Knee Injuries

1. Knee Injuries • History • Palpation • ROM - kinetic analysis • Tests • Muscle testing • Biomechanics • Ligaments • Conditions/Treatment • Home Exercises

2. History of Symptoms • Fall with joint compression • Overall weakness pattern • Tearing type injury • Injury to skin/ligaments/muscles/joint • Slow onset • Repetitive stress

3. History of Symptoms • Pain - constant or in a motion • Weakness - what motion • Numbness - nerve entrapment • Prior history • How it impacts their life

4. Palpation Heads of the hamstrings Junction of the sartorius and gracilis Popliteus Heads of the gastrocnemius ITB Sections of the vastus Lateral collateral ligament Supra and infra patella Patella mobility

5. Kinetic Analysis • Observe alignment of knee standing • Patient bends knee and observe stabilization • Pelvis, knee and ankle • Walking observe • Degree of femur motion • Degree of lower leg extension

6. Drawer test Lachman test Lat. Pivot shift Apprehension Clarke’s sign Dreyer’s sign Abduction stress Adduction stress Apley’s Bounce home McMurray sign Tests

7. Drawer Test • Patient supine with knee bent 90 degrees and thigh bent 45 degrees • Pull tibia forward • Normal = 6 mm • Positive = excess motion • Injured ant. Cruciate or posterior oblique ligament or popliteus

8. Lachman test • Patient supine with knee bent 30 degrees • Apply pressure to move the tibia forward while stabilizing the femur • Positive = soft or mushy end feel • Injured ant. cruciate or medial collateral ligament or posterolateral capsule or posteromedial capsule or posterior oblique ligament or popliteus

9. Lateral pivot shift • Patient supine with hip flexed and medially rotated 20 degrees • Hold foot and bend knee 5 degrees • Apply valgus stress and bend knee to 40 degrees • Positive - tibia shifts posterior • Injured ant. Cruciate or posterolateral capsule or popliteus or ITB

10. Apprehension test • Patient supine or sitting with quadriceps relaxed • Apply lateral pressure against the patella • If patella is about to dislocate, the quadriceps will contract and patient looks apprehensive.

11. Clarke’s Sign • Patient supine with knee extended • Grasp superior portion of patella and press inferior • Hold patella inferior as patient contracts quadriceps • Positive = pain • Chondromalacia patella

12. Dreyer’s sign • Patient cannot raise leg • Grasp above the patella with both hands and compress the quadriceps • Ask the patient to raise the leg • Ability to raise the leg indicates possible patella fracture

13. Abduction stress • Supine - knee extended - one hand under the lower tibia the other on the lateral aspect of the knee • Raise leg 30 degrees and apply pressure against lower leg laterally opening the medial side of the knee • Positive = medial pain - medial collateral ligament

14. Adduction stress • Supine - knee extended - one hand under the lower tibia the other on the medial aspect of the knee • Raise leg 30 degrees and apply pressure against lower leg medially opening the lateral side of the knee • Positive = lateral pain - lateral collateral ligament

15. Apley’s • Prone - knee bent 90 degrees • Strongly int. rotate tibia and bend knee 90 deg. • Strongly ext. rotate tibia and bend knee 90 deg. with downward pressure • Hold femur on table and distract tibia. Then rotate internal and external • Positive = pain - meniscus tear

16. Bounce home • Patient supine with knee bent • Hold heel of foot and let leg drop extending knee • Positive = incomplete extension or rubbery end feel

17. McMurray Sign • Patient supine - knee at 90 degrees • One hand on the knee the other the ankle • Internally rotate the lower leg and extend the knee with valgus pressure • Repeat with external rotation • Positive = pain, snap or click

18. Rectus Femoris Vastus intermedius Vastus lateralis Vastus medialis Adductors Hamstrings medial Hamstrings lateral Popliteus Gastrocnemius Gluteus maximus Gluteus medius Muscle Testing