PRESENTER:-Dr. Baharul Islam Choudhury

PGT

MODERATOR:-Dr. M. Gayan

Asst. Proff.

Date- 04 /11 / 2015

Bony structures-

> Condyles of femur

> Condyles of Tibia

> Patella

JOINT CAPSULE

Ligamentum Patellae

Oblique Popliteal

ligament

Ant & Post Cruciate ligament

Medial & Lateral Meniscus

Transverse ligament

Connects the ant. ends of

med & lat

meniscus.

MUSCLES CONTROL MOVEMENT OF KNEE

Movement Principal Muscle Accessory Muscle

Flexion 1. Biceps Femoris2. Semimembranosus3. Semitendinosus

1. Gracilis2. Sartorious3. Popliteus

Extension 1. Quadriceps Femoris 1. Tensor Fasciae Latae

Med Rotation of flexed leg 1. Popliteus2. Semimembranosus3. Semitendinosus

1. Gracilis

Lat Rotation of flexed leg 1. Biceps Femoris

NERVE SUPPLY OF KNEE JOINT

> Femoral nerve, through its branches to the vasti, especially vast med.

> Sciatic nerve, through the genicular branch of the tibial & common peroneal nerve.

> Obturator nerve, through its posterior division.

Occurs during last stage of extension.

Medial rotation of femur takes place.

All the ligaments are taut in locking position.

Quadriceps Femoris acts on locking mechanism.

PAIN

SWELLING

STIFFNESS

MECH. DISORDER ( locking, giving way, click)

LIMP

LOSS OF FUNCTION

Position during examination

Standing

Sitting

Supine

prone

Inspection

Palpation

Deformity and R.O.M

Measurements

Special tests

INSPECTION

Gait

Attitude

Inspc. Cont..

Swelling

Muscle Wasting

Inspc. Cont..

Sinus

Scar

Inspc. Cont..

Skin condition

Venous prominence

PALPATION Temperature-

Tenderness-

> Bony tenderness

> Joint line tenderness

PALP CONT… Retropatellar Tenderness

>Patellar Grind test-

Patient supine & knee extended

Med & lat pressure over the prox patella

Press it into intercondylar groove

Ask to contract quadriceps

PALP. CONT…

Retropatellar Tenderness

> Facet tenderness test-

PALP.. CONT….

Retropatellar Tenderness

> Friction test-

Patient supine > Knee extended > Compress the patella > Glide the patella from med to lat & sup to inf.

Swelling

Normally when knee is gradually flexed a hollow

appears & then disappears just lateral to the

patellar tendon. In the presence of fluid when

compared to the opposite knee refilling of the

hollow occurs at a lesser angle of flexion.

Other Test For Swelling

Transillumination Test.

+ive- on enlarged bursa, cystic swelling.

-ive-on swelling containing blood, pus.

Compression Test.

+ive in Baker’s cyst, popliteal aneurysm.

PALP. CONT…

Palpation of patella

Palpation of lower end of femur

Palpation of upper ends of Tibia & Fibula

Palpation of popliteal fossa

Palpation of muscle

Palpation for any crepitus

Palpation of Lymph Nodes

MOVEMENTS

Flexion – 0 to 150 degree or till the heel touches the buttock

Extension- till the thigh & leg form a straight line

Abduction & Adduction– absent on extension but slight degree is possible on semiflexion.

Rotation – absent on extension but some degree is possible when hip & knee are flexed to 90 degree

Wasting of Quadriceps

Q- Angle

Indicates the direction of pull of patella by Quadriceps

In male- 14 degree

In female – 17 degree

STABILITY TEST

TESTS FOR ACL.

Lachman test

* Patient on supine.

* Knee on 15-20 deg flex.

* Femur is stabilized.

* Thumb on other hand

on jnt line.

*Anteriorly directed lift

ing force applied.

* Ant. Translation with

soft or mushy end point indicate +ive result.

Lachman Test

Modification I

Stable Lachman Test

Modification II

Drop leg Lachman Test ( Modification III)

Lachman Test ( Modification IV)

Active Lachman Test

ACL test cont..

Anterior Drawer Test-

* Patient is on supine.

* Hip flexed to 45 deg &

knee 90 deg.

* Sits on Patient’s foot.

* Gentle & repeated pull

& push on prox leg.

* Displacement 6-8 mm

Greater than opposite knee +ive result.

Rotary Test For ACL Insufficiency

Lateral Pivot Shift Test Of Macintosh

Rotary Test For ACL Insufficiency

Jerk Test

+ive result when

Lat tibia spontaneously uslysubluxes forward

with sudden

Jerk at about 30 deg

of flexion.

Sag sign

Post. Drawer Test-

Quadriceps active Test

Slocum Test

External Rotation

Recurvatum Test

Jacob Test ( Reverse Pivot Shift Sign )

Mc,murray’sTest

Apley’ Grinding Test-

Thessaly Test-

Squat TestSeveral repetition of full squat with feet & leg

alternately internally & externally rotated.Pain on medial or lateral joint line corresponding

to the side of the torn meniscus.pain in the internally rotated position suggests lat

meniscus inj & pain in externally rotated position

suggests med meniscus inj.

TEST FOR MCL & LCL STABILITY

Valgus & Varus stress test-

Valgus & Varus stress Test

Apley’s Distraction Test For MCL & LCL

TEST FOR RECURRENT PATELLAR DISLOCATION

Apprehension Test-

Pressing patella laterally

Flexing knee slowly

Induce anxiety & resistant

to further movement.

Examination Of Popliteal Fossa.

Examination Of Hip.

THANKING YOU