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Lab 5: Lower Extremities - Part 2

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1 Lab 5: Lower Extremities - Part 2
Matthew Verboom Kathryn Pearson Corrin Porter Jimmy Warner Jesse Bradley Tara Ruberto

2 Medial Tibial Plateau Superior medial portion of the tibia
Start with both thumbs placed on either side of the infrapatellar tendon and inferior to the patella Push medial thumb inferiorly into the soft tissue depression The upper, non articulating edge of the plateau can be palpated posteriorly to the junction of the tibial plateau and the femoral condyle The tibial plateau is a point of attachment for the medial meniscus

3 Medial Meniscus Medial Meniscus is attached to the upper edge of the medial tibial plateau by small coronary ligaments Hard to palpate, and is somewhat mobile When the tibia is internally rotated, its medial edge becomes more prominent and palpable Find the medial tibial plateau and slide thumb anteriorly into soft joint space, this is where the anterior portion is located When torn, the area of the meniscus joint line becomes tender to palpation Tears are more common in the medial meniscus than the lateral meniscus

4 Medial Collateral Ligament
Broad, fan-shaped ligament Joins medal femoral epicondyle and the tibia Has a deep and superficial portion Deep – inserts into the edge of the tibial plateau and meniscus Superficial – inserts more distally, onto the flare of the tibia (medial tibial plateau) The ligament itself is not palpable

5 Medial Collateral Ligament Cont…
To palpate the anatomical region: relocate the medial joint line As you move medially and posteriorly along the joint line, the ligament lies directly underneath Medial Collateral Ligament is part of the joint capsule, and is frequently torn in valgus stress injuries


7 Medial Femoral Condyle
Start with thumb still placed on medial tibial plateau and move thumb anteriorly Also is palpable immediately medial to the patella More of the femoral condyle is accessible to palpation if the knee is flexed more than 90 degrees Has a sharp medial edge

8 Lateral Tibial Plateau
Push down with thumb into soft tissue depression. Palpate along sharp edge to the junction of tibia and femur.

9 Lateral Meniscus - Best palpated with knee in slight flexion and is secured to the edge of the tibial plateau. - To feel probe firmly into lateral joint space.

10 Lateral Collateral Ligament
To palpate have legs crossed, ankle resting on opposite knee. Knee at 90 degrees makes the ligament easier to isolate because the iliotibial tract is relaxed.

11 Lateral Femoral Condyle
- From soft tissue depression, move and laterally to condyle. - It is palpable as far as the junction of the tibia and femur

12 Infrapatellar Tendon Tendon runs from the inferior border of the patella, and is palpable to its insertion into the tibial tubercle Often tender in young individual’s (Osgood-Schlatter’s)

13 Tibial Tubercle Follow the infrapatellar tendon distally to where it inserts into the tibial tubercle on the tibia Area of the Pes Anserine insertion

14 Head of Fibula From the lateral femoral epicondyle, move your thumb inferiorly and posteriorly across the joint line. Situated at about the same level as the tibial tubercle.

15 Lateral Collateral Ligament
To palpate have legs crossed, ankle resting on opposite knee Knee at 90 degrees makes the ligament easier to isolate because iliotibial tract is relaxed

16 Pre Superficial and Deep Bursa of the Patella
Superficial infrapatellar bursa: Can become inflamed due to excessive kneeling Lies in front of the infrapatellar tendon Prepatellar bursa: Can become inflamed due to combination of excessive kneeling and leaning forward Overlies the anterior portion of patella

17 Biceps Femoris Tendon rarely torn but can be avulsed from fibula due to severe trauma of the knee Prominent with flexed knee

18 Semitendinosus Under strain in gait due to the valgus angle between femur and tibia Stabilize patient’s leg by holding it with your legs Cup fingers around knee and feel tautness of the tendons Most posterior in group of tendons

19 Iliotibial Tract Anterior and lateral to knee Thick band of fascia
Easier to palpate with knee extended and leg raised or when, against resistance, knee is flexed Palpate anterior border lateral to superior pole of patella

20 Demonstration of Valgus/Varus Knee Conditions P.172
Valgus knees result when there is a stress placed on the knee in a lateral direction at the knee joint. Valgus knees are often the result of weakness in the medial collateral ligament. Varus knees occur opposite to valgus where the stress placed on the knee causes movement of the lower leg in a medial direction at the knee joint. Varus knees are often the result of weakness in the lateral collateral ligament.

21 Measure for Atrophy of the Quadriceps Muscles P. 179
The vastus medialis and lateralis form visible masses on the medial and lateral sides of the knee, respectively and become more prominent upon isometric contraction. The remaining muscles are evaluated as a unit while comparing the musculature in both legs. Palpate both sides simulataneously noting any defects or ruptures. Note any signs of atrophy, especially in the vastus medialis which atrophies quickly following knee surgery. Evaluate the atrophy of the quadriceps as a whole unit by using the edge of the tibial plateau as a reference point too measure the circumference of each thigh about three inches above the reference point. Any difference in girth is significant. The thigh would normally be evaluated in a clinical setting by evaluating all 4 aspects of the thigh: anterior, posterior, lateral and medial compartments.

22 Valgus and Varus Knee Tests
Abduction Valgus Stress Test: Patient lies supine with leg extended Examiner places heel of one hand on the lateral joint line of knee while the other hand stabilizes the distal leg A lateral force is applied to the joint line while lower leg is held in slight lateral rotation If positive (tibia abducts) damage may have occurred to the medial joint capsule The tibial collateral ligament is isolated by flexing the knee at 30 degrees and the test is repeated with the leg in full extension.

23 Valgus and Varus Knee Tests
Adduction Varus Knee Test Patient lies supine with leg extended Examiner stabilizes lower leg on the lateral aspect while using the heel of the other hand over the medial joint line of the knee A varus stress (adduction) is applied at the knee joint while moving the lower leg medially The test is first performed with the patient’s leg flexed to 30 degrees which will indicate specifically lateral collateral ligament damage. The test is then performed with an extended leg and may indicate damage to lateral collateral ligament, popliteus, and the posterolateral capsule.

24 Anterior Drawer Test for the Knee
Patient lies supine with the hip flexed at 45 degrees and the knee at 90 degrees. The examiner stabilizes the patient’s foot by placing their thigh over top of it thereby preventing tibial rotation. The examiner places both thumbs on either side of the patellar tendon palpating the anteromedial and anterolateral joint line to determine tibial translation as the tibia is drawn forward on the femur. The fingers of the drawing hand are placed behind the popliteal fossa to ensure the hamstrings are lax. The test is performed with the foot in neutral position, external rotation and internal rotation. Stability can be palpated with the thumbs on the joint line or visually from a lateral view. It should be noted that the Anterior Drawer Test is not as effective as the Lachman’s Test for anterior translation of the tibia on the femur.

25 Lachman’s Anterior Drawer Test
A modification of the drawer test It isolates the posterolateral bundle of the ACL Patient lies supine with the knee joint at degrees flexion The examiner stabilizes the top of the femur with one hand, while placing the other hand over the proximal tibia to displace the tibia anteriorly under the femur. A positive sign results in a mushy or soft end feel when the tibia moves anteriorly in relation to the femur When the tibia is in slight internal rotation, anterior displacement indicates damage to the iliotibial band, anterior and middle lateral capsule. When the tibia is in slight external rotation, anterior displacement indicates damage to the ACL, MCL, and medial meniscus.

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