Examination of the Knee- Students PDF

Examination Considerations of the Knee Rebecca Pinkus, PT, DPT, NCS PT8311 Contributions from Jolene Walsh PT, MPT, Keith Cole, PT, DPT, PhD, MBiomedE, OCS https://content.active.com/Assets/ , & Joseph Signori...

Examination Considerations of the Knee Rebecca Pinkus, PT, DPT, NCS PT8311 Contributions from Jolene Walsh PT, MPT, Keith Cole, PT, DPT, PhD, MBiomedE, OCS https://content.active.com/Assets/ , & Joseph Signorino, PT, DPT, OCS, FAAOMPT Active.com+Content+Site+Digital+Assets/Cycling/Galleries/  Objectives Discuss relevant anatomy of the knee complex Discuss pertinent subjective information related specifically to the knee complex Discuss proper technique for examination test and measure procedures Briefly discuss pathological considerations Subjective – Mechanism of Injury TRAUMATIC ATRAUMATIC  Examination questions specific for the knee joint… Mechanism of injury swelling Instability Joint sounds Aggravating/alleviating factors What else?  Bony Anatomy Tibiofemoral joint Patellofemoral joint *Tibiofibular joint (proximal) https://musculoskeletalkey.com/structure-and-function-of-the-knee/  Structure and Function Stability provided by: Anteriorly: quadriceps tendon, patellar ligament, expansions from quadriceps Medially/laterally: medial & lateral collateral ligaments, iliotibial band (ITB), pes anserinus insertion Posteriorly: hamstrings, gastrocnemius Also from ACL and PCL Joint capsule (synovial joint) Large and loose Reinforced by tendons, expansions from muscles & ligaments Muscular Anatomy  Knee extensor mechanism Rectus femoris originates on the ASIS. Vastus lateralis, vastus intermedius, and vastus medialis originate on the femoral shaft. Quadriceps tendon insertion on the superior pole of the patella. Patellar tendon originates at the inferior pole of the patella and inserts onto the tibial tuberosity. Patella redirects the force exerted by the quadriceps, resulting in a large compressive stress on the patellofemoral joint. – MAX compression = knee at 90º with foot planted – Up to 7x BW with squatting! https:// musculoskeletalkey.com/ patella-fractures-open-  Knee extensor mechanism Intercondylar groove of femur articulates with posterior aspect of patella Flexion: patella Extension: slides inferiorly patella slides and medially superiorly and laterally https://fitnesspainfree.com/knee-pain-complete-guide-patellofemoral-pain-syndrome- part-2-biomechanics-knee/  Clinical Consideration Osgood-Schlatter’s “Disease” a.k.a. Tibial Tuberosity Apophysitis Adolescents 8-15 Females present younger than males Pain localized over tibial tuberosity May have visible swelling or a “bump” https://orthoinfo.aaos.org/en/diseases--conditions/osgood-schlatter-disease-knee- Vergara-Amador E. et al, Radiographic features of the development of the anterior tibial tuberosity Radiología. 2016;58:294-300.  Structure and Function Osteokinematics: 2 degrees of freedom: 1) flexion/extension, 2) internal/ external rotation Incongruity/asymmetry of articular surfaces “screw home” (locking) mechanism: last 10 to 15° knee extension (involuntary) Active (voluntary)tibial rotation possible at 90º of flexion (15-30º) *No reliable measurements at this time https://musculoskeletalkey.com/structure-and-function-of- the-knee/  Capsular Pattern Flexion>Extension  Muscle testing considerations Knee extension ☆ Quadriceps have great strength potential To avoid over- grading, consider a hand-held muscle dynamometer or a 1-RepMax leg press  4 tests: single leg sit-stand Step-up test Knee-flexed MMT Knee extended MMT Single leg sit to stand most predictive of L3 radic  Muscle Considerations Knee flexion Medial HS create tibial IR Lateral HS creates tibial ER  Other considerations when examining the knee What is the hip doing? What is the foot/ankle complex doing? What’s their functional movement or limitation? Have the patient show you! Practice!