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