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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. Patellas facing forward? Are the knees fully extended? Genu Valgum: knock knees pronated feet, compression of lateral aspects Genu Varum: Genu recurvatum: hyperextended knees Q Angle 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 - 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