1 / 18

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 Table 6-2, page 197 Mechanism of injury Table 6-3, page 198 Weight-bearing status

tea
Download Presentation

Chapter 6

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 6 The Knee continued

  2. Clinical Evaluation of Knee and Leg Injuries • Evaluation Map • Page 196 • Patient preparedness • Compressive forces, shear forces, and/or rotary forces

  3. History • Location of pain • Table 6-2, page 197 • Mechanism of injury • Table 6-3, page 198 • Weight-bearing status • Associated sounds or sensations • Onset of injury • Past history of injury

  4. 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

  5. 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

  6. 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

  7. Inspection • Inspection of Lateral Structures cont. • Hyperextension • Genu recurvatum (figure 6-16, page 200) • Inspection of Posterior Structures • Hamstring muscle group • Popliteal fossa

  8. Palpation • Refer to list of clinical proficiencies • Utilize pages 201 - 204

  9. Determination of Intracapsular versus Extracapsular Swelling • Swelling within vs. swelling outside capsule • Joint effusion • Sweep Test • Box 6-1, page 205 • Ballotable patella • Causes of Intracapsular swelling • Acute vs. chronic • Causes of extracapsular swelling

  10. 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

  11. 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)

  12. 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

  13. 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

  14. 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

  15. Tests for Posterior Cruciate Ligament Instability • Posterior displacement of tibia on femur • Posterior sag (Figure 6-18, page 201) • Posterior Drawer Test • Box 6-7, page 213 • Godfrey’s Test • Box 6-8, page 214 • Grading Scale for PCL sprains • Page 211

  16. 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

  17. 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

  18. 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

More Related