Download Knee Packet

Knee Packet
Designed to:
1.
2.
Knee Facts:
1.
2. Considered a hinge joint.
3.
4. Provide stability during weight bearing.
5.
Joint Capsule
Fat pads
___________________________ fat pad is the largest.
Cushions the front of the knee and separates the patella tendon from the joint capsule.
Nerve supply
Nerve
Tibial
Muscles
-
Peroneal
-
Femoral
-
Blood Supply
________________________artery stemming from the ______________________________ artery.
Leg Alignment: Deviations may be a factor in knee injury always differs from person to person.
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Patellas facing forward?
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Are the knees fully extended?
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Genu Valgum: knock knees
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pronated feet,
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compression of lateral aspects
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Genu Varum:
Genu recurvatum: hyperextended knees
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Q Angle
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Created when lines are drawn from the middle of the patella to the anterosuperior spine of the ilium and from
the tubercle of the tibia through the center of the patella
Normal angle = 10 degrees for males, 15 for females
Bones
Picture
Name
Description
1.
1
2.
2
3.
3
4.
4
Ligaments :
Picture
Name
Description
1.
2.
4
3
3.
2
1
4.
MCL injury
MCL grade 1
MCL grade 2
MCL grade 3
MCL Special test
Most common injured
ligament in knee
MOI: Valgus stress
Lateral blow w/ foot fixation,
severe twist.
S/S:
Mild ligament fibers torn or
stretched
S/S:
Tearing of the capsule, partial
tear of MCL
Complete tear of MCL and
supporting ligaments
S/S: Moderate instability
(more during flexion) swelling,
joint stiffness, AROM (flexion
and extension) & PROM = pn
and LOF
S/S: +valgus test, complete
loss of medial stability, severe
pn, hear a “pop” severe
swelling, LOF, check ACL, PCL
and meniscus
Valgus Stress Test
Procedure: Place one hand on
the lateral aspect of knee and
the other on the medial
aspect of the ankle
Apply a valgus force to the
knee at 0 and 30 degrees
TX:
TX:
Positive Test:
TX:
TX: PRICE, strengthening
LCL Sprain injury
MOI:
S/S: Pain, inflammation, instability, loss of function and ROM
TX:
ACL sprain injury
MOI: Torsion (Foot fixation w/twisting), or a blow. (EX:
athlete running then turns suddenly.)
Highest incidence = Female soccer players, then female
basketball players
S/S:
ACL special test
Lachmans
Procedure: Firmly grasp the distal femur and
the proximal tibia. With the knee in slight
flexion pull the tibia anteriorly
Positive Test:
TX:
LCL Special test
Varus Stress Test
Procedure: Place one hand on the medial aspect of the knee
and the other on the lateral ankle
Apply a varus force to the knee at 0 and 30 degrees
Positive Test:
ACL special test
Anterior Drawer
Procedure: Put the athlete in knee flexion. Place hands
on the superior aspect of the gastrocnemius and pull
anteriorly
Positive test:
PCL Injury
MOI: severe hyperextension, OR a fall w/knee flexed to
90 degrees.
S/S:
PCL special test
Posterior Drawer
Procedure:
PCL special test
Posterior Sag
Procedure:
Positive test:
TX:
Positive Test:
Meniscus: two oval fibrocartilages that deepen the articulation and cushion any stresses placed on the knee joint
Picture
Name
Description
1.
1
2
Zones
2.
3 zones
Red zone:
Red-white zone:
White-white zone: inner one third is avascular.
Meniscus injury
Bucket handle
Parrot beak
Loose body
S/S: Joint effusion, joint line pain,
giving away, pain with squats or
stairs, locking, clicking, popping
S/S: Joint effusion, joint line pain,
giving away, pain with squats or
stairs, locking, clicking, popping
S/S: Joint effusion, joint line pain,
giving away, pain with squats or
stairs, locking, clicking, popping
higher incident of injury it attaches to
tibia& capsular lig.
MOI: firm Foot fixation with rotary
force (Torsion) while the knee is
extended of flexed, cutting motion,
squatting
S/S:
TX:
Meniscus special tests: McMurrays Click
Meniscus special tests: Apleys comp./distraction
Procedure: w/ one hand on the joint line & on the foot internally rotate the
tibia and apply a valgus force while moving into extension and flexion. Repeat
the same procedure w/ the tibia externally rotated & w/ a varus force.
Positive Test:
Procedure: athlete lies prone with knee in extension. Place one hand on the
distal hamstring and pull up on the tibia with the other hand. Then push down
on the tibia while rotating.
Positive Test:
Sweep Test:
Muscles
Anterior Thigh
Muscle Group, List them out
Action
Posterior Thigh
Muscle Group, List them out
Action
Medial Thigh
Muscle Group, List them out
Action
Lateral Thigh
Muscle
Action
1.
Lower Leg
Muscles
Actions
1.
Quad contusion
Quad strain
Hamstring strain
MMTs Quad
MOI: compression
MOI: muscle fatigue,
force, blow to the soft
tissue of thigh
S/S: inflammation,
discoloration. Loss of
ROM, pain
faulty posture, leg length
discrepancy, tight
hamstrings, improper form
MMTs Hamstring
S/S:
TX:
TX:
Other Knee Injuries pg. 263
1. Bursitis
MOI:
S/S:
TX:
2. Patellar Tendonitis (jumpers knee)
MOI:
S/S:
TX:
3. Patella dislocation
MOI:
S/S:
TX:
4. Osgood-Schlatter Disease
MOI:
S/S
TX:
5. IT Band Tendonitis (runners knee)
MOI:
S/S:
TX:
Palpations: knee should be in flexion!
Quadriceps( ALL)
Hamstrings (ALL)
MCL
LCL
Medial and Lateral Borders of Patella
Lateral and Medial Joint Lines
Lateral and medial meniscus
Patellar Tendon
Tibial Tuberosity
Gastrocnemius
Soleus
PCL (general area)
ACL (general area)
Pes Anserinus Insertion (medial)
Fibular head
Fibula
Tibia
Patella
Knee Rehab
- When injuries occur, the focus shifts from injury prevention to injury treatment and rehabilitation.
Rehab Goals
Designing a Rehab Program:
Short Term Goals:
o
IB’s
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Reestablishing neuromuscular control
Maintain level of CV fitness
Long Term Goal
Functional Activities
o
o
o
o
Return to Play Criteria
Designing a Rehab Program
Phase 2
Phase 3
•Knee Extension PRE’s
•Leg curls PRE’s
•Wall slides
•Calf raises
•½ lunges
•Hip exercises (Pilates, add, abd, flxn, ext)
•Balancing eyes open
•Floor to BOSU or trampoline
•BOSU ball work
•2 foot jumping (front back and lateral )
•Full lunges (matrix)
•Balancing eyes closed, OR catching a ball…
•Bike workout
Sports Specific
•Be creative!
•Running
•Jumping
•Drills
Questions
1.
4.
7.
2.
5.
8.
3.
6.
Knee VOCAB
Patella: largest sesamoid in the body
Menisci:
Avascular necrosis:
Anterior Cruciate Ligament: ACL:
Posterior Cruciate Ligament: PCL:
Medial Collateral Ligament: MCL:
Lateral Collateral Ligament: LCL:
Fat pads: cushion the front of the knee
Genu valgum: knock knees, tension on the medial aspect
Genu varum: bow legs, tension on the lateral aspect
Hemarthrosis: blood in the joint
MRI: soft tissue diagnostic tool
Translation: anterior gliding of the tibia