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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Knee Conditions Chapter 18.

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Presentation on theme: "Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Knee Conditions Chapter 18."— Presentation transcript:

1 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Knee Conditions Chapter 18

2 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy

3 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy (cont.)

4 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy (cont.)

5 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Tibiofemoral Joint Condyles of femur with plateaus of tibia Hinge joint—flexion/extension Tibia does rotate laterally on femur during last few degrees of extension –“Screw-home mechanism” Produces a locking of the knee in final degrees during extension Close-packed position of full extension

6 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Meniscus Fibrocartilaginous discs attached to tibial plateaus –Medial and lateral Functions: –Stabilize joint by deepening the articulation –Shock absorption –Provide lubrication and nourishment –Improve weight distribution

7 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Joint Capsule and Bursae Articular capsule – encompasses both tibiofemoral and patellofemoral joints –Suprapatellar bursa –Subpopliteal bursa –Semimembranosus bursa Bursa outside capsule –Prepatellar bursa –Superficial infrapatellar bursa –Deep infrapatellar bursa

8 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligaments ACL –Prevents: Anterior translation of tibia on femur Rotation of tibia on femur Hyperextension –Discrete bands Knee full extension—posterolateral bundle is taut Knee full flexion—anteromedial bundle is taut

9 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligaments (cont.) PCL –Resists posterior displacement of tibia on femur –Knee full extension—posterior fibers are taut; knee full flexion—anterior fibers are taut

10 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligaments (cont.) MCL –Resist medially directed (valgus) forces –Complete extension—taut midrange—posterior fibers most taut complete flexion—anterior fibers most taut LCL –Resist laterally directed (varus) forces

11 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligaments (cont.) Arcuate-popliteal complex –Oblique popliteal ligament and arcuate popliteal ligament –Supports posterior joint capsule Limits anterior displacement of tibia on femur Limits hyperextension and hyperflexion

12 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Iliotibial Band Extends from tensor fascia latae to Gerdy’s tubercle on lateral tibial plateau Lateral knee stabilizer

13 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patellofemoral Joint Patella –Superior, middle, and inferior articular surfaces –Functions Protect femur Increase effective power of quadriceps

14 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Q-Angle Q-angle –Angle between line of resultant force produced by quadriceps and line of patellar tendon – Males 13°; females 18° – Q-angle— lateral patellofemoral contact  Q-angle— medial tibiofemoral contact A-angle –Measures relationship of patella to tibial tubercle –35° or greater linked to increased patellofemoral pain

15 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

16 Muscles Produce movement Stabilize the knee

17 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nerves Tibial nerve –Hamstrings except short head of biceps Common peroneal –Short head of biceps Femoral –Quadriceps

18 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Blood Supply Femoral artery Popliteal artery Genicular arteries

19 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Kinematics Knee flexion –Hamstrings –Assisted by: Popliteus Gastrocnemius Gracilis Sartorius

20 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Kinematics (cont.) Knee extension –Quadriceps femoris muscle group Rectus femoris Vastus lateralis Vastus intermedius Vastus medialis Vastus medialis oblique (VMO) –Screwing-home motion Rotation and passive abduction and adduction –Capability maximal at approximately 90° of knee flexion

21 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Kinematics (cont.) Knee motion during gait –Midstance – flexed 20°, internally rotated 5°, and slightly abducted –Swing phase – flexed 70°, externally rotated 15°, and 5° adduction Patellofemoral joint motion –With knee flexion and extension, patella glides in the trochlear groove –Tracking is dependent on the direction of the net force produced by the attached quadriceps

22 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Kinetics Forces at the tibiofemoral joint –Compression and shear during daily activities Extension—weight bearing and tension in muscles ↑ compression Flexion—as angle of joint ↑ to 90 → ↑ shear force produced by weight bearing shearing—tendency for the femur to displace anteriorly Forces at patellofemoral joint –Compression during normal walking (50% body weight); increases with stair climbing

23 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Prevention of Knee Injuries Physical conditioning –Strength –Flexibility Rule changes Footwear –Cleats vs. flat sole –Position of cleats and size

24 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contusions Knee –Mechanism: compression –S&S Localized tenderness Pain Swelling –Management: standard acute –Caution: excessive swelling could mask other injuries

25 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contusions (cont.) Infrapatellar fat pad –Entrapped between the femur and tibia –S&S Locking, catching, giving way Palpable pain on either side of patellar tendon Extreme pain on forced extension –Management: standard acute

26 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contusions (cont.) Peroneal nerve –Mechanism: blow to the posterolateral aspect of the knee

27 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contusions (cont.) –S&S Radiating pain down lateral aspect of leg and foot Severe cases  Initial pain—not immediately followed by tingling or numbness  As swelling ↑ within nerve sheath  Weakness in dorsiflexion or eversion  Loss of sensation in dorsum of foot, especially between 1st and 2nd toes  May progressively occur days or weeks later –Management: standard acute; severe S&S—immediate physician referral

28 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Bursitis Prepatellar –Mechanism Acute: direct blow to anterior patella Chronic: repetitive blows –S&S Swelling Pain with direct pressure Pain with passive knee flexion Localized swelling

29 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Bursitis (cont.) Pes anserine –Mechanism: Friction between tendon and MCL Direct trauma –S&S Pain with knee flexion

30 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Bursitis (cont.) Infrapatellar –Mechanism: Friction between patellar tendon and fat pad/tibia May be associated with patellar tendinitis –S&S Point tender with possible swelling posterior to patellar tendon  pain at end range of resisted knee extension and passive flexion Prolonged knee flexion may symptoms

31 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Bursitis (cont.) Baker’s cyst –Posterior aspect of knee—most often: semimembranosus – pain with full extension or flexion Bursitis management –Standard acute;  aggravating activities

32 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions AAOS classifies ligamentous knee injuries according to: –Functional disruption of a specific ligament –Amount of laxity –Direction of laxity Direction divides laxity into 4 straight and 4 rotatory laxities Knowing knee position at impact and direction the tibia displaces or rotates indicates the damaged structures

33 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.)

34 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.)

35 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.) Straight medial laxity (valgus laxity) –Involves MCL; posterior medial capsule—possibly PCL –Lateral forces cause tension on medial aspect of knee –1st degree Mild pain medial joint line Little or no joint effusion/mild swelling at site Full ROM with minor discomfort 30º—+

36 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.) –2nd degree 30º—+ (with positive end feel) Unable to fully extend the leg; often walk on the ball of foot –3rd degree 0—+ (with a soft or absent end feel)

37 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (Cont’d) Straight lateral laxity (varus laxity) –Involves LCL, lateral capsular ligaments, PCL –Medial forces produce tension on lateral aspect of knee Not usually isolated—presence of IT band, biceps femoris, popliteus

38 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.) –S&S Similar to MCL Swelling minimal—no attachment to capsule + 30º Instability may not be obvious if other stabilizers are intact

39 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Straight anterior laxity (anterior instability) –Anterior displacement of tibia on femur –Involves ACL—rarely isolated –Mechanism: cutting or turning maneuver, landing, or sudden deceleration Ligamentous Conditions (cont.)

40 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.) –S&S Pain  Minimal and transient to severe and lasting  Deep in knee difficult to pinpoint “Pop” Effusion within 3 hours; reports knee giving way— does not feel right

41 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.) Straight posterior laxity –Tibia displaced posteriorly –Involves PCL –Mechanism Hyperextension force Fall on flexed knee (initial contact at tibial tuberosity)

42 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.) –S&S Sense of stretching to posterior knee “Pop” Rapid joint effusion ↓ knee flexion due to effusion + reverse Lachman’s test; posterior sag

43 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.) Anteromedial instability –Anterior external rotation of medial tibia condyle on femur –Involves MCL and oblique popliteal ligament, potentially ACL and medial meniscus –S&S ° + Slocum drawer test; + Lachman’s test ↑ anterior translation of the medial tibial plateau (w/ special tests)

44 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.) Anterolateral instability –Anterior internal subluxation of lateral tibial condyle on femur –Caused by a sudden deceleration and cutting maneuver –Involves ACL, IT band, lateral capsule –S&S ↑ anterior translation of the lateral tibial plateau (with special tests)

45 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.) Posteromedial instability –Medial tibial plateau shifts posteriorly on the femur and opens medially –Involves superficial MCL, ACL, PCL, posteromedial capsule, and oblique popliteal ligament –S&S: + posteromedial drawer test and posteromedial pivot shift test

46 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.) Posterolateral instability –Lateral tibial plateau rotates posteriorly –Due to hyperextension with varus –Involves PCL, arcuate–popliteal complex, posterolateral capsule, and LCL –S&S Soft end point with varus stress at 0° and 30° + posterolateral drawer and external rotation recurvatum tests

47 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Instabilities of the Knee

48 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligamentous Conditions (cont.) Management –Standard acute; NSAIDs –Physician referral—timing dependent on severity

49 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Knee Dislocation/Subluxation Minimum of 3 ligaments must be torn for knee to dislocate –Most often—ACL, PCL, and one collateral ligament Concern: damage to other structures; especially neurovascular S&S –Individual describes severe injury –“Pop” –Deformity (unless spontaneously reduced) Management: standard acute –Spontaneous reduction—physician referral –Not reduced—activate EMS

50 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Meniscal Conditions Classified according to location Involve compression, tension, shearing forces Longitudinal –Twisting motion when foot fixed and knee flexed Produces compression and torsion on posterior peripheral attachment –Bucket-handle tear Longitudinal segment displaced medially toward center of tibia

51 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Meniscal Conditions (cont.) Horizontal tear –Due largely to degeneration –Shearing from rotational forces Tears the inner surface of the meniscus –Parrot-beak tear 2 tears; commonly in middle segment of lateral meniscus

52 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

53 Meniscal Conditions (cont.) S&S –Initial symptoms may be vague or limited Limited sensory nerve supply—minimal pain Minimal disability Minimal swelling –Understand mechanism –Delayed swelling –Joint line pain –Classic: clicking/locking (not acutely) leads to knee buckling or giving way –+ McMurray; Apley’s compression; “bounce home” test

54 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Meniscal Conditions (cont.) Management –Standard acute; treat symptoms –Physician referral

55 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patellar Conditions Patellofemoral pain –Causes Mechanical (e.g., patellar subluxation or dislocation) Inflammatory (e.g., prepatellar bursitis, patellar tendinitis) Other causes (e.g., reflex sympathetic dystrophy, tumors) –Dynamic stabilizer— extensor mechanism

56 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

57 Patellar Conditions (cont.) Patellofemoral stress syndrome –Mechanism Poor patellar tracking due to weak VMO or tight lateral structures –S&S Dull, aching pain, ↑ with sitting, squatting, and descending stairs Point tenderness—lateral facet of the patella Pain with manual patella compression into trochlear groove

58 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patellar Conditions (cont.) –Management: Standard acute; NSAIDs Lower extremity assessment

59 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patellar Conditions (cont.) Chondromalacia –Degeneration in articular cartilage of patella –Due to abnormal excursion and compressive forces –S&S: Localized tenderness Anterior knee pain + Clarke’s test; + Waldron test –Management Standard acute Activity modification

60 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patellar Conditions (cont.) Patellar instability and dislocation –Displacement of patella due to internal or external forces –Mechanism: deceleration combined with a cutting motion –S&S subluxation Transient partial displacement; acute or intermittent with spontaneous reduction Feeling of patella slipping when cutting, twisting, or pivoting + apprehension test

61 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patellar Conditions (cont.) –S&S dislocation “Pop” Violent collapse of the knee Localized tenderness—medial extensor retinaculum Effusion –Management: standard acute; immediate physician referral

62 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

63 Patellar Conditions (cont.) Patella plica syndrome –Asymptomatic until trauma –S&S Gradual onset of anterior knee pain Pain with prolonged sitting; individual stands and begins to walk, sharp pain for 8–10 steps, then disappears Slight joint effusion Palpable pain and crepitus – medial and lateral retinacular regions + medial synovial plica and stutter tests –Management: treat symptoms; activity modification

64 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

65 Patellar Conditions (cont.) Patellar tendinitis –Due to repetitive or eccentric knee extension activities –S&S Initial—pain after activity on inferior pole of patella or distal attachment of patellar tendon Progression—pain at start of activity, subsides with warm-up, reappears after activity Pain ascending and descending stairs Pain with passive knee flexion beyond 120° and resisted knee extension –Management: standard acute; NSAIDs

66 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patellar Conditions (cont.) Osgood- Schlatter disease –Inflammation or partial avulsion of tibial apophysis due to traction forces –S&S Individual points to tibial tubercle as source of pain Tubercle appears enlarged Pain during activity and relieved with rest Pain at extreme knee extension and forced flexion –Management: treat symptoms; self-limiting

67 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patellar Conditions (cont.) Sinding-Larsen-Johansson disease –Inflammation or partial avulsion of apex of patella due to traction forces –S&S Gradual onset of pain Pain with palpation of inferior patellar pole with patient’s knee extended and patellar tendon relaxed –Management: treat symptoms; self-limiting

68 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

69 Patellar Conditions (cont.) Extensor tendon rupture –Due to powerful eccentric muscle contractions –S&S Partial rupture—pain and weakness in knee extension Total rupture distal to patella  High-riding patella  Palpable defect over the tendon  Inability to extend knee extension or perform a straight leg raise

70 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patellar Conditions (cont.) Total rupture from superior pole with extensor retinaculum still intact  Knee extension is possible, but weak and painful –Management: standard acute; knee immobilizer and crutches; immediate referral to a physician

71 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Iliotibial Band Friction Syndrome Band drops behind lateral femoral epicondyle with knee flexion, then snaps forward over epicondyle during extension

72 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Iliotibial Band Friction Syndrome (cont.) Due to excessive compression and friction Associated with overuse, abnormal biomechanics, and poor flexibility S&S –Pain with exercise progresses from not restrictive to restrictive even with ADLs –Extreme point tenderness 2–3 cm proximal to lateral joint line over epicondyle with leg flexed at 30° –+ Noble’s and Ober’s compression tests Management: standard acute; NSAIDs; preventative conditioning program

73 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractures and Associated Conditions Avulsion fracture –Due to direct trauma, excessive tensile forces, overuse –S&S: localized pain and tenderness over the bony site Epiphyseal and apophyseal fracture –Tibial tubercle fracture Mechanism  Forced flexion of knee against a straining quadriceps contraction  Violent quadriceps contraction against a fixed foot

74 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractures and Associated Conditions (cont.) S&S  Pain, ecchymosis, swelling, and tenderness  Difficulty going up and down stairs –Distal femoral epiphyseal fracture Mechanism: varus or valgus stress applied on a fixed, weight-bearing foot S&S: pain around knee; unable to bear weight

75 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractures and Associated Conditions (cont.) Stress fractures –Common areas Femoral supracondylar region Medial tibial plateau Tibia tubercle

76 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractures and Associated Conditions (cont.) –Occur when: Load on the bone is increased Number of stresses on the bone increases (e.g., changes in training intensity, duration, frequency) surface area of the bone receiving load decreases –S&S: localized pain before and after activity, relieved with rest and non–weight bearing

77 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractures and Associated Conditions (cont.) Chondral fracture (involves articular cartilage) Osteochondral fracture (involves articular cartilage and underlying bone) –Due to compression from direct blow to knee causing shearing or forceful rotation –S&S Painful “snap” Considerable pain and rapid swelling Displaced fracture: locking; crepitus

78 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractures and Associated Conditions (cont.) Osteochondritis dissecans –Bone fragment due to localized area of avascular necrosis –Due to: Direct and indirect trauma Skeletal abnormalities Prominent tibial spine Generalized ligamentous laxity –S&S Aching, diffuse pain, or swelling with activity As disease progresses, knee locking or giving way

79 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

80 Fractures and Associated Conditions (cont.) Fracture management –Standard acute –Immobilization –Immediate physician referral Stress fracture management –Physician referral –Rest

81 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment History Observation/inspection Palpation Physical examination tests

82 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patella Palpation Patellar glide –Hypomobile < 1 quadrant of displacement –Hypermobile 3+ quadrants (greater than one-half of patellar width)

83 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Palpation for Swelling Brush or stroke test (milking) Patellar tap test (“ballotable patella”)

84 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Range of Motion (ROM) AROM –Flexion (0–135°) –Extension (0–15°) –Medial rotation of tibia on femur (20–30°) with knee flexed at 90° –Lateral rotation of tibia on femur (30–40°) with knee flexed at 90° PROM –Normal end feel Flexion—tissue approximation Extension; medial and lateral rotation—tissue stretch

85 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ROM (cont.)

86 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ROM (cont.) RROM

87 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Tests Anterior drawer test Lachman’s test

88 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Tests (cont.) Modified Lachman’s

89 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Tests (cont.) Posterior sag (gravity) test Posterior drawer test Reverse Lachman’s test

90 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Tests (cont.) Valgus stress Varus stress

91 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Tests (cont.) Slocum drawer test –Anteromedial rotary instability –Anterolateral rotary instability

92 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Tests (cont.) Lateral pivot shift

93 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Tests (cont.) Jerk test

94 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Tests (cont.) Slocum ALRI test Cross-over test

95 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Tests (cont.) Flexion–rotation drawer Posteromedial drawer Posteromedial pivot shift Posterolateral drawer

96 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Tests (cont.) Reverse pivot shift

97 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stress Tests (cont.) External rotation recurvatum

98 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Tests Meniscal tests –McMurray’s test –Apley’s compression/ distraction test –“Bounce home” test

99 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Tests (cont.) Tibiofibular instability –Proximal tibiofibular syndesmosis test Plica tests –Mediopatellar plica test –Stutter test –Hughston’s plica test

100 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Tests (cont.) Tests for patellofemoral dysfunction –Patella compression or grind –Clarke’s sign –Waldron test –Patellar apprehension

101 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Tests (cont.) IT band syndrome tests –Noble compression test –Ober’s test

102 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Neurologic Tests Myotomes –Hip flexion—L1, L2 –Knee extension—L3 –Ankle dorsiflexion—L4 –Toe extension—L5 –Ankle plantarflexion, foot eversion, or hip extension—S1 –Knee flexion—S2

103 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Neurologic Tests (cont.) Reflexes –Patella—L3, L4 –Achilles tendon—S1

104 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Neurologic Tests (cont.) Dermatomes Peripheral nerve distribution

105 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Rehabilitation Restoration of proprioception and balance –Closed-chain exercises Muscular strength, endurance, and power –Open-chain exercises –PNF-resisted exercises Cardiovascular fitness

106 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Rehabilitation (cont.) Range of motion

107 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Rehabilitation (cont.) Patellar self-mobilization

108 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Rehabilitation (cont.) Closed-chain terminal extension


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