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Knee Complex the Knee Is Designed To

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Knee Complex the Knee Is Designed To KNEE VOCAB: USING YOUR BOOKS (CHP. 16 PG. 252) DEFINE THE FOLLOWING • Patella: largest sesamoid in the • Fat pads: cushion the front of body the knee • Menisci: • Genu valgum: • Avascular necrosis: death of • Genu varum: bone tissue due to lack of blood supply. • Hemarthrosis: blood in the • Anterior Cruciate Ligament: joint • Posterior Cruciate Ligament: • MRI: soft tissue diagnostic tool • Medial Collateral Ligament: • Translation: anterior gliding of • Lateral Collateral Ligament: the tibia KNEE STATIONS KEY 12.False 1. Lateral Collateral Ligament (LCL) 13.True 2. Tibia 14.True 3. Anterior Cruciate Ligament (ACL) 15.True 4. Rectus Femoris 16.Flexion, extension 5. Hip flexion, knee extension 17.Femur, tibia, fibula, patella 6. Vastus lateralis 18.MCL 7. Knee extension 19.Femur 8. Semimembranosus 20.Medial meniscus 9. Knee flexion, hip extension 21.Posterior cruciate ligament (PCL) 10.Biceps Femoris 11.Knee flexion, hip extension KNEE LABELING Femur Posterior View Tibia Posterior View Medial Lateral Condyle Condyle Fibula Posterior View Lateral Collateral Medial Ligament Collateral Ligament Posterior View Medial Lateral Meniscus Meniscus Posterior View Anterior Humphrey’s Cruciate Ligament Ligament Posterior Cruciate Ligament Medial Lateral Epicondyle Epicondyle Anterior View Posterior Cruciate Ligament Anterior Cruciate Ligament Tibial Tuberosity Gluteus Gluteus Medius Maximus Iliotibial Band Semimembranosus Biceps Femoris Semitendinosus Iliopsoas Pectineus Adductor Vastus Longus Lateralis Gracilis Vastus Intermedius Sartorius Vastus Medials Rectus Femoris Knee PRACTICE 1 1. 2. 4. 3. 5. Knee PRACTICE 1 KEY 1. Medial condyle 2. Medial 4. Lateral collateral meniscus ligament 3. Posterior cruciate 5. Fibula ligament Popliteus Flexor digitorum Tibialis longus posterior Gastrocnemius Plantaris Soleus Flexor hallucis longus Gastrocnemius Achilles Tendon Knee Palpations, practice w/video KNEE COMPLEX THE KNEE IS DESIGNED TO • PROVIDE STABILITY • PROVIDE MOBILITY KNEE FACTS • MOST COMPLEX JOINT IN THE BODY. • CONSIDERED A HINGE JOINT. • STABILITY DEPENDS ON THE LIGAMENTS, JOINT CAPSULE, MUSCLES. • PROVIDE STABILITY DURING WEIGHT BEARING. • UNSTABLE LATERALLY AND MEDIALLY. KNEE JOINT • SURROUNDED BY JOINT CAPSULE • LARGEST IN BODY • BURSAE: • 2 DOZEN AROUND THE KNEE • FAT PADS: • INFRAPATELLAR IS THE LARGEST. • CUSHIONS ANTERIORLY AND SEPARATES THE PATELLAR TENDON FROM THE JOINT CAPSULE NERVE AND BLOOD SUPPLY NERVE SUPPLY TIBIAL SEMITENDINOSUS, SEMIMEMBRANOSUS, GASTROCNEMIUS PERONEAL NERVE BICEPS FEMORIS FEMORAL NERVE QUADRICEPS BLOOD SUPPLY: POPLITEAL ARTERY STEMMING FROM THE FEMORAL ARTERY. LEG ALIGNMENT • DEVIATIONS MAY BE A FACTOR IN KNEE INJURY, ALWAYS DIFFER FROM PERSON TO PERSON • ARE THE PATELLAS LEVEL? • ARE THE PATELLAS FACING FORWARD? • CAN THE ATHLETE TOUCH THE MEDIAL FEMORAL CONDYLES AND MEDIAL MALLEOLI TOGETHER? • ARE THE KNEES FULLY EXTENDED? • ARE BOTH KNEES EQUALLY EXTENDED? LEG ALIGNMENT GENU VALGUM: KNOCK KNEES • PRONATED FEET • TENSION ON LIGAMENTOUS STRUCTURES OF MEDIAL PART OF KNEE • COMPRESSION OF LATERAL ASPECTS • ABNORMAL TIGHTNESS OF IT BAND GENU VARUM: BOW LEGS • TENSION ON LIGAMENTS ON THE LATERAL SURFACE OF THE KNEE/IT BAND • SUPINATED FOOT LEG ALIGNMENT: GENU RECURVATUM: HYPEREXTENDED KNEES • COMPENSATION FOR LORDOSIS • STRETCHING OF HAMSTRING MUSCLES • PRODUCE ANTERIOR PRESSURE ON KNEE, POSTERIOR LIGAMENTS AND POSTERIOR TENDONS Q ANGLE • CREATED WHEN LINES ARE DRAWN FROM THE MIDDLE OF THE PATELLA TO THE ASIS AND FROM TIBIAL TUBEROSITY THROUGH THE CENTER OF THE PATELLA • SHOULD BE MEASURED WITH THE KNEE FULLY EXTENDED, AND FLEXED AT 30 DEGREES • NORMAL ANGLE = 10 DEGREES FOR MALES, 15 FOR FEMALES • GREATER THAN 20 ARE CONSIDERED EXCESSIVE AND COULD LEAD TO KNEE PAIN AND INJURIES. KNEE LABELING QUIZ EVERYTHING MUST BE SPELLED OUT. INCLUDE DIRECTIONAL TERMS VERSION A VERSION A KEY MUST HAVE DIRECTIONAL TERMS. ALL OR NOTHING CREDIT. 1 PT EACH 1. FEMUR 12. LATERAL CONDYLE/EPICONDYLE 2. MEDIAL CONDYLE 13. LATERAL MENISCUS 3. MEDIAL MENISCUS 14. LATERAL COLLATERAL LIGAMENT 4. POSTERIOR CRUCIATE LIGAMENT 15. MEDIAL COLLATERAL LIGAMENT 5. MEDIAL COLLATERAL LIGAMENT 16. MEDIAL MENISCUS 6. TIBIA 17. ANTERIOR CRUCIATE LIGAMENT 7. LATERAL CONDYLE 18. POSTERIOR CRUCIATE LIGAMENT 8. ANTERIOR CRUCIATE LIGAMENT 19. MEDIAL CONDYLE/EPICONDYLE 9. LATERAL MENISCUS 10. LATERAL COLLATERAL LIGAMENT 11. FIBULA • FEMUR • LONGEST AND THE STRONGEST • PATELLA • SESAMOID = BONE WITHIN TENDON, SHOCK ABSORPTION • TIBIA • PRIMARY WEIGHT BEARING BONE IN LOWER BONES LEG • FIBULA • BEARS NO WEIGHT, ATTACHMENT SITE FOR MUSCLES • GIVES STABILITY TO ANKLE LIGAMENTS • MEDIAL COLLATERAL LIGAMENT (MCL) • PROTECTS FROM VALGUS ( MEDIAL) DISPLACEMENT • LATERAL COLLATERAL LIGAMENT (LCL) • PROTECTS FROM VARUS (LATERAL) DISPLACEMENT, TAUT DURING KNEE EXTENSION • ANTERIOR CRUCIATE LIGAMENT (ACL) • MOST FREQUENTLY RUPTURED, PROTECTS FROM ANTERIOR TIBIA MOTION • ORIGINATES ON ANTERIOR TIBIAL PLATEAU, AND ON POSTERIOR FEMUR, MADE OF 3 TWISTING BANDS • POSTERIOR CRUCIATE LIGAMENT (PCL) • PROTECTS FROM POSTERIOR DISPLACEMENT, STRONGER THAN ACL MCL SPRAIN MCL MOST COMMON INJURED LIGAMENT IN KNEE MOI: VALGUS STRESS LATERAL BLOW W/ FOOT FIXATION, SEVERE TWIST. S/S: SWELLING, LIMITED ROM, PN., LOF, INSTABILITY TX: PRICE, STRENGTHENING/ROM EXERCISES, FUNCTIONAL ACTIVITIES. MCL GRADE 1 SPRAIN MOI: VALGUS FORCE GRADE 1: - MILD LIGAMENT FIBERS TORN OR STRETCHED S/S: JOINT IS STABLE, MILD OR NO SWELLING, MILD PN., STIFFNESS, JOINT TENDERNESS TX: PRICE, STRENGTHENING MCL GRADE 2 SPRAIN MOI: VALGUS FORCE • GRADE 2: • TEARING OF THE CAPSULE, PARTIAL TEAR OF MCL • S/S: MODERATE INSTABILITY (MORE DURING FLEXION) SWELLING, JOINT STIFFNESS, AROM (FLEXION AND EXTENSION) & PROM = PN AND LOF • TX: PRICE, CRUTCHES, STRENGTHENING, POSSIBLE BRACE MCL GRADE 3 SPRAIN MOI: VALGUS FORCE • GRADE 3: • COMPLETE TEAR OF MCL AND SUPPORTING LIGAMENTS • S/S: +VALGUS TEST, COMPLETE LOSS OF MEDIAL STABILITY, SEVERE PN, HEAR A “POP” SEVERE SWELLING, LOF, • CHECK ACL, PCL AND MENISCUS • TX: PRICE, CRUTCHES, MCL BRACE, ROM AND STRENGTHENING, USUALLY NON- OPERATIVE MCL SPRAIN SPECIAL TESTS: VALGUS STRESS TEST Procedure: Place one hand on the lateral aspect of knee and the other on the medial aspect of the ankle Apply a valgus force to the knee at 0 and 30 degrees Positive Test: pn and laxity at the MCL LCL SPRAIN • MOI: VARUS STRESS • MEDIAL BLOW • S/S: PAIN, INFLAMMATION, INSTABILITY, LOSS OF FUNCTION AND ROM • TX: PRICE, STRENGTHENING AND ROM EXERCISES, FUNCTIONAL ACTIVITIES. LCL SPRAIN SPECIAL TEST: VARUS STRESS TEST Procedure: Place one hand on the medial aspect of the knee and the other on the lateral ankle Apply a varus force to the knee at 0 and 30 degrees Positive Test: pn and laxity at the LCL KNEE PRACTICE 2 1. WHAT TYPE OF JOINT IS THE KNEE? • HINGE 2. WHAT IS THE MAIN BURSA IN THE KNEE? • INFRAPATELLAR 3. THE PERONEAL NERVE WORKS WHAT ONE MUSCLE? • BICEPS FEMORIS 4. THIS MALALIGNMENT OF THE KNEES COULD BE FROM PRONATED FEET AND PUTS COMPRESSION ON THE MEDIAL ASPECT AND TENSION ON THE LATERAL ASPECT? • GENU VALGUM 5. WHAT IS THE FORCE CALLED THAT CAUSES AN MCL SPRAIN? • VALGUS ACL SPRAIN • MOI: TORSION (FOOT FIXATION W/TWISTING), OR A BLOW. (EX: ATHLETE RUNNING THEN TURNS SUDDENLY.) • HIGHEST INCIDENCE OF TEAR = FEMALE SOCCER PLAYERS, THEN FEMALE BASKETBALL PLAYERS ACL SPRAIN • S/S: POP, FOLLOWED BY DISABILITY, “FEELS LIKE MY KNEE IS COMING APART” RAPID SWELLING, PAIN. • TX: PRICE, SURGERY…THEN STRENGTHENING, ROM EXERCISES, FUNCTIONAL ACTIVITIES. • PREVENTION: NO SINGLE EXERCISE CAN PREVENT ACL TEARS, BUT CAN BE LOWERED BY PERFORMING TRAINING DRILLS EMPHASIZING POWER AND AGILITY AND BY IMPROVING MUSCULAR REACTIONS WITH JUMPING AND BALANCE DRILLS • HTTP://WWW.YOUTUBE.COM/WATCH?V =FYDUU93DRBM ACL SPRAIN SPECIAL TEST: ANTERIOR DRAWER Procedure: Put the athlete in knee flexion. Place hands on the superior aspect of the gastrocnemius and pull anteriorly Positive test: pn and tibia moves forward ACL SPRAIN SPECIAL TEST: LACHMANS Procedure: Firmly grasp the distal femur and the proximal tibia. With the knee in slight flexion pull the tibia anteriorly Positive Test: Laxity compared to uninjured side BUDDY TAPE, WATCH AND PRACTICE ON PARTNER • HTTPS://SPARK.ADOBE.COM/VIDEO/ZMELXDJWHVRFA PCL SPRAIN • MOI: SEVERE HYPEREXTENSION, OR A FALL W/KNEE FLEXED TO 90 DEGREES. • S/S: FEELING A POP IN BACK OF KNEE, TENDERNESS, LITTLE SWELLING, INSTABILITY, PAIN. • TX: PRICE, NON-OPERATIVE, STRENGTHENING QUADS, ROM EXERCISES. PCL SPRAIN SPECIAL TEST: POSTERIOR DRAWER POSTERIOR SAG Procedure: athlete lies supine with knees and Procedure: W/athlete in knee flexion push hips flexed to 90. hold the tibias at 90 and look posteriorly on tibia for sagging of the proximal tibia Positive test: laxity compared bilaterally Positive Test: sagging of proximal tibia CARTILAGE • MENISCUS: TWO OVAL FIBROCARTILAGES THAT DEEPEN THE ARTICULATION AND CUSHION ANY STRESSES PLACED ON THE KNEE JOINT • MEDIAL MENISCUS • C SHAPED, ATTACHED TO MEDIAL FACET OF TIBIA • LATERAL MENISCUS • O SHAPED, ATTACHED TO LATERAL ASPECT OF TIBIA CARTILAGE RED ZONE: OUTER ONE THIRD, GOOD VASCULAR SUPPLY RED-WHITE ZONE: MIDDLE ONE THIRD AND HAS MINIMAL BLOOD SUPPLY WHITE-WHITE ZONE: INNER ONE THIRD IS AVASCULAR. MENISCUS INJURY • HIGHER INCIDENT OF INJURY BECAUSE IT ATTACHES TO THE TIBIA AND THE CAPSULAR LIGAMENT. • MOI: FIRM FOOT FIXATION WITH ROTARY FORCE (TORSION) WHILE THE KNEE IS EXTENDED OF FLEXED, CUTTING MOTION, SQUATTING MENISCUS INJURY CONT’D • S/S: SWELLING, DISCOLORATION, PAIN ALONG THE JOINT LINE, LOSS OF ROM, LOCKING,
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