Knee Injuries History Palpation ROM - kinetic analysis Tests Muscle testing

Biomechanics Ligaments

Conditions/Treatment Home Exercises

History of Symptoms Fall with joint compression

Overall weakness pattern Tearing type injury

Injury to skin/ligaments/muscles/joint Slow onset

Repetitive stress

History of Symptoms Pain - constant or in a motion Weakness - what motion Numbness - nerve entrapment Prior history How it impacts their life

Palpation

ITBSections of the vastusLateral collateral ligament

Supra and infra patellaPatella mobility

Heads of the hamstringsJunction of the sartorius and gracilisPopliteusHeads of the gastrocnemius

Kinetic Analysis

Observe alignment of knee standing

Patient bends knee and observe stabilization Pelvis, knee and ankle

Walking observe Degree of femur motion Degree of lower leg extension

Tests Drawer test Lachman test Lat. Pivot shift Apprehension Clarke’s sign Dreyer’s sign

Abduction stress Adduction stress Apley’s

Bounce home McMurray sign

Drawer Test

Patient supine with knee bent 90 degrees and thigh bent 45 degrees

Pull tibia forward Normal = 6 mm Positive = excess motion Injured ant. Cruciate or

posterior oblique ligament or popliteus

Lachman test Patient supine with knee bent

30 degrees Apply pressure to move the

tibia forward while stabilizing the femur

Positive = soft or mushy end feel

Injured ant. cruciate or medial collateral ligament or posterolateral capsule or posteromedial capsule or posterior oblique ligament or popliteus

Lateral pivot shift Patient supine with hip

flexed and medially rotated 20 degrees

Hold foot and bend knee 5 degrees

Apply valgus stress and bend knee to 40 degrees

Positive - tibia shifts posterior

Injured ant. Cruciate or posterolateral capsule or popliteus or ITB

Apprehension test Patient supine or sitting

with quadriceps relaxed Apply lateral pressure

against the patella If patella is about to

dislocate, the quadriceps will contract and patient looks apprehensive.

Clarke’s Sign Patient supine with

knee extended Grasp superior portion

of patella and press inferior

Hold patella inferior as patient contracts quadriceps

Positive = pain Chondromalacia patella

Dreyer’s sign Patient cannot raise leg Grasp above the patella

with both hands and compress the quadriceps

Ask the patient to raise the leg

Ability to raise the leg indicates possible patella fracture

Abduction stress Supine - knee extended -

one hand under the lower tibia the other on the lateral aspect of the knee

Raise leg 30 degrees and apply pressure against lower leg laterally opening the medial side of the knee

Positive = medial pain - medial collateral ligament

Adduction stress Supine - knee extended -

one hand under the lower tibia the other on the medial aspect of the knee

Raise leg 30 degrees and apply pressure against lower leg medially opening the lateral side of the knee

Positive = lateral pain - lateral collateral ligament

Apley’s Prone - knee bent 90 degrees Strongly int. rotate tibia and

bend knee 90 deg. Strongly ext. rotate tibia and

bend knee 90 deg. with downward pressure

Hold femur on table and distract tibia. Then rotate internal and external

Positive = pain - meniscus tear

Bounce home Patient supine with

knee bent Hold heel of foot and

let leg drop extending knee

Positive = incomplete extension or rubbery end feel

McMurray Sign Patient supine - knee at 90

degrees One hand on the knee the

other the ankle Internally rotate the lower leg

and extend the knee with valgus pressure

Repeat with external rotation Positive = pain, snap or click

Muscle Testing Rectus Femoris Vastus intermedius Vastus lateralis Vastus medialis

Adductors

Hamstrings medial Hamstrings lateral

Popliteus Gastrocnemius

Gluteus maximus Gluteus medius