Knee Injuries History Palpation ROM - kinetic analysis Tests Muscle testing Biomechanics Ligaments Conditions/Treatment Home Exercises

History of Symptoms Fall with joint compression Overall weakness pattern Tearing type injury Injury to skin/ligaments/muscles/joint Slow onset Repetitive stress

History of Symptoms Pain - constant or in a motion Weakness - what motion Numbness - nerve entrapment Prior history How it impacts their life

Palpation ITB Sections of the vastus Lateral collateral ligament Supra and infra patella Patella mobility Heads of the hamstrings Junction of the sartorius and gracilis Popliteus Heads of the gastrocnemius

Kinetic Analysis Observe alignment of knee standing Patient bends knee and observe stabilization Pelvis, knee and ankle Walking observe Degree of femur motion Degree of lower leg extension

Tests Drawer test Lachman test Lat. Pivot shift Apprehension Clarke’s sign Dreyer’s sign Abduction stress Adduction stress Apley’s Bounce home McMurray sign

Drawer Test Patient supine with knee bent 90 degrees and thigh bent 45 degrees Pull tibia forward Normal = 6 mm Positive = excess motion Injured ant. Cruciate or posterior oblique ligament or popliteus

Lachman test Patient supine with knee bent 30 degrees Apply pressure to move the tibia forward while stabilizing the femur Positive = soft or mushy end feel Injured ant. cruciate or medial collateral ligament or posterolateral capsule or posteromedial capsule or posterior oblique ligament or popliteus

Lateral pivot shift Patient supine with hip flexed and medially rotated 20 degrees Hold foot and bend knee 5 degrees Apply valgus stress and bend knee to 40 degrees Positive - tibia shifts posterior Injured ant. Cruciate or posterolateral capsule or popliteus or ITB

Apprehension test Patient supine or sitting with quadriceps relaxed Apply lateral pressure against the patella If patella is about to dislocate, the quadriceps will contract and patient looks apprehensive.

Clarke’s Sign Patient supine with knee extended Grasp superior portion of patella and press inferior Hold patella inferior as patient contracts quadriceps Positive = pain Chondromalacia patella

Dreyer’s sign Patient cannot raise leg Grasp above the patella with both hands and compress the quadriceps Ask the patient to raise the leg Ability to raise the leg indicates possible patella fracture

Abduction stress Supine - knee extended - one hand under the lower tibia the other on the lateral aspect of the knee Raise leg 30 degrees and apply pressure against lower leg laterally opening the medial side of the knee Positive = medial pain - medial collateral ligament

Adduction stress Supine - knee extended - one hand under the lower tibia the other on the medial aspect of the knee Raise leg 30 degrees and apply pressure against lower leg medially opening the lateral side of the knee Positive = lateral pain - lateral collateral ligament

Apley’s Prone - knee bent 90 degrees Strongly int. rotate tibia and bend knee 90 deg. Strongly ext. rotate tibia and bend knee 90 deg. with downward pressure Hold femur on table and distract tibia. Then rotate internal and external Positive = pain - meniscus tear

Bounce home Patient supine with knee bent Hold heel of foot and let leg drop extending knee Positive = incomplete extension or rubbery end feel

McMurray Sign Patient supine - knee at 90 degrees One hand on the knee the other the ankle Internally rotate the lower leg and extend the knee with valgus pressure Repeat with external rotation Positive = pain, snap or click

Muscle Testing Rectus Femoris Vastus intermedius Vastus lateralis Vastus medialis Adductors Hamstrings medial Hamstrings lateral Popliteus Gastrocnemius Gluteus maximus Gluteus medius