Week 6: Knee and Lower Leg Flashcards
(32 cards)
Knee Joint (3 Joints)
- Tibiofemoral joint
- Patellofemoral joint
- Superior tibiofibular joint
Compartments of Lower Leg (3)
- Lateral: peroneal group
- Anterior: extensor (DF) group
- Posterior: flexor (PF) group
Muscles of Anterior Compartment (4)
- Tibialis anterior
- Extensor hallucis longus
- Extensor digitorum longus
- Peroneus tertius
Muscles of Lateral Compartment (2)
- Peroneus longus
- Peroneus brevis
Muscles of Deep Posterior Compartment (3)
-Tom, Dick & Harry:
1. Tibialis posterior
2. Flexor digitorum longus
3. Flexor hallucis longus
*Together they dynamically help to stabilize medial ankle
Muscles of Superficial Posterior Compartment (3 +1)
- Gastrocnemius
- Soleus
- Plantaris
*Achilles tendon
Intracapsular Structures of the Knee (5)
- Anterior cruciate ligament (ACL)
- Posterior cruciate ligament (PCL)
- Meniscus (medial and lateral)
- Cartilage
- Joint surface
*important to know which structures are intracapsular vs extracapsular because only certain ones are in each space, so it is easy to rule out injuries if you know which is which and where structures are affected
Special Test: Wipe Test
*for intracapsular swelling
-Wipe up medial side, then down lateral side (swelling will pop out medial side)
-Great starter test to narrow in on structures affected (capsule will be full/swollen if intracapsular, if you tear capsule whole knee will be swollen)
Quadriceps Muscle (4)
- Rectus femoris
- Vastus lateralis
- Vastus intermedius *3 lateral pull on patella
- Vastus medialis *1 medial pull on patella
Hamstrings (3)
Medial:
1. Semimembranosus
2. Semitendinosus
Lateral:
3. Biceps femoris
Pes Anserine Group
*Insert medial proximal tibia, “say grace [before] tea” = medial to lateral
- Sartorius
- Gracilis
- Semitendinosus
Functional Anatomy and Biomechanics
-Gluteus medius= hip abduction
-Anterior fibers: internal rotation of hip, assists with hip flexion
-Posterior fibers: extend and externally rotate hip *eccentrically controls IR of femur in WB
-Prevents pelvis on stance side from dropping during gait (Trendelenburg gait= can’t stabilize on one side so the other side drops)
*What happens down the chain if this is weak? Increases forces at the ankle and puts strain on other structures
-Quadriceps= 3 pull. Laterally, 1 pulls medially= natural imbalance
-Quads: Hams ratio ideally 3:2, post ACL injury 1:1
Shin Splints (Medial Tibial Stress Syndrome- MTSS)
-Involves exercise-induced pain over anterior tibia and is an early stress injury in the continuum of tibial stress fractures
-Do not train through shin splints
-Treat cause more than just localized area (tape arches/other supporting structures)
Compartment Syndrome
-Excessive pressure within a muscle/fascial compartment (tap at top open, tap at bottom closed, builds pressure)
-MOI: Acute- trauma or following long bone fracture (e.g. tibia- most common, distal radius). Overuse- often overlooked as shin splints
-S&S: Red, hot, shiny, very painful, numb, weak, faint pulse distal to site, some describe pale skin over damaged tissue
-Acute management: no pressure, reduce inflammation, no RTP, NWB, refer to sport med Dr. (proper management essential), occasional need for fasciotomy to release pressure
Gastrocnemius/Soleus Strains
-MOI: Gastrocs/soleus overstretch in DF with knee extension (gastrocs) especially with forceful contraction
-S&S: “Pop” or “pull”, sharp pain, swelling, bruising
-Special tests: muscle test for gastrocs, soleus, deep flexors, Thompson Test to rule out Achilles rupture, toe raises
-Acute management: PIER, pressure pad with wrap over injured sites, NWB, avoid stretch or contraction
-RTP: No- usually self-limiting; once rehabbed, can tape with heel lift for initial RTP
Achilles Rupture
-MOI: Sudden forceful contraction
-Common in stop and go sports- basketball, tennis, squash
-S&S: Sudden sharp pain (partial rupture) or feeling of being kicked/hit in back of leg, unable to PF or go up on toes, swelling, delayed-onset bruising (becomes extensive)
-Special tests: Thompson Test, 2 foot-1ft toe raise
-Acute management: PIER, NWB, pressure pad over injured tissues with tensor, educate, refer for consult with sports med Dr.
Patellofemoral Pain Syndrome (PFPS)
-MOI: Poor tracking of patella in femoral condyle
-S&S: Posterior aspect of patella TOP
-Check:
-Mechanics from bottom up and top down
-Stable base?
-Quad imbalance- medial vs lateral pull? Static quad contraction- what happens?
-1 leg squat- what happens? Does femur collapse into IR?
-Most often overuse condition; occasionally acute onset
Patellar Dislocation
-MOI: Valgus force with foot planted, causing IR of femur
-Most common in active children ages 10-17
-S&S: Patella positioned on lateral side of knee, significant pain, usually in knee flexion
-Special tests: none if dislocated; sublexed= apprehension test
-1st time dislocation need to rule out osteochondral fracture (can affect patella or femoral condyle, occurs in 25-75% of cases and requires surgical intervention)
-Acute management: rule out fracture, PIER if reduced, refer, braced in full extension for 3 weeks then ROM and VMO strengthening (and top down/bottom up biomechanics corrections)
Patellar Tendonitis
-MOI: Excessive traction on patellar tendon
-S&S: Pain, swelling and heat over patellar tendon, pain with jumping, running, quick change in direction or strong quad contraction, pain with flexion and extension, can often train/compete through pain
-Special tests: Thomas Test; resisted quads
-Acute management: PIER, roll/soft tissue mobility for quads, lower extremity mechanics- how are they moving for components of their sport?
-NB to train hamstrings to prevent anterior translocation of tibia on femur, and stability at hip and knee
-Tendinopathy rehab- eccentrics, x-training
-RTP: patellar tendonitis tape job (common in basketball)
Knee Bursitis
-Bursas: fluid-filled sacs, lay flat b/t areas of friction
-MOI: Direct trauma, friction from tight muscles/tendons
-S&S: Rebound pain, often painless, visible fluid-filled sac (sometimes extreme)
-Acute management: protect with padding to avoid repeat insult, soft tissue mobility of tight muscles
-Chronic bursitis can develop granular rice-like texture
3 Fractures of Lower Leg
- Stress fractures- MTSS/Shin splints
-MOI: Overuse/poor mechanics - Patellar fracture
-MOI: Direct blow, patellar discolouration - Tibial plateau fracture
-MOI: Varus or valgus load, direct blow
Meniscus Structure and Function
-Medial “C”, lateral “O”
-Poor blood supply
-Function: cushion joint during loading
Types of Meniscus Tears (6)
- Vertical
- Transverse
- Peripheral
- Bucket-handle (arch flips up)
- Parrot-beak
- Flap
*if they can save meniscus they will suture it, but will do surgery if severe (and depends on person’s goals)
Meniscus Tears
-MOI: Plant and twist, contact, wear and tear/degeneration
-S&S: Sharp pain at specific ROM, loaded rotation deep squat, catching/clicking/locking, swelling (often presents 24 hours later)
-Commonly associated with ACL injuries
-Special tests: McMurray’s (gold standard), Apley’s, duck walk
-Acute management: PIER, NWB, educate, conservative treatment first choice unless locking- refer
-Plica? Often presents same way
-Bracing can’t stop all movement so not effective for that, but brings awareness to area (proprioception)
