what is the most complex joint in the body?. the knee joint
TRANSCRIPT
What is the most complex joint in the body?
What is the most complex joint in the body?
The KNEE joint
Knee joint!
It takes a pounding as a hinge joint between two substantial bones…
One of the most common operations performed in the U.S. – ???
Knee joint!
One of the most common operations performed in the U.S. – knee arthroplasty (TKR)
Total Knee Replacement
Total Knee Replacementhttps://youtu.be/tKji04oFGdU
(animation )
Surgery:
https://youtu.be/Nmb5-e3cwBw
THE KNEE
The knee
-Largest joint in the body.-Hinge joint-greatest ROM is in flexion-highly susceptible to injury-not protected by layers of fat and muscle-easily palpable
The knee (anterior)
The knee (posterior)
Meniscus and ligaments and anatomy
http://youtu.be/_q-Jxj5sT0g?t=5m29s
Knee Meniscus
http://youtu.be/hwnFgm6jiKY
http://youtu.be/OuiIXMgTlyI
Knee ACL repair
http://youtu.be/rRVAjHJxmX8
http://youtu.be/q96M0jRqn7k
bursas
Goniometer
Knee Flexion
Testing Position: Prone with hip and knee in neutral
Stabilization: Trunk and pelvis stabilized by body weight and position
Goniometer Axis: Lateral epicondyle of the femur
Proximal Arm: Parallel to the long axis of the femur & pointing at the greater trochanter
Distal Arm: Parallel to the long axis of the fibula and pointing at the lateral malleolus
Movement: The hip and knee are flexed as the heel moves toward the buttock
Expected ROM: 135°
*Alternate Position: Supine lying with the femur stabilized.
Alternate position
Alternate position
Knee Extension
Testing Position: Prone with hips and knees in neutral rotation; upper leg on bolster
Stabilization: Trunk and pelvis stabilized by body weight and position
Goniometer Axis: Lateral Epicondyle of the femur
Proximal Arm: Parallel to the long axis of the femur & pointing at the greater trochanter
Distal Arm: Parallel to the long axis of the fibula and pointing at the lateral malleolus
Movement: Knee extension
Expected ROM: 0°. Hyperextension may be present up to -10°
*Alternate Position: Supine with bolster under ankle
Alternate position- supine for knee extension
Goniometry Lab
- Disadvantages:
Goniometry Lab
- Disadvantages: - It is sometimes difficult to position and
maintain the arms of the goniometer along the bones of the segments throughout the measurement
- Intertester reliability- Coordination
Differences between R/L side measurements
Prone vs. Supine knee flexionSupine Prone
Common injuries to knee
Common injuries to knee
-Patellar dislocation
- ACL tear
-PCL tear
- Collateral ligament tears
-Meniscal tears
-Tendon tears
ACL tear Changing direction rapidly or landing from a jump
incorrectly can tear the ACL. About half of all injuries to the ACL occur along with damage to other structures in the knee (articular cartilage, meniscus or other ligaments)
PCL tearPCL is generally injured from a blow to the front of the knee while the knee is bent. This often occurs in motor vehicle crashes and sports-related contact. PCL tears tend to be partial tears with the potential to heal on their own.
Collateral Ligament tears- lateralInjuries to the collateral ligaments are usually caused by a force that pushes the knee sideways. Injuries to the MCL are usually caused by a direct blow to the outside of the knee, and are often sports-related. Blows to the inside of the knee that push the knee outwards may injure the LCL. (LCL tears occur less frequently than other knee injuries.)
Lateral collateral ligament
Collateral Ligament tears- medial
Meniscal Tears
Sudden meniscal tears often happen during sports. ◦ Tears in the meniscus can occur when twisting, cutting, pivoting, or being tackled.
Meniscal tears may also occur as a result of arthritis or aging. ◦ Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have
weakened with age.
Meniscal Tears
Tendon tears The quadriceps and patellar tendons can be stretched and torn. Although anyone can injure these tendons, tears are more common among middle-aged people who play running or jumping sports. Falls, direct force to the front of the knee, and landing awkwardly from a jump are common causes of knee tendon injuries.
Patellar tendon tear
Quadriceps tendon tear
Patellar tendonitis
Manual Muscle TestingManual Muscle Testing Grading System
Grading Scale Range: 0 to 5
0 None No visible or palpable contraction
1 Trace Visible or palpable contraction with no motion
2 Poor Full ROM gravity eliminated
3 Fair Full ROM against gravity
4 Good Full ROM against gravity, moderate resistance
5 Normal Full ROM against gravity, maximal resistance
Manual Muscle testing -Knee
◦ -quadriceps◦ - hamstrings
MMT- quads and hamstrings http://youtu.be/ZkjP9Mw_1gk
1) Have patient go through full ROM first.
2) Then, have patient repeat full ROM while you offer resistance.
3) At the end of the motion, perform a brake test.
4) Record your results (do flexion and extension on both sides).
MMT- knee -Record your results for both the left and right LE.
Bony Landmarks of Knee
- Patella- Tibial tuberosity- Femoral condyles- Tibial condyles
Stability Tests -Ligaments
-Meniscus
-Miscellaneous
Flexibility Tests -SLR (80-90 degrees is a desirable score)
-Thomas Test
http://youtu.be/4mnjUi-41fI
- Review medical abbreviations for quiz