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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

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Chapter 6

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  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

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