knee joint

Chapter 2 The knee joint

ANATOMY 41
Bony landmarks to be palpated 42
Ligaments 42
Muscles 43
Extensors 43
Flexors 44
Medial (internal) rotators 45
Lateral (external) rotators 46
MEASUREMENT 46
Range of movement 46
Extension 46
Flexion 47
Joint girth 48
Knee 48
Muscle bulk 49
Thigh 49
Calf 50
Observational/reflective checklist 52
Muscle strength: Oxford muscle grading 53
Extensors 53
Flexors 55

Anatomy

1. The knee joint is one of the largest and most complex joints of the body.
2. It comprises three separate articulations: two tibiofemoral joints and the patellofemoral articulation.
3. It is a synovial, bicondylar hinge joint.
4. It has a thick capsule encapsulating all three joints which attaches to the articular margins.
5. The capsular ligaments comprise oblique popliteal ligament, the arcuate popliteal ligament and the ligamentum patellae.
6. All hinge joints have collateral ligaments. The knee joint has the tibial (medial) and fibular (lateral) collateral ligaments.
7. The intra-articular structures consist of the cruciate ligaments (anterior and posterior) and the menisci (medial and lateral).
8. The movements that take place at the knee joint are: extension and flexion. When the knee is flexed, axial rotation of the leg can be performed. These movements consist of lateral (external) rotation of the tibia on the femur and medial (internal) rotation of the tibia on the femur.

Bony Landmarks to be Palpated

The femur – medial condyle, lateral condyle, lateral epicondyle, medial epicondyle and adductor tubercle.
The patella – anterior surface of the patella, and the apex of the patella.
The tibia – medial and lateral condyles, and the tibial tuberosity.
The fibula – the head of the fibula.

Ligaments

Table 2.1Knee ligaments

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Muscles

Extensors

Table 2.2The extensors of the knee

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Flexors

Table 2.3The flexors of the knee

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Medial (internal) rotators

Table 2.4The medial (internal) rotators of the knee

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Lateral (external) rotators

Table 2.5The lateral (external) rotators of the knee

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Measurement

Range of Movement

Extension

Starting position:

image

Fig 2.1 Goniometric measurement of knee extension.

The patient is positioned in half lying/supine lying on the plinth, their hip in neutral and their knee in extension.

Goniometer axis:

The axis of the goniometer is placed over the lateral epicondyle of the femur.

Stationary arm:

This is parallel to the longitudinal axis of the femur, pointing towards the greater trochanter of the femur.

Moveable arm:

This is parallel to the longitudinal axis of the fibula, pointing towards the lateral malleolus of the fibula.

Command to patient:

‘Straighten your leg as much as possible.’

End position:

The knee is extended to its limit of motion.

Flexion

Starting position:

image

Fig 2.2 Goniometric measurement of knee flexion.

The patient is positioned in half lying/supine lying on the plinth. Their hip is in neutral and their knee is in extension.

Goniometer axis:

The axis of the goniometer is placed over the lateral epicondyle of the femur.

Stationary arm:

This is parallel to the longitudinal axis of the femur, pointing towards the greater trochanter of the femur.

Moveable arm:

This is parallel to the longitudinal axis of the fibula, pointing towards the lateral malleolus of the fibula.

Command to patient:

‘Bend your knee up towards you so that your heel moves towards your buttock as much as possible.’

End position:

The hip and knee are flexed to the limit of motion. The heel is moved towards the buttock to the limit of knee flexion.

NB: It may be necessary to reposition the stationary and moveable arms of the goniometer prior to taking the reading, as they may have moved when the patient flexed their knee.

Joint Girth

Knee

Patient’s position:

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Jun 4, 2016 | Posted by in MANUAL THERAPIST | Comments Off on knee joint

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