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: 0 o – (-10 o ) 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 25 o 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