the knee complex complete anatomy, biomechanics, pathomechanics and its physical assessment in one single slideshow.a brief table given for easy understanding of what special test to be performed in which condition along with evidences of each special test.
small correction in slide number: 10
during flexion of tibia over femur in OKC; tibia glides and rolls posteriorly
during extension of tibia over femur in OKC: tibia glides and rolls anteriorly
Myofascial release refers to the manual
technique for stretching the fascia and
releasing bonds between fascia and
Lintegument, musles,and bones, with the goal of
eliminating pain, increasing range of motion
and balancing the body.
Myofascial release refers to the manual
technique for stretching the fascia and
releasing bonds between fascia and
Lintegument, musles,and bones, with the goal of
eliminating pain, increasing range of motion
and balancing the body.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Includes detailed description of BIOMECHANICS & PATHOMECHANICS OF KNEE JOINT AND PATELLOFEMORAL JOINT with recent evidences . Hope you find it useful!!
this slideshow describes about the hip joint anatomy, biomechanics and its pathomechanics along with angles of hip joint. the slide show also briefs about the pelvic femoral rhythm in daily activities
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
this is a slide show which gives in brief about anatomy and detailed description about biomechanics as well as pathomechanics of shoulder joint. various rhythms of shoulder complex are discussed as well along with the stability factors
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Includes detailed description of BIOMECHANICS & PATHOMECHANICS OF KNEE JOINT AND PATELLOFEMORAL JOINT with recent evidences . Hope you find it useful!!
this slideshow describes about the hip joint anatomy, biomechanics and its pathomechanics along with angles of hip joint. the slide show also briefs about the pelvic femoral rhythm in daily activities
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
this is a slide show which gives in brief about anatomy and detailed description about biomechanics as well as pathomechanics of shoulder joint. various rhythms of shoulder complex are discussed as well along with the stability factors
Osteoarthritis of the Knee Joint is a quite common condition found in Indian Population. This presentation is made to understand how this condition affects patients and what are the different Physiotherapy measures to make the patient functionally independent.
Osteoarthritis knee- introduction and approachJoe Antony
Osteoarthritis (OA) of the knee is a degenerative joint disorder characterized by structural changes like cartilage loss, synovial inflammation, and bone remodeling . Knee OA commonly affects daily activities due to symptoms like joint pain and stiffness, impacting functional abilities . Various factors contribute to knee OA development, including mechanical, enzymatic, and biological factors . In knee OA patients, proinflammatory cytokines like IL-6 and TNF-α have been found to correlate with functional impairment assessed by WOMAC scores, indicating a potential impact on knee joint function . Understanding the interplay between aging and knee OA is crucial, as aging processes can exacerbate the degenerative changes in the knee joint, leading to functional limitations . Evaluating patients' perspectives on knee OA management through instruments like the Knee Outcome Survey Activity Daily Living Scale (KOS-ADLS) is essential for assessing the success of interventions
A traditional manual therapy technique developed by John Upledger, involving bare hands and stretching the tension membrane so as to ease the tension within
Its a compilation of both traditional and recent advance techniques of not only assessing musculoskeletal but also cardiovascular and respiratory endurance as well as strength
Traction: a basic physiotherapy modality used for inducing space between the joints. this slideshow deals with various types of traction and its application to cervical, thoracic and lumbar spine.
the PPT Describes about various types of dysfunction in mechanical pattern as described by Janda's. it also describes about normal muscle slings prresent within the body and its compensation and decompensation patterns towards the adaptations of the body
Thoracic and rib cage anatomy, biomechanics, and pathomechanicsRadhika Chintamani
This slide show describes about thoracic and rib cage in detail with its anatomy, kinetics and kinematics along with force couple. the slideshow also describes about the pathology and pathomechanics related to the topic
A very old school of manual therapy which comprises of two main principle centralization and peripheralization thought given by Robin McKenzie. The slideshow explain theoretical and practical part of both entire spine and extremities as well
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
Massage of therapeutic form is beneficial in many conditions like stroke, flaccidity, muscle tightness, spasm etc.
it has many physiological effects along with many types for different conditions as well as different body areas.
it is another taping technique which inhibits or control the movement. it is helpful in postural correction and movement pattern correction as well. usually used clinically
Sacroiliac joint biomechanics, dysfunctions, assessment and its manual therapyRadhika Chintamani
Sacroiliac joint: mostly commonly affected joint due to its smaller articular surfaces. this slideshow briefs about its anatomy, biomechanics i.e. movements and axis, muscles, ligaments around it, types of dysfunction of SI joints, its special test and manual therapy management of the dysfunctions.
Taping a therapeutic and a protective approach by physiotherapist having various types; Kineso, McConnell, Rigid, Neutral tape, Mulligan taping techniques.
this slideshow states brief about taping techniques with elaboration of Kinesiotaping technique
McConnell taping technique: 05/04/2020
Other taping techniques: 08/04/2020
Comprises of assessment and diagnostic techniques of neurodynamics.
it includes both the mechnaical interface and neurological aspect, along with the level of application of diagnostic as well as treatment part of neurodynamics
An orthopedic operative procedure which stabilizes and aligns the fractured segment with the help of externally placed mechanical devices holding up the intact bone.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
4. *Menisci
*Fibro cartilaginous disk
*Thick peripherally and
thin centrally
*Wedge shape in cross section
*Medial meniscus is C-shaped
*Lateral meniscus is 4/5 th of a circle , covers
more surface of small lat.tibial plateu
*Medial condyle more prone for compressive loads
6. *Menisci nutrition & innervations
•During I year of life ----- entire
•Wt bear ----- only outer 25% -33%
•>50 year age
only periphery
Central ----synovial fluid
Wt bearing Muscle contraction
femur rotation on fixed
tibia
Immobilization
Only periphery
-inflammation
-Repair
-remodelling
Vascular:
oHorns ,peripheral vascular
area---free nerve endings
3 different mechano receptors
ruffini - ----stretch
pacinian --- compression
galgi -----pressure
Loss of mechanoreceptors
Loss of proprioception
Innervation
7. *Meniscal attachments
*Horns attach firmly to tibia below
*Transverse ligament
*Patello- meniscal ligament
*Coronary ligament
Semi membrinosus via
capsular connections
Popliteal muscle tendon
A & P horns of medial
meniscus
Attach to ACL@PCL resp.
Posteriorly lateral meniscus
attach to PCL
MCL
8. *Joint capsule
*Attachments
*The A-M& A-L portion of the capsule called M&L
patello femoral retinaculae----- extensor
retinaculam
*It is innervated by nauci , mechanoreceptors
(muscle stabilization)
9. *Synovial layer
Structures intra capsular and extra synovial
ACL , PCL , popliteus muscle tendon(PL) , semi
membrinosus and gastrocnemious medial head(PM)
PATELLAR PLICA: synovial folds
In ng order frequency of location
inferior(infra patellar plica)
superior(supra patellar plica)
medial(medio patellar plica)
10. Joint Kinetics
Movement Axis Arthrokinematics
Flexion Femoral epicondyle Roll posteriorly and
glide anteriorly
Extension Femoral epicondyle Rolls anteriorly and
glide posteriorly
In weight bearing phase
In non-weight bearing phase
Movement Axis Arthrokinematics
Flexion Tibial epicondyle Rolls anteriorly
Glide posteriorly
Extension Tibial epicondyle Rolls posteriorly
Glide anteriorly
11. Osteokinematics
Knee Flexion
Normal: 130-140 degrees
Normal gait: 60-70 degrees
Ascending stairs: 80 degrees
Knee extension
Normal: 0
Genu recurvatum: >5 degree
Knee rotations (maximum at
90degree of knee flexion)
LR: 0-20 degrees
MR: 0-15 degrees
Valgus / varus:
Full extension: 8
At 20degree of knee flexion:
13 degree
Calliet R. Knee Pain and Disability. 1992: ed.3:1-70
13. Patellofemoral Joint
KNEE POSITION PATELLO-FEMORAL CONTACT
Extension Inferior pole
At 100-200 of knee flexion Inferior margin of medial &lateral facets of
patella
As range progress Inferior to more superior
By 900of knee flexion Except ODD FACET all portions
experience some contact
>900 Odd facet begins with medial femoral
condyle first time
At full knee flexion Lodged in inter condylar groove
Contact is only lateral& odd facet
Calliet R. Knee Pain and Disability. 1992: ed.3:1-70
14. PATELLO FEMORAL JOINT STRESSES
*Stress(F/A) can be influenced by force
&contact areas (large and small )
*P-F jt force is influenced by
oThe Q’ceps forces and knee angle
oVertical position of patella
At full knee extension –minimal
compressive forces
Knee flexion - joint
compressions
15. *>900 contact area decreases –stress increases on
lateral &odd face
Vertical position of patella (Insall –salvati
index)
*Patellar alta --------- more joint compression
*Patellar baja--------- less joint compression
oFrom 0-900 although joint compressive forces
increases the patellar contact area also increases
accordingly
17. Q angle lateral force compression
forces enough lateral force
subluxation
W>M : - wider pelvis
Increased femoral anteversion
Relative knee valgus angle
18. *Q angle of 200 or >200 is
abnormal(leads to pain)
*Imbalance between VL and VM muscles
*Presence of tight IT band
*Genu valgum
*Ante version
*Lateral tibial torsion
*Laxity of medial retinaculum
*Excessive tension and adaptive shortening of
lateral retinaculum
19. *WB vs NWB exercises with P-F
joint pain
In NWB &WB due to more Q’cep force against MA resistance ----
- increase compression-----increase pain
Studies recommended
--- avoid deep flexion while doing WB extension exercises
--- avoid the final 300 of extension during NWB knee extension
exercises
20. *
static : providing stability and strength to
support the weight of the body.
dynamic: Flexibility, strength, and stability are
needed for standing and for motions like
walking, running, crouching, jumping, and
turning.
21. *Lateral rotation of tibia with extension
During last 300 of knee extension(300-00)
shorter lateral tibial plateu /femoral condyle first
complete its rolling and gliding movts before the longer
medial articular surface do it
Most evident in final 50 of extension
Also known as locking or screw home mechanism
Screw home mechanism
22. Common conditions seen in Knee
jointCondition Structures
affecting
Mechanisms
1. Ligament
Injury
ACL Sudden landing on unstable knee,
twist and turn in unstable flexed knee
PCL Sudden posterior blow
MCL Accidental Injury experienced during,
lateral rotation of tibia with foot on
ground usually in extension
LCL Same as above but with Medial
rotation of tibia in extension
23. 2. Meniscal
injury
Medial If cutting and grinding in foot on ground
in laterally rotated position, may lead to
meniscal tear.
Lateral If cutting and grinding in foot on ground
in medially rotated position, may lead to
meniscal tear.
3. Arthritis Tibio-
femoral
Age related changes, post-menopausal,
obesity.
Patello-
femoral
Age related changes, post-menopausal,
obesity.
24. Assessment
History:
*Reason for his entrance in clinic
*How was the injury?
*Stiffness or pain since??
*Particular movement or task inducing
or aggravating pain?
*Difficulty in ADL’s?
26. Title, Author,
Year
Aim Methodology Conclusion
Implementation
of the Ottawa
rule for the use
of radiography
in acute knee
injuries- A
clinical Trial
Stiell IG, Wells
GA, Hoag RH,
Sivilotti ML,
Cacciotti TF,
Verbeek PR, et
al.
December 1997
To assess
impact on
clinical
practice of
implementin
g the
Ottawa knee
rule.
3907 adults with
acute knee
injuries during 12
months period
before and after
the intervention.
Main outcome
measures were:
referral for knee
radiography,
accuracy and
reliability of the
rule, mean time
in emergency
department
Reduction of 26.4%
in the proportion of
patients referred for
knee X-ray
compared to control
group. (p<0.001*).
Both group by
group and group by
time were
significant.
Thus
implementation of
this rule led to
decrease in use of
knee radiography.
27. Parameter ACL PCL
Onset Traumatic. Traumatic
Precipitating
factor
Active movement
(flexion)
Active movement
(extension )
Quality of pain Deep Deep
Relieving factor Rest, medications Rest, medications
Site of pain Avulsion: tibial
tuberosity and mid-
substance tear: intra-
articular.
Usually mid-substance tear
is seen: intra-articular
Temporal
variations
NS NS
Pain History
28. Parameter MCL LCL
Onset Traumatic Traumatic
Precipitating factor Active movement
(extension, flexion and
maximum pain in
lateral rotation of tibia)
Active movement
(extension, flexion and
maximum pain in
medial rotation of
tibia)
Quality of pain Deep Deep
Relieving factor Rest, medications Rest, medications
Site of pain medial aspect of the
knee joint.
Lateral aspect of knee
joint
Temporal
variations
NS NS
29. Parameter Medial meniscus Lateral meniscus
Onset Traumatic Traumatic
Precipitating factor Weight bearing,
walking, closed kinetic
movements
Weight bearing,
walking, closed kinetic
movements
Quality of pain Deep Deep
Relieving factor Rest, medications Rest, medications
Site of pain Medial knee joint line Lateral knee joint line
Temporal
variations
NS NS
30. Parameter Arthritis Pain of muscular
origin
Onset Insidious in onset,
gradual increase.
Sudden/Traumatic,
gradual increase.
Precipitating factor PFA: stair climbing up
TFA: Climbing down
Weight bearing,
walking, closed kinetic
movements
Contraction of muscle
Eccentric painful more
than concentric
Quality of pain Deep Tear: deep and dull
Spasm: Dull
Relieving factor Rest, medications Rest, medications
Site of pain Area affected Muscle affected
Temporal
variations
NS NS
31. Cook C. Orthopedic Manual Therapy-An evidence based approach; 2007: pg-25-26
32. Parameter Onset
ACL Develops within an hour or two post injury.
PCL Develops within an hour or two post injury.
MCL Develops within an hour or two post injury.
LCL Develops within an hour or two post injury.
Arthritis Present only on exertion of WB activities.
Muscular origin May be present at the site of the impact.
Swelling
Calbach W, Hutchens M. Evaluation of patients presenting with knee pain: Part II.
Differential Diagnosis: 2003; 68 (5): 917-922
33. Cyriax palpation:
1. Joint line
2. Patella
3. Patellar tendon
4. Tibial tuberosity
5. MCL
6. LCL
7. Gastrocnemius: Medial and Lateral head
8. Hamstring
9. Quadriceps: the bulk
10. Meniscii, ACL and PCL can not be palpated
On Palpation
34. Palpation of swelling
Large Medium Small
Palpation form 10
cm above patella
Dancing patella test Phase I: Proximal
and lateral
Phase II: Back to
medial
(Fluid displacement
test)
35. Resisted Isometric done post-surgery or even after immediate
injury. Otherwise Manual muscle testing can be used to
assess the strength of the muscle.
Muscle strength testing
ISOKINETIC DEVICE
A novel device used to determine the strength of knee joint
within each range of knee motion also targeting every
individual muscle.
37. *The tool is invented by Dr. Tony Shield.
*Uses: assess eccentric hamstring strength, risk of hamstring
injury in athletes and bilateral limb strength assymetry.
Title , Author
Year
Aim Procedure Results
A novel device using
the Nordic Hamstring
Exercise to assess
Eccentric knee flexor
strength: a reliability
and retrospective
injury study.
Opar D, Piathowski
T, Williams M, Shield
A
2013
To assess the
reliability of
the hamstring
nord board
while
measuring
eccentric
hamstring
strength.
30
recreationally
active males
without a
history of HSI
completed the
Nordic
hamstring
exercise on
the device.
High to
moderate
reliability(IC
C=0.83 to
0.90)
39. *
Title , Author
Year
Aim Procedure Results
Isokinetic
dynamometer
in anterior
cruciate
ligament
injury and
reconstruction
Yong-Hao P,
Bryant A,
Steele J,
Newton R,
Wrigley T.
2008
To determine
the
usefulness of
isokinetic
dynamomete
r to isolate
and qunatify
the muscular
deficits
present
within ACL
deficient or
reconstructe
d knees.
Considered 6 studies
with ACLR patients
having isokinetic
angular velocity in
common. Few studies
having peak quadriceps
torque and hamstring
torque, and some
considering peak quads
torque alone.
Accuracy on
comparison
with self-
reported
athletic
performance
was moderate
to best
(r<0.70)
41. ACL Reduced flexion due to pain.
Extension reduced if quadriceps tendon is also affected.
PCL Reduced extension due to pain.
MCL Reduced both flexion and extension due to pain.
LCL Reduced both flexion and extension due to pain.
Arthritis In chronic stage: Reduced movements in both WB and
NWB status.
In acute stage: reduced in WB status.
Muscular
origin
Tear: Reduced both positive and negative muscle work
Spasm: only positive work is reduced
Range of Motion
42. ACL NWB (unstable) flexion affected, Walking impaired,
WB impaired.
PCL NWB (unstable) extension affected, Walking and
weight bearing impaired.
MCL NWB (unstable) flexion-extension affected, Walking
and weight bearing impaired
LCL NWB (unstable) flexion-extension affected, Walking
and weight bearing impaired
Arthritis Walking for too long, constant standing, squatting,
sitting with crossed legs, stair climbing.
Muscular
origin
Any movement leading to eccentric contraction of the
affected muscle.
Functional Disability
43. Functional Testing
Starting
position
Action Functional test
Standing Walking backward
Running forward (20
degrees of knee
flexion)
6-8mts: Functional
3-6mts: functionally fair
1-3mts: functionally poor
0mts: nonfunctional
Standing Squat: 20-30degrees
Jump, lifting body off
floor
5-6reps: functional
3-4reps: functionally fair
1-2reps: functionally poor
0reps: nonfunctional
Palmar M, Epler M. Clinical Assessment Procedures in Physical Therapy.
Philadelphia, J.B. Lippincott, 1990. pp 275-276.
44. ACL Lever sign, Heel height test
PCL Dial test
MCL Swain test, Slocum antero-medial
rotatory instability test
LCL Slocum antero-lateral rotatory
instability test
Meniscal involvement Ege’s test
Arthritis Duck walk test
Patellofemoral disorders Vastus medialis co-ordination test
Special test
45. Lever Sign Test
The lever sign is one of the diagnostic test to assess partial as
well as complete anterior cruciate ligament tears and even for
acute injuries.
A: Intact ACL
B: Ruptured ACL
46. *
Title, Author,
Year
Aim Procedure Results
The “Lever
sign” a new
clinical test for
the diagnosis of
anterior cruciate
ligament
rupture.
Jarbo K,
Hartigan D,
Scott K, Patel K
and Chhabra A.
2017
To assess the
sensitivity and
specificity of
the lever sign
for diagnosis
of acute ACL
injuries
Out of 102 patients
54 were posted for
operation cases and
48 were non-
operative cases.
Test was performed
on both groups. For
non-operated cases
in OPD and
operative cases
before SX
intervention on GA.
MRI results were
compared.
The accuracy
was similar
between
patient under
anesthesia and
awake. The
study showed
high sensitivity
and specificity
values.
47. Heel height test
The examiner grasps the great toe and lifts the foot vertically
while stabilizing the distal thigh to avoid knee elevation and
rotation. An assistant measures the distance between the heel and
the examination or surgical table. Side to side difference was
calculated.
48. Title, Author,
Year
Aim Methodology Conclusion
Heel height test: A
novel tool for the
detection of
combined anterior
cruciate ligament
and fibular
collateral ligament
tear
Cinque M, Geeslin
A, Chahla J,
Moatshe G,
Laprade R,
Dephillipo N. et al
2017
To determine
the clinical
utility of
heel height
SSD
assessment
in
ACL+LCL
ligament
injury
2 groups; A:
isolated ACL
tears, B:
ACL+FCL
tears.
(158 patients)
High sensitivity and
excellent specificity
for diagnosis of
ACL+FCL tears
compared with
sensitivity and
specifictiy of MRI
detection.
49. Dial test
Compare it with the
contralateral limb, different
degrees of rotation at 30 as
well as 90 degrees of knee
flexion. Check at both the
degree of knee flexion. The
ACL ruptured leg rotates
more compared to intact
leg.
50. Title, Author,
Year
Aim Methodology Conclusion
Evaluation of
reliability of dial
test for postero-
lateral rotatory
instability: a
cadaveric study
using an isotonic
rotation machine
Bae JH, Choi IC,
Suh SW, Lim HC,
Bae TS, Nha KW,
et al.
2008
To evaluate
reliability of
dial test by
assessing
correlation
between the
severity of
posterolateral
corner injury
and the amount
of external
rotation of the
tibia
41 paired
cadaveric legs. 2
Groups;
A: Posterolateral
corner +PCL
B: isolated PCL.
External rotation
angle were
measured with a
6-Nm rotational
torque
Valuable
method for
diagnosing
PCL and
posterolateral
structures
51. The knee is flexed to 90 degree and tibia is fully
externally rotated. The test is considered positive if
patient complains of pain in medial side of knee
joint.
52. *
Title , Author
Year
Aim Procedure Results
Medial
Collateral
Ligament
Injuries of the
Knee: An
evolution of
surgical
reconstruction-
A pilot study
Lonergan K,
Taylor D.
2002
To discuss
initial
evaluation
and the pre-
operative
assesement
8 patients with non-
operative treatment
with isolated MCL
injuries were assessed
for rotatory instability
test with Swain test.
Excellent
accuracy was
found with the
test.
53. *
Title ,
Author
Year
Aim Procedure Results
Anterolater
al rotatory
instability
of the
knee: an
analysis of
the Ellison
procedure
Hanks G,
Joyner D,
Kalenak A
1981
To identify wheather
the solcum
anterolateral test was
accurate in
identifying the
anterolateral
instability due to
MCL alone or in
combination with
ACL injuries
Out of 30 patients who had
injured their knee during
athletic activities were
conservatively managed
before OT. After a follow-up
of 9 months 28 patients
returned to the clinic with
knee giving away. Physical
examination of solcum ALRI
test against MRI was done
and patients were operated for
the same using Ellison
procedure.
Slocum test
proved to be as
significant as MRI
with accuracy of
about 70%.
Also, Ellison
procedure
significantly
reduced the giving
away of knee, and
was as efficient
compared to other
procedures.
Slocum AMRI/ALRI test
54. Ege’s test (WB McMurray’s test)
It is nothing but
McMurray’s test but in
weight bearing
position.
55. *
Title , Author
Year
Aim Procedure Results
A new weight
bearing
meniscal test
and a
comparison
with
McMurray’s
test and joint
line tenderness
Akeseki D,
Pinar H.
2004
To describe
a new
weight
bearing
McMurray’
s test
(Ege’s test)
and to
compare its
dignostic
value with
McMurray’
s test and
joint line
tenderness
127 patients among
which 90 had medial,
28 had lateral and 9 had
both meniscal tears.
Better
accuracy
(71%)
sensitivity
(67%)and
specificity
(81%) rates
were found
with the new
test.
56. *
Title , Author
Year
Aim Procedure Results
Diagnostic accuracy of
the Thessaly test,
standardised clinical
history and other clinical
examination tests
(Apley’s, McMurray’s
and joint line tenderness)
for meniscal tears in
comparison with
magnetic resonance
imaging diagnosis
Blyth M, Anthony I,
Downie P, MacLean A,
Norrie J, Powell A. et al
2015
To determine
diagnostic
accuracy of
the Thessaly
test and to
determine if
Thessaly test
alone or in
combination
with other
tests can
obviate the
need of
investigation
by MRI
367 subjects
were recruited in
2 groups. A: 292:
with knee
pathology and B:
75: without knee
pathology as
control.
Thessaly test
had sensitivity
of 0.66 and
specificity of
0.55 and
diagnostic
accuracy of
54%. Hence it
was moderately
accurate in
diagnosing Knee
pathology on
comparison with
MRI.
Thessaly test
59. *
Title , Author
Year
Aim Methodology Conclusion
What is the
diagnostic
accuracy of the
duck walk test
in detecting
meniscal tears
Van der A,
Noorduyn J,
Scholtes V,
Mutsaerts E.
2017
To
determine
the
sensitivity
and
specificity
of the duck
walk test in
diagnosing
medial
meniscal
tear.
136 subjects with
knee injury who
had MRI before
(24%) or after
(76%) physical
examination and
had duck walk
test performed.
The calculated
sensitivity was 71%,
with low specificity
39% and no
significant scores
between medial and
lateral tears in
diagnosing the
specific site of tear.
61. *
Title , Author
Year
Aim Methodology Conclusion
Diagnostic
value of five
clinical tests in
patellofemoral
pain syndrome
JoNijs,
BartVan, Velde
2005
Examining
the validity
of five
clinical
patellofemo
ral tests
used in
dignosis of
patellofemo
ral pain
syndrome.
45 subjects were
divided into
either PFPS or
the non-PFPS
group. The five
tests were Vastus
medialis
cordination test,
Patellar
apprehension test,
Waldron’s test,
Clarke’s test and
eccentric step
test.
The postive
likelihood of Vastus
medialis
coordination test and
patellar apprehension
test was 2.36 and rest
were below 2. but
these data question
the validity of the
tests as negative
threshold value
exceeded 0.5
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Therapy. Philadelphia, J.B. Lippincott, 1990. pp 275-276
11.Jarbo K, Hartigan D, Scott K, Patel K and Chhabra A. The “Lever sign”
a new clinical test for the diagnosis of anterior cruciate ligament rupture;
2017
12.Cinque M, Geeslin A, Chahla J, Moatshe G, Laprade R, Dephillipo N. et
al. Heel height test: A novel tool for the detection of combined anterior
cruciate ligament and fibular collateral ligament tear; 2017
13.Bae JH, Choi IC, Suh SW, Lim HC, Bae TS, Nha KW, et al. Evaluation
of reliability of dial test for postero-lateral rotatory instability: a
cadaveric study using an isotonic rotation machine; 2008:
65. 14. Lonergan K, Taylor D. Medial Collateral Ligament Injuries of the
Knee: An evolution of surgical reconstruction- A pilot study; 2002.
15. Hanks G, Joyner D, Kalenak A. Anterolateral rotatory instability of
the knee: an analysis of the Ellison procedure;1981.
16. Akeseki D, Pinar H. A new weight bearing meniscal test and a
comparison with McMurray’s test and joint line tenderness; 2004.
17. Blyth M, Anthony I, Downie P, MacLean A, Norrie J, Powell A. et
al. Diagnostic accuracy of the Thessaly test, standardised clinical
history and other clinical examination tests (Apley’s, McMurray’s
and joint line tenderness) for meniscal tears in comparison with
magnetic resonance imaging diagnosis;2015
18. Van der A, Noorduyn J, Scholtes V, Mutsaerts E. What is the
diagnostic accuracy of the duck walk test in detecting meniscal
tears;2017
19. JoNijs, BartVan, Velde. Diagnostic value of five clinical tests in
patellofemoral pain syndrome. 2005;5:109-115