Abridged Upper leg muscles, Knee Injuries and Tests
Muscles and their functions
Intrinsic Knee Postures
Genu Valgum
- "Knock knees” - More common in Females
- Born this way, can cause medial leg pain and iliotibial band
- Buckles inward when jumping, quads are weak.
Genu Varum
- “Bowed legs”
- Lateral leg pain
Genu Recurvatum
- “Back - knee”
}}Muscle Strains}}
- Refers to pulling the hamstrings too far/fast
- Explosive starts and stops can cause torn cells and fibers
Hamstring Strain
- Hamstring function - Flex the knee, extend the hip, knee stabilizer
- Function by eccentric contraction to decelerate, aldo prevents forward progression of tibia
- Under greatest strain when sprinting in arch or coming out of a turn
- Prolonged and high rate of recurrence
Quadriceps Strain
- Common strain
- Forceful eccentric contraction of the quads
- During regulation of knee flexion and hip extension
Osgood Schlatter (Traction Epophysitis)
- A painful lump below the knee cap pulling force on tibial tuberosity
- Caused by irritation of bone growth plate, repeated stress on patellar tendon
- Lump, pain in knee or lower leg, limping
- Treatments can include NSAIDS, RICE, Tubular padding
{{Patella Tendon Reflex{{
L2 - L4 Neurological Assessment
}}The Patella}}
Q-Angle
- Angle formed by a line drawn from the Anterior Superior Iliac Spine to the patella and a line drawn from the patella to the tibial tuberosity
- AKA - Angle between quads and patellar tendon
- Causes Genu Valgum, lateral patella movement, patella tracking deficiency
Patella Tracking Deficiency
- Shifts out of place as leg moves
- Twisting movements that strain knee joint, blow to knee
- Popping, grinding, catching in the knee cap
- Bracing, rest, stretching, taping NSAIDs
Patella Subluxation/Dislocation
- Patella moves out of place (usually lateral)
- Cutting motions, acceleration/deceleration
- Loss of knee functions
- Reduction, referral RICE
- Involves the weakening of the medial patellofemoral ligament
{{Patellar Dislocation Apprehension Test{{
- Use both thumbs to apply pressure medially across the joint. Positive sign = contraction of quads.
- Tests patella tracking
Chondromalacia Patella/Patella Femoral Chondrosis
- Damage to the cartilage under the kneecap
- Post traumatic injuries, wear and tear, overuse
- Most common symptom = knee pain worsens during use
- Therapy, RICE, NSAIDs
External Tibial Rotational Deformity
- Seen in children, runs in family
- External rotation of the tibia, results in duck footed posture but knees still straight
- Surgery and bracing to help fix
Internal Tibial Rotational Deformity
- Seen in children, runs in family
- Internal rotation of the tibia, results in pigeon toes posture but knees are still straight (ACL Stress)
- Surgery and bracing o help fix.
Tibiofemoral Dislocation
- Dislocated knee, femur goes posterior usually
- Caused by an external force
- Pain, unable to move the knee
}}Ligaments}}
Tests can be found at the end
Posterior Cruciate Ligament (PCL) Sprain
- Most important ligament in the knee
- Can be caused by falling on the knees, blow to the front of bent knee
- Symptoms can include pop in the back of the knee, point tenderness, posterior translation
- Treatments can include surgery, RICE, crutches
Anterior Cruciate Ligament (ACL) Sprain
- Common in sports
- Don’t always have to treat it since it has a 12 week rehab - Dependant on age and activity
- Can be caused by Anterior translation of tibia, pain, swelling, deceleration and change of direction
Medial Collateral Ligament (MCL) Sprain
- Valgus force on the knee
- Symptoms can be that the patient was hit on the lateral knee, but hurts on the inside
- RICE, cryotherapy, crutches
Lateral Collateral Ligament (LCL) Sprain
- Less common than MCL
- Varus Stress, a lot in skiing
- Tenderness over the LCL, swelling
- Cryotherapy, crutches, surgery
Unhappy Triad
- MCL
- Medial Meniscus
- ACL
Meniscal Tears
- Meniscus lacks blood supply
- Medial one tears more often because it is more attached to it and isn’t as flexible
- Knee feels like it’s locking, giving out, feels weak, can’t squat
- Refer to orthopedic for imaging, RICE
- Caused
Tests
| <<Test<< | <<What it tests<< | <<Description<< | <<Image<< |
|---|---|---|---|
| Q - Angle | The difference in the angle of pull of the quads and the patella tendon | Center of patella to center of tibial tuberosity. Center of patella to ASIS |  |
| Kendall Test | Rectus Femoris Contracture | Positive test = Hip flexion and Knee extension |  |
| Stretch for Rectus Femoris |  | ||
| Patellar Tendon Reflex | Neurological Assessment for L2 - L4 | Tapping on the patellar tendon |  |
| Patellar Grind Test | Chondromalacia patella | Glide the patella distally, and firmly compress patella against trochlear grooveActive quad contraction yields pain |  |
| Patellar Dislocation Apprehension test | Patella Tracking | Use both thumbs to apply pressure medially across the joint. Positive = contraction of quads |  |
| Tibial Torsion Test | Measures the thigh-foot angle, if the foot is shaped normally | Lying relaxed and prone, with the knee and ankle each at 90 degrees, imagine a line from the second toe to the middle of their heel. Normal tibial angle in older children and adults is 10 - 20 degrees |  |
| Anterior Drawer Test | ACL | Patient supine, knee flexed to 90, evaluator applies anterior force to tibia, notes any glide >5mm |  |
| Lachman Test | ACL | Patient supine, knee flexed to 30, evaluator applies anterior force to tibia, while holding femur in place, notes any anterior glide >5mm |  |
| Posterior Drawer Test | PCL | Patient supine, knee flexed to 90, evaluator applies posterior force to tibia, notes any posterior glide >5mm |  |
| Varus Stress Test | LCL | Patient supine, knee extended (0, 10, and 30), a varus stress is applied as indicated in the picture. Note pain or instability |  |
| Valgus Stress Test | MCL | Patient supine, knee extended (0, 30), a valgus stress is applied as indicated in the picture. Note pain or instability |  |
| Apley’s Distraction Test | Collateral ligaments | It is done together with Apley’s Compression Test for meniscal tear. Location of pain is noted |  |
| Apley’s Compression Test | Meniscus | Test is positive if pain is reproduced in the joint line |  |
| Bounce Home Test | Meniscus | Positive = full extension of knee is not complete or has a rubbery end feel indicating a torn meniscus or other intra-articular pathology |  |