knee joint - psau...is genu recurvatum present? ! observe the alignment of the feet with and without...

Knee Joint Assessment and General View Done by;

Mshari S. Alghadier

BSc Physical Therapy

RHPT 366

[email protected] http://faculty.sau.edu.sa/m.alghadier/

Functional anatomy

¤ The knee is the largest synovial joint of the body.

¤ One of the most complex joint.

¤ The knee is composed of; ¤  Three bones (femur, tibia, and patella). ¤ Two articulations “Joints” (tibiofemoral

and patellofemoral).

1/28/13 Knee joint, RHPT 366, M.G

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Functional anatomy

¤ Has the ability to flex and bend the lower extremity, which implement on the functionality of the body.

¤  The tibiofemoral joint is formed by two large, femoral condyles resting on a flat tibial plateau.

¤  It is unstable.

¤  The tibiofemoral articulation can potentially move without limit in four directions: ¤  Flexion– extension, varus–valgus, external–internal

rotation, and anterior–posterior translation (or glide).


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Tibial plateau


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Functional anatomy

¤  This excessive movements can be limited by muscles or ligaments.

¤  Menisci, increase stability of the knee joint by increasing the articular congruity the tibial plateau presents to the femoral condyles.


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Meniscus


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Functional anatomy

¤  The patellofemoral articulation gives stability as well, because of the the concave femoral trochlea and convex patellar articular surface.

¤  There are two pairs of major ligaments: ¤  Medial and lateral collateral ligaments.

¤  Anterior and posterior cruciate ligaments.

¤  The medial collateral ligament and lateral collateral ligament prevent excessive valgus or varus displacement of the tibia relative to the femur.


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Torn MCL


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Ligaments

¤  The anterior cruciate ligament and posterior cruciate ligament lie intra-articularly.

¤  The posterior cruciate ligament is about 50% larger in diameter than the anterior cruciate ligament.

¤  PCL, prevents posterior displacement of the tibia on the femur.

¤  ACL, prevents anterior displacement of the tibia on the femur also prevents excessive internal rotational movement of the tibia on the femur.


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Torn ACL


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Functional anatomy

¤  If the anterior cruciate ligament is compromised by injury, it is theoretically possible to reduce the effects of its absence by increasing hamstring function and avoiding knee extension.

¤  Chondromalacia is due to an irritation of the undersurface of the kneecap.

¤  Chondromalacia patellae (chondro means “cartilage,” malacia means “softening”).


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Observation

¤  The examination should begin in the waiting room before the patient is aware of the examiner’s observation.

¤  Information regarding the degree of the patient’s disability, level of functioning, posture, and gait can be observed.


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Observation

¤  Note whether the patient is able to sit with the knees flexed to 90 degrees or whether the involved knee is extended.

¤  Pay attention to the alignment of the knee from both the anterior and lateral views. Does the patient appear to have an excessive degree of genu valgum or varum?


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Observation


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Q angle

¤  Genu valgum creates an increase in the Q angle, is also a cause of patellofemoral malalignment syndromes.

¤  Increased Q angles can create a predisposition to patella subluxation.

¤  The patient will also have increased stress placed on the medial collateral ligament.


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Observation

¤  Is genu recurvatum present?

¤  Observe the alignment of the feet with and without shoes.

¤  Observe the swing and stance phases of gait, noticing the ability to move quickly and smoothly from flexion to extension.

¤  Note any gait deviations and whether the patient is using or requires an assistive device.


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Subjective Examination

¤  More mobile joint than the hip.

¤  In normal conditions its stable, nut the trauma and degenerative changes are the most.

¤  Mechanism of injury.

¤  Trauma.

¤  Any clicking, buckling, or locking?

¤  Ascend and descend the stairs without difficulty.


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Gentle palpation

¤  It is easiest to begin the palpatory examination with the patient in the supine position since asymmetry is easier to observe with the knee in the extended position.

¤  Note any areas of ecchymosis, bruising, muscle girth asymmetry, bony incongruities, incisional areas, or open wounds.


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Gentle palpation

A. Anterior Aspect; ¤ Bony Structures:

¤ Patella. ¤ Tibial Tuberosity.

¤ Soft-Tissue Structures: ¤ Quadriceps Muscle. ¤ Patellar (Infrapatellar) Ligament

(Tendon). ¤ Bursae.


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Gentle palpation

¤ Medial Aspect; ¤ Bony Structures:

¤  Medial Femoral Condyle. ¤  Adductor Tubercle. ¤  Medial Tibial Plateau.

¤ Soft-Tissue Structures: ¤  Medial Meniscus. ¤  Medial Collateral Ligament. ¤  Sartorius, Gracilis, and Semitendinosus Muscles (Pes

Anserinus). ¤  Anserine Bursa.


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Gentle palpation

¤ Lateral Aspect; ¤ Bony Structures:

¤ Lateral Femoral Condyle. ¤ Lateral Femoral Epicondyle. ¤ Lateral Tibial Plateau ¤ Lateral Tubercle (Gerdy’s Tubercle) ¤ Fibular Head. ¤ Iliotibial Tract. ¤ Common Peroneal Nerve.


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Gentle palpation

¤ Posterior Aspect; ¤ Bony Structure:

¤  There are no bony structures that are best palpate on the posterior aspect.

¤ Soft-Tissue Structures: ¤  Biceps Femoris. ¤  Gastrocnemius. ¤  Popliteal Fossa. ¤  Popliteal Vein, Artery, and Nerve. ¤  Semimembranosus Muscle. ¤  Gastrocnemius–Semimembranosus Bursa.


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Special Test

¤ Flexibility Tests; ¤ Bring the heel toward the buttocks.


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Special Test

¤  Tests for Stability and Structural Integrity;

¤  Anterior Stability Tests: ¤  Anterior drawer test.

¤  Lachman Test.


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Special Test

¤  Anterior Medial and Lateral Instability Tests: ¤  Slocum Test.

¤  Pivot Shift Test (MacIntosh).


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Special Test

¤ Posterior Stability Tests: ¤  “Reverse” Lachman Test. ¤  Hughston (Jerk) Test.

¤ Posterior Medial and Lateral Stability: ¤  Hughston Posteromedial and Posterolateral

Drawer Test.


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Special Test

¤ Posterior Stability Tests: ¤  “Reverse” Lachman

Test. ¤  Hughston (Jerk) Test.

¤ Posterior Medial and Lateral Stability: ¤  Hughston

Posteromedial and Posterolateral Drawer Test.


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Special Test

¤ Tests for Meniscal Damage: ¤  McMurray’s Test.

¤  Bounce Home Test.

¤  Apley (Grinding, Distraction) Test.


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Knee Tests


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Special Test

¤ Patellofemoral Joint Tests: ¤  Apprehension (Fairbanks) Test.

¤  Clarke’s Sign (Patella Grind Test).

¤  Patellofemoral Arthritis (Waldron) Test.

¤  Test for Plica.


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Special Test

¤  Clarke’s Sign (Patella Grind Test).


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Special Test

¤ Tests for Joint Effusion: ¤  Wipe Test.

¤  Ballotable Patella.


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Thank you


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References,

¤  Musculoskeletal Examination, 3rd Edition Jeffrey M. Gross, chapter 12.


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knee joint - psau...is genu recurvatum present? ! observe the alignment of the feet with and without...

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