and other patellar tracking problems can occur because of this
A

Quadriceps Angle

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11
Q

most posterior of the tarsal bones
Known as the heel, the gastrocnemius & soleus attach here

A

Calcaneus

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12
Q
  • Lateral to and smaller than the tibia
  • This bone gives the rounded shape to the lower leg
  • Not a part of the knee joint but articulates with the tibia and glides as an accessory motion on the tibia during knee ROM
  • Larger role of motion at the ankle
A

Fibula

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13
Q

attaches to the anterior surface of the intercondylar eminence and just medial to the medial meniscus and runs superiorly and posteriorly to the lateral condyle of the femur

A

ACL

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14
Q

attaches to the posterior surface of the intercondylar eminence and runs superior/inferiorly to the medial side of the ACL and attaches to the medial condyle of the anterior femur

A

PCL

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15
Q

Both ACL & PCL provide stability in the ______ plane of motion

A

Sagittal plane

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16
Q

ACL –prevents

A

excessive hyperextension

When the knee is slightly flexed, it limits anterior translation of the tibia on the femur

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17
Q

PCL – keeps the femur from_____________on the tibia. Tightens during flexion and is less injured overall than the ACL

A

displacing anteriorly

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18
Q

flat, broad ligament that provides stability to the medial side of the knee
Fibers of the medial mensicus are attached to this ligament and result in frequent tearing of the meniscus

A

MCL

Medial collateral ligament

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19
Q

round and cordlike, provides stability to the lateral side of the knee (book states medial – it protects from a blow to the medial knee)
These ligaments provide stability in the frontal plane

A

LCL

lateral collateral ligament

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20
Q

two half moon, wedge shaped fibrocartilagenous disks located on the superior surface of the tibia

A

Medial and Lateral Meniscus

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21
Q

reduce friction and there are approximately 13 at the knee joint

  • Due to the tendinous insertions around the knee
A

Bursae

22
Q

Contains important structures

  • Tibial nerve
  • Common peroneal nerve
  • Popliteal artery
A

Popliteal Fossa

23
Q

Borders of popliteal fossa

A
  1. Superior/medial – semitendinosus/semimembranosus
  2. Superior/lateral – biceps femoris
  3. Inferior - gastrocnemius
24
Q

goose/duck foot

  • Say grace before tea
    • Sartorius
    • Gracilis
    • Semitendinosus
A

Pes Anserine

25
Q

Patellar tendonitis

A

Jumper’s Knee

26
Q

popliteal cyst

A

Baker’s cyst –

27
Q

housemaid’s knee

A

Prepatellar bursitis –

28
Q

Muscles of the Knee(9)

A
  1. Rectus femoris
  2. Vastuslateralis
  3. Vastusmedialis
  4. Vastusintermedius
  5. Semimembranosus
  6. Semitendinosus
  7. Biceps femoris
  8. Popliteus
  9. Gastrocnemius
29
Q
  • One of the more challenging disorders to treat for both the patient and the PT/PTA
  • Not always easy to identify this region as the source of the patient’s complaints or to isolate causes of the pain
  • Understanding the biomechanics of the knee and the lower extremity is essential for successful management
A

Patellofemoral Problems

30
Q

Signs and Symptoms:

  • Aching pain in the front of the knee, typically of gradual onset
  • Can be “behind” the knee
  • Complaints of the knee “giving way”
  • Thought of a protective response to pain caused by an aggravating factor such as climbing stairs
  • Grinding noises in the knee
  • Crepitus, typically benign
  • Pain with walking up stairs, squatting, and running and other bent-knee weight bearing activities
  • Pain with prolonged sitting
  • Mild swelling, if any
  • Excessive foot pronation, tight hip internal rotators/weak hip external rotators alter the pull of the quadriceps on the patella
  • Patellar tilt, seen with palpation
A

Patellofemoral Problems

31
Q
  • Inflammation of the patellar tendon, often seen with jumping activities
    • Referred to as Jumpers Knee
  • Seen with sports that require fast running and abrupt changes in direction
A

Patellar Tendonitis

32
Q

Signs and Symptoms:

  • Anterior knee pain
  • Local, point tenderness
  • Small amount of local swelling
A

Patellar Tendonitis

33
Q

Inflamed and painful infrapatellar fat pad
Often confused with patellar tendonitis

Signs and Symptoms:

  • Pain just below the patella
  • Movement of the knee typically aggravates the symptoms
  • Tender to palpation
  • Swelling in the anterior knee
A

Fat Pad Syndrome

34
Q
  • Typically caused by a blow to the outside of the knee or a high energy twisting maneuver
  • Forces result in stretching and a valgus force on the medial tibiofemoral joint
  • Graded on a system of I -> III
A

Medial Collateral Ligament Sprain (MCL)

35
Q
  • LCL is on the lateral side of the knee and is not frequently involved with high-level activities
  • Injured by a blow to the medial side of the knee, resulting in a varus (from inside) stress to the knee joint
  • Confirmed with tenderness to palpation as well as possible laxity with a varus
A

Lateral Collateral Ligament Sprain (LCL)

36
Q

Symptoms:

  • Mild tenderness over the affected ligament
  • Usually no swelling
  • For an MCL sprain, when the knee is bent to 30 degrees and force is applied to the outside of the knee, pain is felt, but there is no laxity/looseness
A

Grade I Ligament Sprain

37
Q

Symptoms:

  • For MCL, significant tenderness on the inside of the knee for the medial collateral ligament
  • Some swelling seen over the ligament
  • When the knee is stressed, there is pain and laxity in the joint and there is a definite end point/end feel to the joint
A

Grade II Ligament Sprain

38
Q

Symptoms:

  • There is a complete tear of the ligament
  • Pain can very and is sometimes less than that of a grade II sprain
  • When the knee is stressed, there is significant joint laxity
  • The patient might complain that there is significant instability or “wobbly” feeling in the joint
A

Grade III Ligament Sprain

39
Q
  • Injury to the ACL can be from contact or noncontact causes
  • Situations that place a loaded, weight bearing knee in a combined position of flexion, valgus and rotation of the tibia on the femur can rupture the ACL in a noncontact manner
  • Rapid changes in direction
  • Once the ACL is stretched or ruptured, it will not heal on its own
  • Sometimes accompanied by medial meniscus tears and MCL sprains
  • Unhappy Triad
  • The ACL and PCL do not follow the same grading scale as for MCL and LCL sprains
  • They are either damaged or not damaged – there is no middle ground
A

Ruptured Anterior Cruciate Ligament

40
Q

Signs and Symptoms:

  • “Pop” in the knee is either felt or heard by the patient
  • Followed by rapid effusion/swelling in the joint cavity
  • Nausea immediately after the injury
  • Positive special testing for ligament instability must be completed within 5 minutes of injury otherwise, the test will be invalid due to muscle guarding
  • Diagnosis by a physician in conjunction with an MRI (magnetic resonance)
A

Ruptured Anterior Cruciate Ligament

41
Q
  • Account for 3-20% of all knee injuries
  • Most injuries occur from athletics, MVAs or industrial accidents
    • Athletic – fall onto a flexed knee with foot in plantar flexion
    • Hyperextension
    • Dashboard injuries
A

Posterior Cruciate Ligament Tear

42
Q

Signs and Symptoms:

  • Pain
  • Positive “Sag” Test – giving the illusion when the knee is flexed that it is bending backwards
  • Positive diagnostic imaging on an MRI
A

Posterior Cruciate Ligament Tears

43
Q
  • Menisci help to make a more concave surface for the condyles to rest and glide on and make the knee more stable
  • Medial meniscus tears more easily than the lateral because it is attached to the medial collateral ligament and is more restricted during movement
  • Lateral meniscus is attached only at the back of the knee and moves more freely as the knee is bent and straightened
  • Torn when twisted suddenly and one or more menisci become caught between the knee
A

Meniscus Tears

44
Q

Signs and Symptoms:

  • Isolated tears develop mild swelling slowly over several hours or more
  • Pain
  • Popping
  • Locking
  • Giving way of the knee
A

Meniscus Tears

45
Q
  • Knee is subjected to sports-induced trauma at the center of bone growth in skeletally immature athletes.
  • Epiphyseal plates are zones of cartilage cells from which new bone is formed
  • The joint capsule and ligaments near these growth plates are 2->5x stronger than the growth plate itself
  • Because the epiphysis is responsible for bone growth, injuries involving this area may alter the length of the involved bone
A

Epiphyseal Injuries (growth plate)

46
Q
  • A group of symptoms involving the tibial tubercle epiphysis
  • Most likely to involve males age 12-16 and females 10-14
  • Traction of the quadriceps muscle inflames and irritates the layers of the tibial tubercle, causing it to swell
  • If the femur is growing faster than the quadriceps, the quadriceps will exert undue pressure on the growth center of the tibia
A

Osgood-Schlatter Condition

47
Q

Signs and Symptoms:

  • Pain over the tibial tubercle
  • Swelling over the tibial tubercle
  • Weakness in the quadriceps muscle group
  • Increased pain and swelling with activity
  • Visible lump
  • Pain to the touch over the affected area
A

Osgood-Schlatter Condition

48
Q
  • Inflammation of the band that begins at the hip and extends to the knee on the outside of the leg
  • Irritation usually occurs over the outside of the knee joint at the lateral epicondyle
    • Where the IT band crosses bone and muscle at this joint
    • Should be smooth and gliding motion
    • When inflamed, motion becomes painful and guarded
  • People who suddenly increase their level of activity are prone to developing
A

Iliotibial Band Syndrome

49
Q
  • Typically a result of high-energy trauma
  • Fractures vary in location and severity
  • Patellar fractures are a result of direct impact to the anterior knee
    • Knee strikes hard ground or some other hard surface
  • Distal femoral and proximal tibial fractures may occur from violent twisting injuries such as falls from heights
A

Fractures

50
Q

What is involved in the terrible triad?

A
  • Medial Meniscus
  • Anterior Cruciate Ligament,
  • Medial Collateral Ligament.

MAM

51
Q

Normal ranges of the Q-angle are between ___&___degrees and it is measured in knee____________.

A
  1. 13-18
  2. extension

kinesiology test (16 decks)

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