Download Knee Palpation Anterior Cruciate Ligament Posterior Cruciate

7/29/13 Palpation Knee By Dr. Erienn
e Blanchard
, PT Anterior Cruciate Ligament •  ACL Tear •  ACL Tests •  Knee hyperextension and •  Knee effusion: sweep test dynamic valgus •  KT 1000 •  Report a pop or giving way •  Lachmans •  Poor quad contraction •  Anterior Drawer •  Decreased superior •  Pivot Shift patellar glide •  Flexed knee gait •  Loss of knee ROM • 
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Lateral femoral condyle Lateral joint line Fibular head LCL ITB insertion Medial femoral condyle Medial joint line MCL Pes Anserine Inferior pole of patella Patellar tendon •  MCL Tests •  Valgus stress test 0 deg and 30 deg knee Ylexion •  Lateral patellar facet •  Medial patellar facet •  Medial patellofemoral ligament •  VMO insertion Posterior Cruciate Ligament •  PCL injury •  Fall on knee with foot in PF position, dashboard MVA •  Feel for tibial plateaus (not there= + PCL injury) Medial Collateral Ligament •  MCL Injury •  Hit on the outside of the leg with foot planted, knee in valgus position with landing •  Pain on medial aspect of knee •  Pain with knee extension •  Pain over MCL •  Tibial tuberosity •  Inferior patellar fat pad •  PCL Tests •  Posterior Drawer •  Posterior Sag (Godfrey’s Sign) •  Quad Active LCL & PLC •  Lateral Collateral Ligament •  Posteriorlateral Corner •  Hyperextension and varus stress (usually in •  Hit on the inside of the leg conjunction with ACL or with foot planted, knee in PCL injuries) varus position with landing. •  LCL, popliteus complex, •  Pain on lateral aspect of arcuate ligament complex, knee biceps femoris tendon, •  Tests for LCL posterolateral capsular •  Varus Stress test 0 deg and •  Test: prone ER (dial) test 30 deg Ylexion= Grade I, II, with knee in 90 deg and 30 III. Injury deg Ylexion 1 7/29/13 Meniscal Tears •  Traumatic: compression with rotation, knee extension from deep Ylexion, shear force with ACL/PCL injury •  Degenerative: shear force (knee OA, ADL) •  Pain with squatting, stair climbing, clicking, locking, giving way, effusion, may have “locked” knee. •  Tests: •  McMurray •  Joint line tenderness •  Pain with deep squatting •  Thessaly Test •  Ege’s Test Tendonitis •  Quadriceps/Patellar •  “jumper’s knee”=patellar •  Traction overuse injury •  Pain to palpation at inf or sup pole of patella •  Decreased Ylexion ROM •  Pain with stairs, jumping, squatting. •  Weakness/Pain with knee extension muscle testing Others •  Quadriceps Contusion •  Blow to the thigh •  Pain to palpation •  Swelling •  Loss of knee Ylexion ROM •  Poor quad contraction •  Pre-­‐patellar Bursitis •  Kneeling on a hard surface •  Blunt trauma •  Infections •  Swelling/thickening of bursa, possibly pain •  Pes Anserine Bursitis/
Tendonitis •  Sequelae to MCL injury •  Blow to medial knee •  Tight hamstrings •  ER position of tibia •  Pain to palpation over insertion •  Generalized Anterior knee pain •  Pain increased with activity and decreased with rest •  Aggravated by stairs, squatting, kneeling, and prolonged sitting •  Quad atrophy: “giving way” (caused by inhibition) •  Tracking Issues •  Malalignment •  Soft Tissue Imbalances Others •  Baker’s Cyst •  Swelling in popliteal fossa caused by herniation of synovial tissue through posterior capsule wall •  Anything that causes intracapsular swelling (OA) •  Pain with resisted knee Ylexion Patellofemoral ClassiYication •  Patellar Instabilities •  Congenital/
malalignment •  Traumatic •  Patellar instabilities •  ITB/Friction Syndrome •  Overuse injury caused by friction of ITB against lateral femoral condyle •  Tenderness over lateral femoral condyle or Gerdy’s tubercle •  Possibly decreased hip abductor strength •  + Ober’s Test and Noble’s Compression Test •  Common Peroneal Nerve Injury •  Results from traumatic injury or compression •  Sensory loss around the Yibular head, lateral aspect of leg, dorsum of foot, web space between 1st-­‐2nd toe •  Inability to DF and EV foot •  + Tinel’s Sign Patellofemoral Pain (PFP) •  Pain with squatting, kneeling, stairs, prolonged sitting •  General anterior knee pain with no speciYic localization •  An ache that can become sharp in nature •  Stiffness in knee after prolonged positioning •  No structural alignment •  Gait is normal, no usual swelling, muscle mass may be slightly different •  No crepitus and negative apprehension •  No signiYicant tenderness •  Categories •  Decreased Ylexibility, decreased strength, altered neuromuscular control, patellar arthritis/
chondral lesion, patellar fracture 2 7/29/13 Conservative Treatment •  ACL/PCL Conservative •  Acute •  Knee PROM/AAROM •  Quad Sets/ SLR •  Patella Mobilization •  Subacute •  Stationary bike •  AROM exercises/
stretching •  ACL: Quad strengthening 90-­‐40 deg range; PCL: quad 0-­‐40 range •  Return to Function •  MCL Conservative •  Acute •  Minimal valgus force •  Gradually work toward full knee extension •  Brace locked in ~30 deg Ylexion •  Subacute/Return to Fxn •  Tx impairments •  Gradually add exercises that apply valgus force to knee Surgery •  ACL/PCL •  Acute (0-­‐4 wks) •  RICE •  Knee PROM/AROM/
•  Return to Function (8-­‐12 wks) •  Full knee ROM, no pain with ADL, knee effusion < 1+, quad index= 60-­‐80% AAROM •  Increase quad contraction (NMES, quad sets/SLR, pateallar mobility) •  Return to Sport (4-­‐6 mo to •  Subacute (4-­‐8/12 weeks) •  Knee Ylexion at 90 deg •  Aggressive scar mobs •  Stationary bike satisfactory graft stability, succesfully completed fxn progression, quad index=80-­‐90% 1 yr) •  Full knee ROM, Conservative Treatment •  LCL Treatment •  Acute •  Follow non-­‐operative ACL rehab •  Minimize varus force •  Subacute/Return to Fxn •  Tx impairments •  Gradually add exercises that apply varus force •  Correct varus gait Articular Cartilage •  Non-­‐Operative: •  ROM/Ylexibility, quad strengthening, orthotics, unloading brace, NSAIDs. •  Surgical •  Chrondroplasty: remove loose cartilage Ylaps •  Osteoarthritis •  Non-­‐Op: aerobic, joint ROM/Ylexibility, perturbation training •  Operative •  Total knee arthroplasty •  Cemented: Full WB •  Uncemented: Partial WB or toe touch WB •  Post Surgery •  Acute: CPM, ROM, quad sets •  Subacute: stationary bike •  Return to Fxn: pt preference 3