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THE KNEE
- is the largest joint in the body. - it is a ginglymus joint, and as such provides a fairly wide range of motion. - the knees greatst range of motion is in flexion.
INSPECTION
Starts when the patient walks into the examination room, his gait should flow in a smooth, rhythmic motion. Ask the patient to remove his clothing from the waist down, watch carefully for any movement used to compensate for pain or stiffness in the knee. To inspect the anterior aspect of the knee have the patient stand strainght, with knee fully extended.
PALPATION
Have the patient sit on the edge of the examining table. A bed patient should be in supine position with his knees flexed in 90 degree. Place your hand upon the knee joint so that your fingers curve around the posterior popliteal area. Place your thumbs on the anterior portion of the knee and press into the soft tissue depression on either side of the infrapatellar tendon. This depression will serve as the central point of orientation for palpating the lateral and the medial aspect of the knee.
BONY PALPATION
MEDIAL ASPECT LATERAL ASPECT
The patella is fixed in the groove during flexion and mobile in extension. It is easier to push medially than laterally.
Quadriceps
Infrapatellar Tendon
often tender in patient with Osgood schlatters Syndrome.
Bursa
Superficial Infrapatellar Bursabecomes inflamed as a result of excessive kneeling. Prepatellar Bursainflamed in combination of excessive kneeling and leaning forward (housemaids knee) Pes Anserine Bursawhen palpable indicates pathology
Medial Meniscus
tears are more common in this area
Lateral meniscus
Popliteal Fossa
RANGE OF MOTION
Four basic movement in the knee: Flexion performed by quadriceps Extension- performed by hamstring muscle and gravity Internal rotation and External rotation performed by the reciprocal action of the semimembranosus, semitendinosus, gracilis, and Sartorius on the medial side, and biceps in the lateral side.
RANGE OF MOTION
SPECIAL TESTS:
McMurray test
test for the integrity of posterior meniscal tears Positive if it causes a palpable or audible click within the joint
designed to determine the quality of the articulating surfaces of the patella and the trochlear groove of the femur. Positive if the patient complain of pain and discomfort
The knee should be fully extended at heel strike and flexed during all stages of stance phase.