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Knee
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Terminology Tibial Tuberosity: Boney protrusion where the patellar tendon inserts. Femoral Condyles: Distal end of the femur. Intercondyler Notch: An indentation in the distal femur where the anterior cruciate descends. Quadriceps Femoris Muscle group: attach to the patella through the quadriceps tendon.
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Terminology Pes Anserine:“foot of a bird”, the insertion of the semitendinosis, sartorius, and gracilis to the anteromedial tibia Unhappy Triad (Terrible Triad): Tearing of the anterior cruciate ligament, medial collateral ligament and the medial meniscus. Varus Stress: Stress applied to the medial aspect of the knee. Valgus Stress: Stress applied to the lateral aspect of the knee.
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Terminology Direct trauma: A blow or fall on the knee.
Indirect trauma: violent contracture of the quadriceps Distal pulses: pulses in the foot. The dorsalis pedis and the posterior tibial pulse. Chondromalacia: A degenerative condition in which there is a wearing away of the cartilage on posterior patella. Subchondral: Below the cartilage.
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Bones Of The Knee Femur Tibia Fibula Patella Femur Patella Fibula
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Condyles of the Knee Lateral Condyle Medial Condyle
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Patellar Tendon Tuberosity
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Cartilage known as Menisci
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Cruciate ligaments form an “X”
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Primary and Secondary Motions of The Knee
1. Primary Motions Flexion Extension 2. Secondary Motions Internal Rotation External Rotation Gliding Motion (a little)
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Quadriceps Strongest muscle group in the body Vastus Medialis
Vastus Intermedius Vastus Lateralis Rectus Femoris Responsible for knee extension
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Hamstrings Biceps Femoris (long and short head) Semimembranosus
Semitendinosus Responsible for knee flexion
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Bursa Fluid sac acting as a cushion and lubricant in areas of friction
Suprapatellar - under patella (running) Perpatellar - on top of patella (direct blow) Anserine - below knee (running)
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Medial Collateral Ligament Sprain
MOI: occurs most often in violently adducted and internally rotated knees. Path: a tear or sprain in the MCL S/S: swelling, pain, loss of stability, popping noise, (+) valgus stress test on MCL (may vary depending on degree of injury) Tx: RICE, rehab-light weights, straight leg raises, whirl pool (if available), crutches for discomfort and degree of injury, MCL taping
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Lateral Collateral Ligament Sprain
MOI: blow to inside of the knee (varus force) Path: partial to complete tear of ligament S/S: pain on lateral side of knee, swelling, positive varus stress test Tx: RICE, crutches and referral to physician
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Anterior Cruciate Ligament Sprain (ACL)
MOI: twisting of the knee, hyperextension of the knee, forward movement of the tibia on the femur Path: Stretching or tearing of the ACL; secondary injuries: medial meniscus tear and medial collateral ligament sprain Terrible Triad: ACL pathology WITH secondary injuries S/S: A pop followed by immediate disability, pain, rapid swelling at the joint, feels like knee is coming apart Tx: RICE, crutches, refer to doctor.
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Meniscus Tear MOI: sudden twisting and compression
Path: tear of the meniscus S/S: locking, swelling, pain, giving way Tx: RICE, crutches, refer to doctor.
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Patellar Subluxation or Dislocation
MOI: athlete plants their foot and changes direction. Path: the quadriceps muscles attempt to pull in a straight line and in a result pulls the patella laterally.
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Patellar Subluxation or Dislocation Cont.
S&S: Complete loss of knee function; pain and swelling Tx: immobilize in the position it is in, place ice around the joint, see physician, use crutches.
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Patellar Fractures MOI: caused by direct or indirect trauma. Forcible muscle contraction, falling, jumping, and running can also cause a fracture. Path: a severe pull of the patellar tendon against the femur when knee is semi flexed resulting in a fracture S/S: causes hemorrhage and joint effusion, resulting in generalized swelling. An indirect fracture causes capsular tearing, separation of bone. Tearing of the quadriceps tendon is also a sign. Direct fracture involves bone separation.
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Patellar Fracture Cont.
Tx: a cold wrap should be applied, followed by elastic compression wrap, splinting, crutches and Doctor referral.
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Knee Dislocation The most Serious knee injury is the dislocation of the tibiofemoral joint. THIS IS AN EMERGENCY!
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Knee Dislocation Cont. MOI: Direct blow to the anterior proximal tibia, forceful twisting, lateral blow to the knee. S/S: Grossly displaced tibia, sever pain, swelling, and may have absence of distal pulses. Tx: Calm athlete down, splint, and immediate transport to the hospital. Check distal pulses.
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