The Knee

Description:	Ch 6 Evaluation of the Knee
Category:	Sports Medicine
Created by:	Msathletic on 2008-10-21

Question	Answer
What Three Muscle Groups make up the Pes Anserine?	The Gracilis, Sartorius, and Semitendinosus
What kind of pain will the person complain of the ACL?	Pain beneath the kneecap or inside of the knee
Location of pain of the PCL?	Mimics gastrocnemius strain
Location of pain of the Meniscus ( vascular)?	Joint line pain
Location of pain of the meniscus ( avascular)?	Popping, clicking or locking
MOI Varus tensile forces( 4) ?	1.LCL,2. Lateral joint capsule,3. IT band, 4.Biceps Femoris.
MOI Valgus Tensile forces (4)?	1. MCL, Medical jont capsule, pes anserine mucsle group, and Medial meniscus
MOI Anterior tibial Displacement ( 5)Tensile Force?	ACL, IT band, LCL, MCL, medical and lateral joint capsules.
MOI Posterior Tibial Displacment(4)Tensile Force)?	PCL, poplitus, medial and lateral joint capsules
MOI Internal Tibial Rotation(Tensile Force)?	ACL, Anterolateral joint capsule, posteromedial joint capsule, posterolateral joint capsule, LCL
MOI External tibial rotation(Tensile Force)?	Posterlateral joint capsule, MCL, PCL, LCL, ACL
MOI hyperextension(Tensile force)?	ACL, posterior joint capsule
MOI Hyperflexion( tenseile force)?	ACL, PCL
MOI Compressive forces- Valgus?	Lateral Meniscus
MON Compressive forces- Varus?	Medical Meniscus
MOI Compressive forces- Anterior tibial displacement?	Posterior portion of the medial and lateral meniscus
MOI compressive forces- Porterior tibial displacement?	Anterior portion of the medial and lateral meniscus
MOI Compressive force to the Interal tibial rotation?	Anterior horn of the medial meniscus, posterior horn of the medial meniscus
MOI compressive force of external tibial rotation?	Anterior horn of the lateral meniscus, posterior horn of the lateral meniscus
MOI compressive force hyperextenion?	anterior portion of the medial and lateral meniscus
MOI Compressive force of Hyperflexion?	Posterior portion of the medial and lateral meniscus
When inspecting the alignment of the patella, should you be looking for?	Should rest normally above the femoral trochlea, evenly aligned with the medial and lateral aspects of the knee
While inspecting the patellar tendon, you should look for?	Swelling over or directly around the tendon may indicate tendinitis or bursitis, swelling on both sides may indicate inflammation of the underlying fat pad
When inspecting the Quadriceps muscles, you should be looking for?	Compare mass and tone bilaterally, note any discoloration, swelling, loss of continuity
Inspection of the alignment of the femur on the tibia?	Observe angle of articulation ( genu valgum, Genu varum)
Inspection of the Tibial Tuberosity	Note if enlarged( Osgood-Schlatter disease)
Inspection of the medical aspect, what should you be looking for?	Any swelling or discoloration of the joint line, tibia, femur, or pes anterine tendon
Inspection of the Oblique fiber of the vastus medialis?	Note tone and grith compared bilaterally, first to inhited following injury ( disuse or result of inflammation)
Inspection of the lateral aspect?	Notice any swelling or discoloration of the tibia joint line and femur.
Inspection of the Fibular head?	Should be aligned equally ht when compared bilaterally. Biceps femoris tendon and LCL may be visble during knee flexion.
Inspection of Posterior sag of the tibia?	Patient is supine and knees at 90 degrees, Observe postions of the tibia(PCL- deficient knee)
Inspection of hyperextension?	Genu recurvatum
Inspection of the hamstring muscles?	Observe Length of the hamstring group for signs of contusions, indicating a blow to this area, ecchymosis, indicating a strain
Inspection of the Popliteal Fossa?	Notice any swelling or discoloration, indication of capsular trauma or tear of the distal hamstring tendons or the heads of the gastrocnemius muscle
Determining intracapsular swelling, what is the test?	Sweep Test
What indicated that a sweep test is postive?	Reformation of the edema on medical aspect of the knee pressure appliesd to lateral aspect
What are the implications of a postive Sweep Test?	Joint capsule swelling- indicative of possible ACL trauma, osteochondral fx, synovitis, menisal lesion, or patellar dislocation.
ROM testing when during flexion and extension of the knee what are the degrees?	0( extension)- 135 to 145 (Flexion)degrees
ROM testing of recurvatum what are the degrees?	-10 degrees
ROM testing of internal and external rotation?	Observer and compare bilaterally the rotation of the tibial tuberosity to estimate the amount of ER and IR occurs during active flexion and extension.
What are the three ligamentous test that test of ACL instablitliy	Anterior drawer test, Lachman's Test, Modified lachman's test
What are the two ligamentous test for PCL Instability?	Posterior Drawer test, Godfreys test (Sag)
What is the test for MCL instability?	Valgus stress test
What is the test for LCL instability?	Varus stress test
What are the two Special test for Meniscal tears?	McMurrays Test, and Apley's compression and distraction test
What are the five special test of rotary knee instabilies?	Slocum Drawer, Crossover test, Lateral pivot shift, Slocum ALRI, FRD test
What are the tests for IT band friction Syndrome?	Noble's compressive test, Ober's test
What the MOI for an MCL sprain?	A valgus Force to the knee or less commonly, external rotation of the tibia.
What is the MOI of a LCL sprain?	Varus force placed on the knee or excess internal tibial rotation.
what is the MOI of a ACL Sprain?	Rotation of the knee while the foot is planted (tensile force)a blow that drive the tibia anterio relative to the femur or the femur posterior relative to the tibia ( shear force)or hyperextenion
What is the MOI of a PCL Sprain?	Posterior displacement of the tibia on the femur, Hyperflextion of the knee, Hypextension of the knee
What is the posterolateral rotatory instablitiy?	Most commonly, a direct blow to the posterolateral aspect of the knee, rotational force
During RROM of flexion of the knee what muscles are you testing(7)?	Semitendinosus, semimembranosus, biceps formois, sartoris, gactrocnemis, graclis, poplitus
During RROm of extersion what muscles are being being tested (4)?	Rectur femoris, vastus lateralis, vastus intermedius, vastus medialis.
what are u testing for during a Anterior Drawer test for the ACL?	Increased amount of anterior tibial translation compared with the opposite limb.
What does a postive test for a anterior drawer test mean?	a sprain of the anteromedial bundle of the ACL or complete tear of the ACL.
What are you testing for during a Lachman's test for the ACL laxity	Increaced amount of anterior tibial translation compared with the opposite side limb or the lack of a firm end feel
When performing the posterior drawer test for the PCL instablity, what are you looking for ?	Increased amounts of posterior tibial translation compared with the opposite limb or lack of the firm end feel
A postive result from lackmans means?	Sprain to the ACL
A postive result from the posterior drawer test means?	Sprain to the PCL
Godfreys test for PCL instability, what are you looking for?	unilateral posterior displacement of the tibial tuberosity
A postive result from a Godfreys test is?	A sprain to the PCL
valgus stress test for the MCL instability is testing for?	Increased laxity, decreased quality of the end point and pain compared with the uninvolved ligament
resuls to the valgus stress test for a MCL means?	At 0degrees flexion( sprain to the macl, medial joint capsule and possibly cruciate ligamentsAt 25 degrees ( sprain to the MCL)
Varus stree test for LCL ligament instability testing for?	Increased laxity, dreacred quality of the end-point or pain compared with the uninvolved limb
Results to a Varus stress test fot the LCL mean?	at 0 degrees of extension- sprain of the LCL,lateral joint capsule cruciate ligaments and related structures indicate rotatary of the joint25 degrees- a sprain to the LCL
Anterolateral rotatory instability are a disruption to what 7 structural?	ACL, anterolateral joint capsule, LCL, IT band, biceps femoris, lateral meniscus, posterolateral capsule.
Anterolateral rotatory instability involves what kind of trauma?	Trauma to the ACL, and the anterolateral capsule restraints, anterolateral rotary instablity resulting in a greater displacment of the tibia.
what are the three test to the anterolateral rotatory instability>	Lateral pivot drawer, the slocum ALRI test, and flexion rotation drawer.
When performing the Slocum drawer test at interally rotated at 25 degrees what are the implications?	Test for anterolateral instability: damage to the ACL, anterolateral capsule, lcl, IT band, popliteus tendon, posterolateral capsule
When performing the slocum drawer test at externally roated at 15 degrees what are the implications?	test for the anteromedical instablity: damage to the MCL, anteromedical capsule, ACL posteromedical capsule
Lateral pivot test for anterolateral knee instablity a postive test would be?	tibia;s postion on the femur reduces as the leg is flexed of 30 degreees or 40 degrees, during extension the anterior subluxation is felt
Lateral pivot test for anterolateral knee instalility a implication are?	tear of the ACLm posterolateral capsule, arcuate ligament complex or the IT band
Slocum anterolateral rotatory instablilty a postive test means?	appreciable" chuck or instability as the lateral tibial plateau subluxates or pain or instability reported
Posteriolateral rotatory instability involves?	anterior displacement of the lateral femoral condyle relative to the tibia ( the tibia externally rotating relative to the femur)
Posterolateral structures are of the knee? ( 4)	Arcuate ligament complex, LCL, biceps femoris, posteral capsule
Postormedical structues are of the knee? (4)	Posterior oblique ligament, MCl, semimembranosus, anteromedical capsule,
Anteromedical structures of the knee?( 6)	ACLm Anteromedical joint capsule, MCL, pes anserine, medial meniscus, postermedial capsule
External rotation test for posterolateral knee instability postive test is?	Increased external rotation greater than 10 degrees compared to the opposite limb
External rotation test posterolateral knee instablility implicatioin at 30 degrees not at 90?	injury isolated to the arcuate ligament complex and posterolateral structed of the knee
External rotation test posterlateral knee instability implication at 30 and 90 degrees?	trauma to the PCL, posterolateral knee structures, and arcuate ligament complex
External rotation test posterlateral knee instablility implication at a90 degrees	isolates the PCL
The McMurry's test for meniscal lesions, postive test would result in?	Popping or clicking or locking of the knee, pain emanating from the meniscus
Nobles compressive test for IT band friction syndrome, postive test results in?	Pain under the thumb most commonly as the knee approaches 30 degrees
Ober's test for IT Band tighness postive test results in?	The leg is unable to adduct past parallel
Scew Home Mechanism is?	When extension of the Knee the finial degrees, resulting in extenal rotation of the tibia when the lateral meniscus seving as a pivot point.