Lower Extremity 1. hip joint complex 2. Knee joint complex 3. ankle & foot complex
Lower Extremity Hip Part. 1. Anatomical consideration Part. 2. special test Part. 3. clinical consideration
Knee joint Anterior view
Knee joint Lateral view lateral collateral lig. LCL does not attach lat. Meniscus LCL runs nearly vertical LCL functions Resists varus(adduction) Resists knee extension Resists axial rotation
Knee joint Medial view medial collateral lig. post. med. collateral lig. ant. med. collateral lig. MCL attach the med. Meniscus MCL runs in a slightly oblique MCL functions Resists valgus(abduction) Resists excessive knee extension Resists axial rotation
Knee joint Posterior view arcuate popliteal lig. oblique popliteal lig.
Meniscus Fibrocartilaginous disc Ant. & post. horn Meniscus is attached to the tibia & capsule by Coronary lig. (=meniscotibial lig.) Transverse lig. connects the two menisci anteriorly Medial meniscus : oval or C shape attach to MCL & adjacent capsule Lateral meniscus : circular attach only to the lateral capsule
Meniscus Functions of meniscus - reduce the compressive stress - stablilizing the jt. during motion - lubricating the articular cartilage - reducing the friction Meniscus as shock absorbers while walking, compression forces at the knee joint reach approximately 2 to 3 times body weight. The menisci support about half the total load across the knee
Injury of the menisci of the knee Tears of the meniscus occur by forceful horizontal plane rotation of the femoral condyles over a partially flexed & weight-bearing knee. Locked-knee syndrome dislodged or folded flap of meniscus block knee movement Excessive valgus force taut MCL meniscus tearing
Osteokinematics of the knee open kinematic chain closed kinematic chain
Osteokinematics of the knee open kinematic chain closed kinematic chain
Arthorokinematics
Screw home motion Screw-home motion Automatic rotation Terminal rotation Locking mechanism Conjunction rotation Factors guiding screw home motion 1. Shape of medial femoral condyle 2. Tension in ACL 3. Lateral pull of quadriceps
Functions of collateral lig.
Cruciate ligament ACL : provides about 85% of the total passive resistance to the anterior translation of the tibia. PCL : provides about 95% of the total passive resistance to the posterior translation of the tibia.
Without patella 20% loss of internal moment arm needs to generate 25% more force to produce extensor torque
Cross-section through the right quadriceps
Q-angle 1. line connecting ASIS to midpoint of patella 2. Line connection the tibial tuberosity with the midpoint of patella Male : 11.2 Female : 15.8 Q-angle > 15 patellofemoral joint pain chondromalacia patellar dislocation
Excessive knee valgus and external rotation
Lower Extremity Knee Part. 1. Anatomical consideration Part. 2. special test Part. 3. clinical consideration
2. 특수검사 골절및탈구와불안정성검사및평가
드레이어징후검사 (Dreyer s sign test) 1) 검사의미 : 무릎뼈의골절유무를알기위한검사 2) 검사방법 3) 검사반응
무릎뼈불안검사 (patellar apprehension test) 1) 검사의미 : 무릎뼈의가쪽불완전탈구에의한불안정성을알기위한검사 2) 검사방법 3) 검사반응
야콥검사 (Jakob test) 1) 검사의미 : 정강뼈의뒤가쪽돌림불안정성을알기위한검사 2) 검사방법 3) 검사반응
교차검사 (crossover test) 1) 검사의미 : 무릎관절의앞가쪽불안정성을알기위한검사 2) 검사방법 3) 검사반응
슬로컴검사 (slocum test) 1) 검사의미 : 무릎관절의앞가쪽과앞안쪽의불안정성을알기위한검사 2) 검사방법 3) 검사반응
뼈, 관절변형검사및평가
넙다리네갈래근또는 Q 각검사 (quadriceps or Q angle test) 1) 검사의미 : 무릎뼈의불완전탈구나연골연화증을알기위한검사 2) 검사방법 3) 검사반응
안굽이무릎검사 (genu varus test) 1) 검사의미 : 무릎관절의비정상적인정렬을알기위한검사 2) 검사방법 3) 검사반응
밖굽이무릎검사 (genu valgus test) 1) 검사의미 : 무릎관절의비정상적인정렬을알기위한검사 2) 검사방법 3) 검사반응
뼈, 관절병변검사및평가
무릎뼈타진검사 (patellar tap test) 1) 검사의미 : 무릎관절의퇴행성관절염을알기위한검사 2) 검사방법 3) 검사반응
무릎뼈밀기검사 (patellar grind test) 크라크징후 (Clark s sign) 1) 검사의미 : 무릎뼈의연골연화증을알기위한검사 2) 검사방법 3) 검사반응
수정된졸러징후 (modified Zohler s sign) 1) 검사의미 : 무릎뼈의연골연화증을알기위한검사 2) 검사방법 3) 검사반응
동요검사 (fluctuation test) 1) 검사의미 : 무릎관절의부기 (swelling) 유무를알기위한검사 2) 검사방법 3) 검사반응
안쪽넓은근협응성검사 (vastus medialis coordination test) 1) 검사의미 : 무릎넙다리관절의기능부전을알기위한검사 2) 검사방법 3) 검사반응
계단내려가기검사 (step down test) 1) 검사의미 : 무릎넙다리관절의기능부전을알기위한검사 2) 검사방법 3) 검사반응
왈드론검사 (Waldron test) 1) 검사의미 : 무릎넙다리관절의기능부전을알기위한검사 2) 검사방법 3) 검사반응
물렁조직, 근육병변검사및평가
물렁조직, 근육병변검사및평가
맥머레이검사 (McMurray test) 1) 검사의미 : 무릎관절의반달손상을알기위한검사 2) 검사방법 3) 검사반응
아플레이검사 (Apley test) 1) 검사의미 : 관절면의상태와반달의손상또는주변인대손상과의감별진단을알기위한검사 2) 검사방법 3) 검사반응
되튕김검사 (bounce home test) 1) 검사의미 : 무릎관절의반달손상을알기위한검사 2) 검사방법 3) 검사반응
테실리아검사 ( 디스코검사 ) Thessaly test(disco test) 1) 검사의미 : 무릎관절의반달손상을알기위한검사 2) 검사방법 3) 검사반응
에그검사 (Ege s test) 1) 검사의미 : 무릎관절의반달손상을알기위한검사 2) 검사방법 3) 검사반응
중력끌림검사 (posterior sag test) 1) 검사의미 : 무릎관절의뒤십자인대의손상을알기위한검사 2) 검사방법 3) 검사반응
끌림 ( 서랍 ) 징후검사 (drawer test) 1) 검사의미 : 무릎관절의앞쪽과뒤쪽방향으로관절면에서움직임과십자인대의안정성을알기위한검사 2) 검사방법 3) 검사반응
라크만검사 (Lachman test) 1) 검사의미 : 무릎관절의십자인대에대한불안정성을알기위한검사 2) 검사방법 3) 검사반응
축이동검사 (pivot shift test) 1) 검사의미 : 무릎관절의앞십자인대와뒤가쪽관절주머니의손상을알기위한검사 2) 검사방법 3) 검사반응
밖굽이긴장검사 (valgus stress test) 1) 검사의미 : 무릎관절의안쪽구조물 ( 안쪽곁인대 ) 의안정성을알기위한검사 2) 검사방법 3) 검사반응
안굽이긴장검사 (varus stress test) 1) 검사의미 : 무릎관절의가쪽구조물 ( 가쪽곁인대 ) 의안정성을알기위한검사 2) 검사방법 3) 검사반응
노블검사 (Noble test) 1) 검사의미 : 무릎관절의엉덩정강근막띠증후군을알기위한검사 2) 검사방법 3) 검사반응
무릎주름검사 (patellar plica test) 1) 검사의미 : 무릎관절의주름손상을알기위한검사 2) 검사방법 3) 검사반응
티넬검사 (Tinel test) 1) 검사의미 : 무릎관절부위의말초신경병변을알기위한검사 2) 검사방법 3) 검사반응
Lower Extremity Knee Part. 1. Anatomical consideration Part. 2. special test Part. 3. clinical consideration
3. 사례형문제
Problem solving strategy Physical therapist 나 는 할수있는가?