Knee Joint Assessment and General View Done by; Mshari S. Alghadier BSc Physical Therapy RHPT 366 m.alghadier@sau.edu.sa 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). 2
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). 3
Tibial plateau 4
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. 5
Meniscus 6
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. 7
Torn MCL 8
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. 9
Torn ACL 10
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 ). 11
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. 12
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? 13
Observation 14
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. 15
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. 16
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. 17
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. 18
Gentle palpation A. Anterior Aspect; Bony Structures: Patella. Tibial Tuberosity. Soft-Tissue Structures: Quadriceps Muscle. Patellar (Infrapatellar) Ligament (Tendon). Bursae. 19
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. 20
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. 21
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. 22
Special Test Flexibility Tests; Bring the heel toward the buttocks. 23
Special Test Tests for Stability and Structural Integrity; Anterior Stability Tests: Anterior drawer test. Lachman Test. 24
Special Test Anterior Medial and Lateral Instability Tests: Slocum Test. Pivot Shift Test (MacIntosh). 25
Special Test Posterior Stability Tests: Reverse Lachman Test. Hughston (Jerk) Test. Posterior Medial and Lateral Stability: Hughston Posteromedial and Posterolateral Drawer Test. 26
Special Test Posterior Stability Tests: Reverse Lachman Test. Hughston (Jerk) Test. Posterior Medial and Lateral Stability: Hughston Posteromedial and Posterolateral Drawer Test. 27
Special Test Tests for Meniscal Damage: McMurray s Test. Bounce Home Test. Apley (Grinding, Distraction) Test. 28
Knee joint, RHPT 366, M.G Knee Tests 29
Special Test Patellofemoral Joint Tests: Apprehension (Fairbanks) Test. Clarke s Sign (Patella Grind Test). Patellofemoral Arthritis (Waldron) Test. Test for Plica. 30
Special Test Clarke s Sign (Patella Grind Test). 31
Special Test Tests for Joint Effusion: Wipe Test. Ballotable Patella. 32
Thank you 33
References, Musculoskeletal Examination, 3rd Edition Jeffrey M. Gross, chapter 12. 34