Examination of the Knee
기능해부학 functional anatomy Knee joint 의구성 - distal of femur + med, lat epicondyle of tibia - meniscus : fibroscartliage : knee joint에내, 외측에부착된연골륜 : 외측 < 내측, 내측이외상받기쉽다
http://www.eorthopod.com/images/contentimages/knee/knee_anatomy/knee_anatomy01.jpg
http://www.eorthopod.com/images/contentimages/child/child_knee_blounts/child_knee_blounts_anatomy02.jpg
Knee joint 의 cartilage 반월상연골의형태 - medial & lateral meniscus - 반달-쐐기형이며 fibrous cartilage - 혈액공급이없어손상시회복불능 - 외측반월상연골의모양은 0 형, 내측 C
http://www.cartilagerestoration.org/sites/default/files/normal_knee_top_down.jpg
Function of meniscus: shock absorption http://www.mendmyknee.com/_img/meniscus-knee-joint-load.gif
knee joint 의 ligament http://www.eorthopod.com/sites/default/files/images/knee_collateral_anatomy01.jpg
knee joint 의 ligament 1) Cruciate ligament * anterior cruciate ligament - 경골전면내측반월에서대퇴후방외과에부착 - 대퇴가경골에서후방으로전위되는것을방지 - 경골이대퇴에서전방으로전위되는것을방지 - 과도한과신전방지
http://www.baseballprospectus.com/u/images/cd2.png
knee joint 의 ligament 1) Cruciate ligament * posterior cruciate ligament - 후경골에서대퇴전방외측과에부착 - 대퇴가경골에서전방으로전위방지 - 경골이대퇴에서후방으로전위방지
http://www.eorthopod.com/sites/default/files/images/knee_anatomy04.jpg
Knee joint 의 ligament 2) Collateral ligament - frontal plane 에서안정성제공 * 내측측부인대 (medial collateral ligament) - femur 의내측상과에서기시하여경골상단연결 - 외전방지 * 외측측부인대 (lateral collateral ligament) - femur 의외측상과에서기시하여비골두연결 - 관절낭과독립적으로분리 - 내전방지
슬개인대 (infrapatella ligament) - quadriceps tendon 이슬개골하연에서 tibial tuberocity 에부착 - 전방안정성
Inspection 보행이부드럽고율동적인가 bursitis ; prepatella bursitis infrapatella bursitis pesanserine bursitis 근위축 : vastus medialis Valgus angle ; 내반슬, 외반슬, 반장슬
http://meded.ucsd.edu/clinicalmed/knee_surface_anatomy.jpg
http://www.nature.com/nrrheum/journal/v7/n1/images/nrrheum.2010.195-f2.jpg
https://edc2.healthtap.com/ht-staging/user_answer/avatars/754710/large/open-uri20121219-30492-w4u2sr.jpeg
Bony Palpation 1) 내측면 1 내측경골플라토 (Medial tibial plateau) 2 경골조면 (Tibial tubercle) 3 대퇴골내측과 (Medial condyle) 4 내전근결절 (Adductor tubercle)
Bony Palpation 2) 외측면 1 외측경골플라토 (Lateral tibial plateau) 2 외측결절 (Lateral tubercle) 3 대퇴골외측과 (Lateral femoral condyle) 4 대퇴골외측상과 (Lateral femoral epicondyle) 5 비골골두 (Fibular head) 3) 활차절흔과슬개골
Latera plateau Fibular head
Soft tissue palpation 1) 제 1 구역 - 전면 (anterior aspect) 1 대퇴사두근 (Quadriceps femoris) Rectus femoris Vastus medialis, Vastus lateralis, Vastus intermedius
Soft tissue palpation 1) 제 1 구역 - 전면 (anterior aspect) 2 슬개인대 (Infrapatella tendon) - os good-schlatter syndrom e - bursitis 3 천슬개하점액낭 (superficial infrapatellar bursa) 4 전슬개점액낭 (prepatella bursa) ; 주부 5 아족점액낭 (Pes anserine bursa)
http://physioneeds.ie/wp-content/uploads/2014/12/osgood_schlatter-2.jpg http://www.eorthopod.com/sites/default/files/images/child_knee_osgood_intro01.jpg
http://physioworks.com.au/images/injuries-conditions/knee_bursitis.jpg
Soft tissue palpation 2) 제 2 구역 - 내측 (medial aspect) 1 내측반월판 (Medial meniscus) 2 내측측부인대 (Medial collateral lig.) 3 Sartorius, Gracilis, Semitendinosu)
Soft tissue palpation 3) 제 3 구역 - 외측연 (Lateral aspect) 1 외측반월판 (Lateral meniscus) 2 외측측부인대 (Lateral collateral lig.) 3 전상경비인대 (anterosuperior tibiofiular lig.) 4 대퇴이두근건 (Biceps femoris) 5 장경인대 (Iliotibial tract) 6 총비골신경 (Common peroneal N.)
http://www.eorthopod.com/iliotibial-band-syndrome/topic/63
http://classconnection.s3.amazonaws.com/661/flashcards/1011661/jpg/sacral-plexus-tibial-nerve-common-fibularnerve1333654508571.jpg
Soft tissue palpation 4) 제 4구역 - 후면 (Posterior aspect) 1 슬와 (Popliteal fossa) - superior lateral border ; biceps femoris - superior medial border ; semitendimosus, mem- - inferior border ; gastrocnemius 2 후경골신경 (Posterior tibial N.) ; 가장표층 3 슬와정맥 (Popliteal vein) ; 신경바로밑 4 슬와동맥 (Popliteal artery) ; 가장심층 5 비복근 (Gastrocnemius) ; 손상이심할경우 calcaneous gait
https://classconnection.s3.amazonaws.com/807/flashcards/589807/png/screen_shot_2011-07- 20_at_2.24.49_pm1311197125463.png
http://arabbones.com/educations/popliteal-cysts_files/image018.gif