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Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
Kin 188   Knee Injuries And Evaluation
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Kin 188 Knee Injuries And Evaluation

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  • Genu = knee
  • Transcript

    • 1. KIN 188 – Prevention and Care of Athletic Injuries Knee Evaluation and Injuries
    • 2. Anatomy
    • 3. Bony Anatomy
      • Femur
        • Medial/lateral femoral condyles
      • Tibia
        • Medial/lateral tibial plateaus
        • Tibial tuberosity
      • Fibular head
      • Patella (“knee cap”)
    • 4. Ligamentous Anatomy
      • Anterior cruciate ligament (ACL) – prevents anterior tibial translation
      • Posterior cruciate ligament (PCL) – prevents posterior tibial translation
      • Medial collateral ligament (MCL) – protects against valgus stress
      • Lateral collateral ligament (LCL) – protects against varus stress
    • 5. Menisci
      • Medial meniscus
        • Larger, C-shaped
      • Lateral meniscus
        • Smaller, O-shaped
    • 6. Muscular Anatomy
      • Anterior
        • Quadriceps (vastus medialis/intermedius/lateralis, rectus femoris)
        • Primary knee extensors
      • Posterior
        • Hamstrings (biceps femoris/lateral, semimembranosus and semitendinosus/medial)
        • Primary knee flexors
      • Medial
        • Pes anserine (“goose foot”) muscles (sartorius, gracilis, semitendinosus)
      • Lateral
        • Iliotibial (IT) band
    • 7. Evaluation
    • 8. History
      • Mechanism of injury/etiology
        • Direct trauma (contusion, fracture, bursitis)
        • Hyperextension (ACL/joint capsule sprain)
        • Hyperflexion (PCL/joint capsule sprain)
        • Fall on flexed knee (PCL sprain)
        • Valgus stress (MCL sprain, meniscus injury)
        • Varus stress (LCL sprain, meniscus injury)
        • Rotational stress (ACL sprain, meniscus injury)
    • 9. History
      • Unusual sounds/sensations
        • Clicking/locking – meniscus injury
        • “ Pop” – cruciate ligament injury, patellar dislocation
      • History of previous injury/surgery
    • 10. History
      • Change in activity
        • Intensity, duration, frequency, surface change, footwear change
      • Acute/gradual onset of symptoms
        • Macrotraumatic vs. microtruamatic
      • Characterize pain
        • Location (point with 1 finger)
        • Dull, sharp, burning, throbbing, etc.
        • Rate on scale (1-10)
        • What increases or decreases?
      • Treatment, medication, evaluation to date
    • 11. Inspection/Observation
      • ALWAYS compare bilaterally
      • Obvious deformity
        • Genu valgum (“knock knees”)
        • Genu varum (“bow legged”)
        • Genu recurvatum (“hyperextension”)
      • Bleeding
      • Discoloration/ecchymosis
      • Swelling
        • Immediate vs. gradual, amount
      • Scars
    • 12. Inspection/Observation
    • 13. Palpation
      • Patella
      • Femoral condyles
      • Tibial plateaus
      • Tibial tuberosity
      • Fibular head
      • Joint line (menisci)
      • MCL
      • LCL
      • Infrapatellar tendon
      • Quadriceps
      • Hamstrings
      • Gastrocs
    • 14. Special Tests
      • ROM
        • Active – patient/athlete moves joint
        • Passive – clinician moves joint, evaluates end feel
        • Resistive – proximal stabilization and distal application of resistance (“break” test vs. resistance through ROM)
      • Neurovascular
      • Special tests
    • 15. ROM
      • Knee extension
        • Primary movers are quadriceps
      • Knee flexion
        • Primary movers are hamstrings
        • Secondary movers are gastrocs (cross knee joint posteriorly)
    • 16. Neurovascular
      • Neurological evalation
        • Nerve root level and peripheral nerve sensory and motor distributions
      • Vascular evaluation
        • Skin temperature/color
        • Capillary refill
        • Popliteal pulse
        • Dorsal pedal pulse
        • Posterior tibial pulse
    • 17. Special Tests
      • Anterior drawer/Lachman tests – ACL
      • Posterior drawer/posterior sag tests – PCL
      • Valgus stress tests – MCL
      • Varus stress tests – LCL
      • Apprehension test – patellar instability
      • McMurray’s/Apley’s tests - menisci
    • 18. Injuries
    • 19. Ligamentous Injuries
      • ACL injuries
      • PCL injuries
      • MCL injuries
      • LCL injuries
    • 20. ACL Injuries
      • Most MOI are non-contact rotational forces
      • Tibia displaced anteriorly on femur (or vice versa), rotational stress (cutting) or hyperextension
      • May be isolated, but typically due to MOI, other structures (joint capsule, menisci) also injured
      • Positive anterior drawer and/or Lachman’s tests
    • 21. PCL Injuries
      • Most common MOI is fall on flexed knee driving tibia posterior on femur
      • May also occur with rotational and/or hyperextension MOI
      • Often treated non-operatively as quadriceps muscles are able to minimize posterior displacement of tibia on femur
      • Positive posterior drawer and/or posterior sag tests
    • 22. MCL Injuries
      • Most common MOI is blow to lateral knee with resulting valgus tension forces
      • May also be injured by non-contact and/or rotational stresses
      • Positive valgus stress test
    • 23. LCL Injuries
      • Most common MOI is blow to medial knee with resulting varus tension forces
      • Internal rotation of tibia may be secondary contributor to LCL injury
      • Positive varus stress test
    • 24. Meniscal Injuries
      • May be isolated from flexion/hyperflexion with rotation of the knee – “pinched” between tibia and femur
      • Often injured in association with cruciate ligament injury
      • “ Classic” symptoms include joint line pain and clicking or locking – helpful but not definitive evaluative tools
      • Limited reliability of special tests
    • 25. Patellar Injuries
      • Lateral displacement is most common
      • Positive apprehension test
    • 26. Patellar Tendon Rupture
      • Occurs with excessive tension through tendon causing failure in mid-substance or at either insertion point
      • Present with gross deformity, inability to actively extend the knee and significant swelling immediately
    • 27. Additional Injuries
      • Muscle strains to quadriceps/hamstrings
        • Severity based upon degree of tissue damage
      • Tendonitis
        • Overuse condition associated with training changes, biomechanical insufficiencies, poor flexibility, etc.
        • Most common to infrapatellar tendon, but can involve IT band, pes anserine muscles and/or hamstrings as well
    • 28. Additional Injuries
      • Osgood-Schlatter’s disease
        • Inflammatory condition of tibial tuberosity at patellar tendon insertion, symptoms similar to patellar tendonitis but tuberosity often enlarged and only site of pain, most prominent in adolescents
      • Bursitis
        • Typically inflamed secondary to acute trauma, but may be chronic or associated with infection
        • Prepatellar, presents with significant anterior swelling

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