Surface Anatomy of Knee Lab Outline 2024 PDF

**[Clinical Conference I]** **Lower Extremity: The Knee Complex** **Anterior Knee** - ***patient is seated at the edge of the plinth with the leg RELAXED and knee flexed to 90 degrees*** - palpate the **patella** on the anterior knee and palpate around its edges; locate the patella's...

**[Clinical Conference I]** **Lower Extremity: The Knee Complex** **Anterior Knee** - ***patient is seated at the edge of the plinth with the leg RELAXED and knee flexed to 90 degrees*** - palpate the **patella** on the anterior knee and palpate around its edges; locate the patella's apex and the base - **apex:** move distally from mid patellar level, and locate a triangular structure - **base:** from the apex, follow edges up on (B) sides; the base is the superior aspect of patella, you can palpate 2 edges (of the base) - note the superficial edge first and then deeper, proximal edge of the base of the patella - **medial & lateral femoral condyle** - from the apex of the patella, slide and palpate directly medially and proximally to find the edge of the medial femoral condyle; followed medially to the **medial joint line** of the knee - the medial femoral condyle can also be followed ventrally, until it disappears under the patella but then reemerges proximally at the base of the patella - from the apex of the patella, slide and palpate laterally and proximally to find the edge of the condyle; followed laterally to the **lateral joint line** of the knee - the lateral femoral condyle can also be followed ventrally, until it disappears under the patella but then reemerges proximally at the base of the patella - **medial & lateral femoral epicondyles** - locate the patella, slide directly medial from the patella and past the medial condyle on the inside of the knee, identify the round structure of the **medial femoral epicondyle** - locate the patella again and slide directly lateral again to the outside of the knee to find the **lateral femoral epicondyle,** note it's location proximal to the head of the fibula - **tibial plateau, tibial tuberosity, and patellar tendon** - from the medial and lateral joint lines, you can palpate distally to find the firm edge of the **tibial plateau at the anterior aspect of the knee** - from the apex of patellar tendon, you can palpate distally along the firm tissue of the **patellar tendon** until its attachment at **tibial tuberosity (this protrudes visibly)** - once you have the two attachment points (apex of patella and tibial tuberosity) of the patellar tendon you can now palpate the edges of the **patellar tendon** **Medial Knee** - ***patient is seated at the edge of the plinth with the leg relaxed and knee flexed to 90 degrees and slight external rotation of the tibia; can place the*** tibia in slight ER to make easier to locate structures - **medial collateral ligament (MCL)** - from the apex of the patella, palpate along the medial joint line until your finger is pressed out by the space slightly raised by the anterior edge of the **medial collateral ligament** - you can continue palpation along the joint line posteriorly until you feel the posterior edge of the medial collateral ligament, strum your fingertips horizontally across the space between the tibia and femur to locate the broad fibers of the MCL - just proximal to the medial epicondyle in the concavity we can palpate deeply for the **adductor tubercle** that protrudes from the superior aspect of the medial epicondyle. This concavity serves as the insertion site of the adductor magnus tendon; you may strum the adductor magnus tendon by rubbing the finger anteriorly and posteriorly - if you are having difficulty feeling this you can ask your patient to resist hip adduction; this is also the femoral attachment of the medial collateral ligament - the tibial attachment of the **medial collateral ligament** is located on the posterior half of the tibia and is about 10-12 cm long Image result for adductor tubercle of femur  - **pes anserine** group (Geese's Foot -- Three tendons, three toes) - facing the anterior aspect of the knee, place the palm of your outside hand at a 45-degree angle to the midshaft of the tibia so that your index finger points toward the posterior medial aspect of the knee and your thumb points in the direction of the patellar tendon - slide your hand proximally toward the medial joint line of the knee until the radial border comes in contact with a small convexity - this is the area of the **pes anserine** group, consisting of the distal attachments of the sartorius, gracilis, and semitendinosus - draw a line reflecting the orientation of your hand at this point - the **sartorius** is the most anterior of the muscle group - can be found by asking for slight hip flexion, hip external rotation, and knee flexion (ie. ask partner to sit in figure 4 position and raise knee towards the ceiling) - this can be followed down toward its attachment on the tibia (pes anserine) - Most medial muscle - palpate the convexity of the medial hamstring group - continue posteriorly and the most posterior of the hamstrings is a prominent tendon, which can be felt when you ask the patient to resist flexion in slight knee extension; this is the tendon of the **semitendinosus**; this can also be followed anteriorly and it will blend with the other tendons at its tibial attachment at the pes anserine - Semitendionosus is the most prominent - just medial to the semitendinosus is a much smaller, flat tendon of the **semimembranosus** muscle (semimembranosus is not part of it) - just medial to this tendon is also the small, slender tendon of the **gracilis**; all three muscles assist to flex the knee, however if you are having problems differentiating between the semimembranosus and the gracilis, ask for resisted hip adduction  Image result for gracilis sartorius and semitendinosus https://radiologykey.com/knee-10/ **Lateral Knee** - ***patient is seated at the edge of the plinth with knee flexed to 90 degrees and slight IR of the tibia*** - palpate along the lateral joint line until your finger pressed out of the space slightly by the anterior edge of the **iliotibial band** - this can be followed distally to its attachment on the tibia a large bony knob, **gerdy's tubercle** - the distal 1/3 of the iliotibial band can be better appreciated if you ask the patient to extend the knee and slightly internally rotate the femur - palpate along the lateral joint line and continue posteriorly until will come in contact with a very prominent ligament, the **lateral collateral ligament** **(LCL)** of the knee; this can be best felt if you ask the patient to cross their leg into a figure-four position; gently strum in a horizontal direction to locate - this is a strong, thin ligament that feels like a pencil-like structure as it crosses the knee - it can be followed proximally to its attachment at the **lateral femoral epicondyle** and distally to its attachment on the **head of the fibula; the head of the fibula can be located 3-4 inches lateral from the tibial plateau and is a about an inch wide** - with the knee placed back in flexion and slight internal rotation of the tibia, we can continue posterior along lateral joint line until we meet the prominent tendon of the **biceps femoris** - ask the patient to resist slight flexion of the knee and the biceps femoris tendon can be followed distally to its attachment on the head of the fibula - now palpate posterior to the head of the fibula - apply force anterior toward the head of the fibula - you will feel soft rubbery structure the **common peroneal/fibular nerve as it is just deep and medial to the biceps femoris tendon and lateral to the gastrocnemius muscle belly Hook your finger around the biceps femoris tendon for a ropey feeling thingy will be the nerve** A tattoo on his arm Description automatically generated  **Anterior Muscle Structures** - **Rectus femoris** - **Book says use a bolster in supine or sitting, we can use our knee in this class** - start with your partner in supine w/knee bolstered - locate AIIS (Anterior Inferior Iliac Spine) and patella - draw an imaginary line between these 2 points and follow path of the rectus femoris - palpate along this line and strum across the muscle (it will be 2-3 fingers wide) - ask patient to flex hip and hold foot off table to make it more pronounced - **Vastus medialis** - **Tear drop shape** - start with your partner supine w/knee bolstered - ask patient to fully contract quads by extending the knee - palpate just medial and proximal to the patella for the bulbous and teardrop shape of the vastus medialis - is surrounded by the rectus femoris and sartorius - **Vastus lateralis** - have your partner in sidelying (This is what the book describes) - place flat of hand on the lateral side of the thigh while partner slowly extends and relaxes their knee, the vastus lateralis will contract and relax Repeatedly - palpate the entire belly - You want to make sure you are feeling the muscle and not the IT Band (Which Is ropey) **Posterior Knee** - ***have your partner lie prone with the knee slightly flexed*** - ask for slight resisted knee flexion and you see the more prominent tendons of the semitendinosus (medially) and the biceps femoris muscle (laterally) will frame the contents of the posterior knee, also known as the "popliteal fossa" - directly midline in the popliteal fossa you will note a cord like structure without a pulse, the **tibial nerve** - just medial to the tibial nerve but lateral to the tendon of the semitendinosus is a pulsating structure the **popliteal artery, the popliteal vein** is also in this region but not palpable - just lateral to the tibial nerve but medial to the tendon of the biceps femoris you can again located the **common peroneal nerve** - **semimembranosus** is deep to the semitendinosus and often difficult to isolate in the posterior knee - **Make your frame the biceps femoris and semitendinosus, you then palpate the tibial nerve and you will feel a pulse for the popliteal artery** FullSizeRender (8) Reichert B. Palpation Techniques Surface Anatomy for Physical Therapists. Stuttgart, Germany: Thieme; 2011. Sizer P., et al. International Academy of Orthopedic Medicine-US Presents Diagnosis-Specific Orthopedic Management of the Shoulder Complex. OPTP.