Palpation Techniques_ Surface Anatomy for Physical Therapists ( PDFDrive )

122 6 Knee Joint Lateral Femur Femur Gerdy epicondyle Lateral tubercle Medial epicondyle Gerdy epicondyle Tibial tubercle Head Patella of the fibula Tibial tuberosity Fibula :-_-Tibia Fibula --_-�: Tibia Fig. 6.1 Topography of the osseous reference points-anterior Fig. 6.2 Topography of the osseous reference pOints-lateral view. view. Knee-joint stabilization in the frontal plane is the func­ Common Assessment and Treatment tion of both the collateral ligaments and the posterior cap­ Techniques sule. • Assessment and mobilization of existing restrictions in The dynamization of different collagenous structures mobility. at a joint was not an \"invention\" of the knee joint. How­ ever, it is quite distinct in this region. Dynamization • Improvement of muscular tracking of thejoint in cases means that muscles, and sometimes their tendons, are at­ of instability. tached to the capsule or menisci. Different sections of the capsule are placed under tension and strengthened when • Treatment of injuries in ligaments and muscles or the these muscles contract. During active movement of the symptoms associated with overloading. knee, the femoral condyles not only \"roll\" over the menisci on the tibia in an anterior or posterior direction, the con­ The high prevalence of irritation or injury to ligaments, traction of muscles also pulls on the menisci and causes tendons, and bursae shows in the established use of inde­ movement. pendent terms such as \"runner's knee\" (iliotibial band fric­ tion syndrome), \"jumper's knee\" (insertion tendinopathy Common Applications for Treatment in of the patellar ligament at the apex of the patella), and this Region \"housemaid's knee\" (prepatellar bursitis). A Selection of Possible Symptoms Required Basic Anatomical and Biomechanical Knowledge It is beyond the scope and objectives of this book to list all Therapists must have a good basic knowledge of anatomy types of disease and injuries seen in the knee joint. There­ to locate specific important structures in the knee joint fore, only the most important groups are listed below: and its surroundings. Therapists are famili' ar with most • Capsular and noncapsular restrictions in movement. bony and ligamentous structures. It is important to de­ • Hypermobility and/or instability. velop good spatial sense so that the construction of the • Pathological conditions of the meniscus. knee can be considered from different perspectives. • Injuries to ligaments or Iigamental overuse syndromes. Here are a few pointers: • Injuries to the muscles or muscular overuse syndromes Construction of the Femorotibial Joint (including tendons and insertions). • Disease of the femorotibial articular cartilage (e.g., ar­ • Anterior view of the position and shape of the femoral condyles (Fig. 6.1 ). thritis or osteochondrosis dissecans) or the patellofe­ moral articular cartilage (e.g., chondromalacia patellae or patellofemoral pain syndrome).

Quadriceps Patellar Palpating Edema and Increase in Temperature 123 femoris ligament A-- Rectus Biceps femoris femoris Iliotibial tract --:--- -\\-t-!t e Patella Patellar lig. Lateral collateral ---I!7i ligament Common peroneal nerve Head of the fibula Fig. 6.3 Relevant lateral soft tissues. Fig. 6.6 Rectus femoris, patella, and ligament during knee Vastus _,__-_ - Gracilis extension. Semi­ �-- Vastus tendinosus lateralis '__-_ -- Patella Patellar Saphenous nerve Fig. 6.4 Relevant medial soft tissues. Fig. 6.7 Rectus femoris, patella, and ligament during knee flexion. Base of the patella ---, Construction of the Patellofemoral Joint Medial pole • General construction of the patella (its shape in the view demonstrating its base, poles, and apex; Fig. 6.5). • Patellar ligament (Figs. 6.6 and 6.7). • Position of the patella in extension and flexion (Figs. 6.6 and 6.7). .,\"-\" Apex of the patella Palpating Edema and Increase in Temperature Fig. 6.5 Sections of the patella-anterior view. Summary of the Palpatory Process • Shape of the tibial plateau, crucial when locating the joint space and following the space laterally (Figs. 6.2 Techniques will be described that identify the presence of and 6.4). edema and increased temperature in thejoint in terms of: • Large effusions. • Position and pathway of peripheral nerves (tibial • Medium-sized effusions. nerve, common peroneal nerve, and saphenous nerve; • Minimal effusions. Fig. 6.4). • The palpation of an increase in temperature.