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Kin 188 Knee Injuries And Evaluation


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Kin 188 Knee Injuries And Evaluation

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