Transcript C _ P Chapter 7 - Coral Gables Senior High School

Chapter 7
Knee
and
Thigh
Knee
Anatomy
• Largest Joint of
the body
• Structurally
weak
– Weakness due
to unstable
boney structure.
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Knee
Anatomy
Consider the femur the longest & strongest
bone of the body.
Sits on the much smaller tibia; which is the main
weight bearing bone!
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Knee
Femur / Tibia
Condyles – 2 slightly convex surfaces on the
distal end of the femur
• Condyles articulate with the slightly concave
surfaces of the tibia
– This is stable
– However once the knee bends (like in walking &
running) stability of these surfaces decrease.
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Knee
Femur / Tibia
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Knee
Femur / Tibia
These two bones slide back & forth on each other.
• Even in non-athletic activities
Add to the issue the lack of rotation of the joint
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Knee
Fibula
• Non-Weight bearing bone
• Serves as the attachment for the Lateral
collateral ligament (LCL) & the Bicep Femoris
Muscle
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Knee
Patella “knee cap”
Incased in the powerful patellar tendon
• Moves up & down in front of the knee in the
space between the 2 condyles of the femur
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Ligaments & Muscles
Instability of boney structures is compensated
by strong ligaments and even stronger
muscles
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Ligaments & Muscles
1.
2.
3.
4.
4 Ligaments that stabilize the knee.
Medial Collateral Ligament
Lateral Collateral Ligament
Anterior Cruciate Ligament
Posterior Cruciate Ligament
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Ligaments & Muscles
MCL
Remember ligaments hold bones to bones.
MCL – Helps secure the femur to the tibia
• Also connects to medial meniscus
– Creates issue with evaluation
– Not as strong as the MCL
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Ligaments & Muscles
LCL
Cordlike and does not attach to the meniscus
• Assists in valgus / varus movement of the
knee.
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Ligaments & Muscles
ACL / PCL
• Form an X in the middle of the knee
• Controls movement Posterior & Anterior
movement of femur on the tibia.
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Ligaments & Muscles
More than any other joint, the depends on good
muscle support.
• There are 12 muscles that support the
anatomical structures of the knee
–
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Most of this support comes from the large
muscles of the quad and lower leg.
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Ligaments & Muscles
Quadriceps:
• Anterior
– Rectus Femoris
– Vastis medialialis
– Vastus intermedialis
• Quads extends when straightened
Hamstrings
• Posterior
– Semitendinosis
– Semimembranosus
– Biceps femoris
Controls rotary movements and flexes the knee.
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Ligaments & Muscles
Other “less” popular muscles:
• Sartorius
• Gracilis
• Popliteus
• Gastronemius
• Plantaris
• Tensor Fascia Latae / Iliotibial Band (IT Band)
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Menisci
Medial & Lateral Meniscus:
• 2 Tough, fibrous cartilages
• Rest on top of the Tibia
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Menisci
Function:
• Form a cushion for Femoral Condyles
• Shock absorption
• Adds to Joint Stability
• Helps to smooth the gliding & rotating
movements of femur and tibia
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Other Structures
• Bursae – closed, fluid filled sacs that serve as
cushions against friction over a prominent
bone, or whatever moves over a bone.
• Synovial Membrane – a large closed sac that
lines the inside of the knee joint, helping to
lubricate the tendons, ligaments, and bones.
• Fat Pads – specialized soft tissue structure for
weight bearing and absorbing impact
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Nerves
Dermatome – the sensory distribution of a
nerve root; produces feeling in a certain
anatomical area.
Myotome – the motor distribution of a group of
muscles innervated by a single nerve root; it
produces movement of the anatomical
structures.
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Range Of Motion
Flexion – Decreasing angle between the Femur
and the Tibia
Extension – Increasing the angle between the
Femur and the Tibia
Tibial Internal Rotation – Rotation of the Tibia
toward the midline of
the body
Tibial External Rotation - Rotation of the Tibia
away from the midline of
the body
Range Of Motion
Anterior / Posterior Translation – movement of
the femur on
the Tibia in a
forward or
backward
movement
pattern
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Evaluation
• Proper evaluation is used to determine
seriousness of the injury
History
Mechanism of injury, location of pain, sensations experienced,
and previous history
• This will guide you through the rest of the evaluation
Observation
Compare the uninjured to the injured, look for: deformation,
swelling, discoloration, scars, other signs of trauma or
abnormality.
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Evaluation
Palpation
Again; compare right to left
Check for:
• Neurological Trauma
• Circulation (nail bed return / pulse)
• Anatomical structures
• Potential Fractures
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Evaluation
Special Test
• Start with strength evaluation
Valgus / Varus Test – used to evaluate medial and lateral
ligament stability
Anterior / Posterior Drawer – Assesses stability of the ACL & PCL
Lachman – Used to evaluate ACL
Apley’s Compression – Evaluates the integrity of the menisci
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RefeR When….
•
•
•
•
•
•
•
•
Gross deformity
Significant Pain
Increase Swelling
Circulation or neurological impairment
Joint instability
Suspect a fx or dislocation
Dislocated patella
Abnormal sensations such as clicking, popping,
grating, or weakness
• Locked knee or excessive / limited motion
• Any doubt
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Common Injuries
Due to the complexity of the knee it is
frequently injured
• It is possible to severely injure the knee & not get a lot of
swelling.
• And get very little pain
Ligament Sprains: can be cased by multidirectional forces and
are compounded when the athlete's foot is
stationary (planted)
• Most common is a direct blow to the lateral aspect of the
knee injuring medial structures
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Common Injuries
Knee Ligaments are usually injured by one of the
following methods:
1. Compression (Direct Blow)
2. Torsion (Fixed foot, twist body part or body)
3. Shearing (Forced applied to the opposite side
of the joint)
Sports that use cleats have an increase chance
of injury.
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Common Injuries
All Ligamentous Sprains are classified the same.
1st Degree Sprain – one or more supporting
ligaments & surrounding
tissue stretched.
2nd Degree Sprain – A portion of 1 or more
ligaments is torn.
3rd Degree Sprain – 1 or more ligaments is torn.
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Common Injuries
Patellar Tendinitis
• Excessive stress placed on the patellar tendon
cause inflammation above or below the
patella
• Athlete complains of pain “when they first get
up” and/or after activity. May have swelling.
– Treat with Cold/Heat/Ultrasound/Rest
– Rehab Strengthen Quads / Hamstrings
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Common Injuries
Chondromalacia Patellae
• A degenerative condition that results in the
irritation and softening of the cartilage on the
posterior aspect of the patella.
– Running, jumping, kneeling, and climbing stairs
will elicit pain
– Causes muscle weakness or imbalance, body
structure
• Treatment: Ice before & after activity
– Surgery?
• Rehab: Again work on Strengthening
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Common Injuries
Female Athletes Knee
(Anterior Superior Iliac Spine – ASIS)
• Patellar problem may be more prevalent in
female athletes b/c of structural differences in
the pelvic girdle.
• Wider pelvis creates a sharper angle where
the femur attaches to the pelvis.
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Common Injuries
Female: Q Angle – an imaginary line from the
ASIS to the medial edge of patella.
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Common Injuries
• A sharper Q Angle changes the line of pull of
the quads and may cause the patella to be
pulled laterally, with muscle contraction.
• Changes in mechanics can increase conditions
like:
– Chondromalacia
– Patellar dislocation/subluxation
– ACL?
• Key to treatment is pevention!
– Strengthen medial aspects of quads (VMO)
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Common Injuries
Osgood-Slatters
• Common to adolescents due to rapid growth
during “growth spurts”
• Characterized by swelling & point tenderness
below 1 or both knees.
– Can be caused by partial separation of the patellar
tendon from tibial tubercle
– Inflammation of the tibial tubercle
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Common Injuries
Whatever the cause it is
aggravated by activity, relieved by
rest
In cases of long duration the front
of the knee appears enlarged and
a bony prominence can be felt.
Although the condition is usually
disappears after adolescence the
boney prominence remains.
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Common Injuries
Other Musculoskeletal Disorders / Conditions
• Muscle strains
• Bursitis
• Dislocation (knee, patella)
• Iliotibial Band Friction Syndrome
• Meniscal Tear
• Myositis Ossificans
• Osteochondritis Dissecans (OCD)
• Popliteal Cyst
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