Download Chapter 6

Chapter 6
The Knee continued
Clinical Evaluation of Knee and Leg
Injuries
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Evaluation Map
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Page 196
Patient preparedness
Compressive forces, shear forces, and/or
rotary forces
History
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Location of pain
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Mechanism of injury
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Table 6-2, page 197
Table 6-3, page 198
Weight-bearing status
Associated sounds or sensations
Onset of injury
Past history of injury
Inspection
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Girth Measurements
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Determination of amount of swelling in and
around joint and atrophy of muscles
Must be consistent and done bilaterally
Figure 6-15, page 199
Inspection of Anterior Structures
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Alignment of patella
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More detail in chapter 7
Inspection
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Inspection of Anterior Structures cont.
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Patellar tendon
Quadriceps muscle group
Alignment of femur on the tibia
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genu valgum vs. genu varum
Figure 6-16, page 200
Tibial tuberosity
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Figure 6-17, page 199
Inspection
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Inspection of Medial Structures
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Medial aspect
Oblique fibers of vastus medialis
VMO is first to atrophy after injury
Inspection of Lateral Structures
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Lateral aspect
Fibular head
Posterior sag of tibia
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Figure 6-18, page 201
Inspection
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Inspection of Lateral Structures cont.
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Hyperextension
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Genu recurvatum (figure 6-16, page 200)
Inspection of Posterior Structures
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Hamstring muscle group
Popliteal fossa
Palpation
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Refer to list of clinical proficiencies
Utilize pages 201 - 204
Determination of Intracapsular versus
Extracapsular Swelling
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Swelling within vs. swelling outside capsule
Joint effusion
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Sweep Test
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Ballotable patella
Causes of Intracapsular swelling
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Box 6-1, page 205
Acute vs. chronic
Causes of extracapsular swelling
Range of Motion Testing
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Goniometry (Box 6-2, page 206)
Active Range of Motion
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Flexion and extension
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Arc of 135 – 145 degrees (Figure 6-19, page 206)
Full extension: 0o – (-10o)
Knee flexion – affected by quad group and hip joint
Internal and External Rotation
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Occurs during flexion/extension
Observe/compare tibial tuberosity
Range of Motion Testing
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Passive Range of Motion
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Extension
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Measured with tibia slightly elevated
Firm end-feel (posterior capsule, cruciate ligaments
stretch)
Effected by hamstring tightness
Flexion
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Measuring in supine vs. prone position
Soft end-feel (gastrocnemius/heel contact)
Range of Motion Testing
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Resisted Range of Motion
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Box 6-3, page 208
Resisted knee flexion - observe for excessive
internal/external rotation of tibia
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Excessive internal rotation = biceps femoris weakness
Excessive external rotation = semimembranosus and/or
semitendinosus pathology
Tests for Joint Stability
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Tests for Anterior Cruciate Ligament
Instability
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ACL provides 86% of restraint against tibia
translating anteriorly on femur
Anterior Drawer Test
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Box 6-4, page 209
Figure 6-20, page 207
Lachman’s Test
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Box 6-5, page 210
Tests for Anterior Cruciate Ligament
Instability
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Arthrometers
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Positives vs. negatives of use
Figure 6-21, page 211
Tests may be affected by PCL insufficiency
Alternate Lachman’s test
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Box 6-6, page 211
Tests for Posterior Cruciate Ligament
Instability
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Posterior displacement of tibia on femur
Posterior sag (Figure 6-18, page 201)
Posterior Drawer Test
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Godfrey’s Test
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Box 6-7, page 213
Box 6-8, page 214
Grading Scale for PCL sprains
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Page 211
Tests for Medial Collateral Ligament
Instability
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Full extension – MCL, posterior oblique
ligament, posteromedial capsule, cruciate
ligaments, muscles limit valgus stress
25o of flexion – MCL is primary resister
Valgus Stress Test
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Box 6-9, page 215
Varus Stress Test
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Box 6-10, page 216
Tests for Stability of the Proximal
Tibiofibular Syndesmosis
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Box 6-11, page 217
Instability may be caused by “glancing” blow
Attachment of LCL and biceps femoris to
fibular head
Neurologic Testing
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Neurologic examination necessary when:
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Referred pain to knee
Proximal tibiofibular joint laxity
Dislocation
Swelling within popliteal fossa or lateral joint line
Lower quarter screening – Chapter 1