knee joint - psau...is genu recurvatum present? ! observe the alignment of the feet with and without...
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Knee Joint Assessment and General View Done by;
Mshari S. Alghadier
BSc Physical Therapy
RHPT 366
[email protected] http://faculty.sau.edu.sa/m.alghadier/
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Functional anatomy
¤ The knee is the largest synovial joint of the body.
¤ One of the most complex joint.
¤ The knee is composed of; ¤ Three bones (femur, tibia, and patella). ¤ Two articulations “Joints” (tibiofemoral
and patellofemoral).
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Functional anatomy
¤ Has the ability to flex and bend the lower extremity, which implement on the functionality of the body.
¤ The tibiofemoral joint is formed by two large, femoral condyles resting on a flat tibial plateau.
¤ It is unstable.
¤ The tibiofemoral articulation can potentially move without limit in four directions: ¤ Flexion– extension, varus–valgus, external–internal
rotation, and anterior–posterior translation (or glide).
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Tibial plateau
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Functional anatomy
¤ This excessive movements can be limited by muscles or ligaments.
¤ Menisci, increase stability of the knee joint by increasing the articular congruity the tibial plateau presents to the femoral condyles.
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Meniscus
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Functional anatomy
¤ The patellofemoral articulation gives stability as well, because of the the concave femoral trochlea and convex patellar articular surface.
¤ There are two pairs of major ligaments: ¤ Medial and lateral collateral ligaments.
¤ Anterior and posterior cruciate ligaments.
¤ The medial collateral ligament and lateral collateral ligament prevent excessive valgus or varus displacement of the tibia relative to the femur.
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Torn MCL
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Ligaments
¤ The anterior cruciate ligament and posterior cruciate ligament lie intra-articularly.
¤ The posterior cruciate ligament is about 50% larger in diameter than the anterior cruciate ligament.
¤ PCL, prevents posterior displacement of the tibia on the femur.
¤ ACL, prevents anterior displacement of the tibia on the femur also prevents excessive internal rotational movement of the tibia on the femur.
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Torn ACL
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Functional anatomy
¤ If the anterior cruciate ligament is compromised by injury, it is theoretically possible to reduce the effects of its absence by increasing hamstring function and avoiding knee extension.
¤ Chondromalacia is due to an irritation of the undersurface of the kneecap.
¤ Chondromalacia patellae (chondro means “cartilage,” malacia means “softening”).
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Observation
¤ The examination should begin in the waiting room before the patient is aware of the examiner’s observation.
¤ Information regarding the degree of the patient’s disability, level of functioning, posture, and gait can be observed.
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Observation
¤ Note whether the patient is able to sit with the knees flexed to 90 degrees or whether the involved knee is extended.
¤ Pay attention to the alignment of the knee from both the anterior and lateral views. Does the patient appear to have an excessive degree of genu valgum or varum?
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Observation
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Q angle
¤ Genu valgum creates an increase in the Q angle, is also a cause of patellofemoral malalignment syndromes.
¤ Increased Q angles can create a predisposition to patella subluxation.
¤ The patient will also have increased stress placed on the medial collateral ligament.
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Observation
¤ Is genu recurvatum present?
¤ Observe the alignment of the feet with and without shoes.
¤ Observe the swing and stance phases of gait, noticing the ability to move quickly and smoothly from flexion to extension.
¤ Note any gait deviations and whether the patient is using or requires an assistive device.
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Subjective Examination
¤ More mobile joint than the hip.
¤ In normal conditions its stable, nut the trauma and degenerative changes are the most.
¤ Mechanism of injury.
¤ Trauma.
¤ Any clicking, buckling, or locking?
¤ Ascend and descend the stairs without difficulty.
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Gentle palpation
¤ It is easiest to begin the palpatory examination with the patient in the supine position since asymmetry is easier to observe with the knee in the extended position.
¤ Note any areas of ecchymosis, bruising, muscle girth asymmetry, bony incongruities, incisional areas, or open wounds.
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Gentle palpation
A. Anterior Aspect; ¤ Bony Structures:
¤ Patella. ¤ Tibial Tuberosity.
¤ Soft-Tissue Structures: ¤ Quadriceps Muscle. ¤ Patellar (Infrapatellar) Ligament
(Tendon). ¤ Bursae.
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Gentle palpation
¤ Medial Aspect; ¤ Bony Structures:
¤ Medial Femoral Condyle. ¤ Adductor Tubercle. ¤ Medial Tibial Plateau.
¤ Soft-Tissue Structures: ¤ Medial Meniscus. ¤ Medial Collateral Ligament. ¤ Sartorius, Gracilis, and Semitendinosus Muscles (Pes
Anserinus). ¤ Anserine Bursa.
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Gentle palpation
¤ Lateral Aspect; ¤ Bony Structures:
¤ Lateral Femoral Condyle. ¤ Lateral Femoral Epicondyle. ¤ Lateral Tibial Plateau ¤ Lateral Tubercle (Gerdy’s Tubercle) ¤ Fibular Head. ¤ Iliotibial Tract. ¤ Common Peroneal Nerve.
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Gentle palpation
¤ Posterior Aspect; ¤ Bony Structure:
¤ There are no bony structures that are best palpate on the posterior aspect.
¤ Soft-Tissue Structures: ¤ Biceps Femoris. ¤ Gastrocnemius. ¤ Popliteal Fossa. ¤ Popliteal Vein, Artery, and Nerve. ¤ Semimembranosus Muscle. ¤ Gastrocnemius–Semimembranosus Bursa.
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Special Test
¤ Flexibility Tests; ¤ Bring the heel toward the buttocks.
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Special Test
¤ Tests for Stability and Structural Integrity;
¤ Anterior Stability Tests: ¤ Anterior drawer test.
¤ Lachman Test.
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Special Test
¤ Anterior Medial and Lateral Instability Tests: ¤ Slocum Test.
¤ Pivot Shift Test (MacIntosh).
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Special Test
¤ Posterior Stability Tests: ¤ “Reverse” Lachman Test. ¤ Hughston (Jerk) Test.
¤ Posterior Medial and Lateral Stability: ¤ Hughston Posteromedial and Posterolateral
Drawer Test.
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Special Test
¤ Posterior Stability Tests: ¤ “Reverse” Lachman
Test. ¤ Hughston (Jerk) Test.
¤ Posterior Medial and Lateral Stability: ¤ Hughston
Posteromedial and Posterolateral Drawer Test.
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Special Test
¤ Tests for Meniscal Damage: ¤ McMurray’s Test.
¤ Bounce Home Test.
¤ Apley (Grinding, Distraction) Test.
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Knee Tests
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Special Test
¤ Patellofemoral Joint Tests: ¤ Apprehension (Fairbanks) Test.
¤ Clarke’s Sign (Patella Grind Test).
¤ Patellofemoral Arthritis (Waldron) Test.
¤ Test for Plica.
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Special Test
¤ Clarke’s Sign (Patella Grind Test).
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Special Test
¤ Tests for Joint Effusion: ¤ Wipe Test.
¤ Ballotable Patella.
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Thank you
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References,
¤ Musculoskeletal Examination, 3rd Edition Jeffrey M. Gross, chapter 12.
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