Hip Quiz

1. Which muscle has orign at posterior sacrum

and illium and inserts just distal to the
greater trochanter?
2. The gluteus medius is a prime mover in this
hip motion?
3. Which one joint muscle extends the hip?
4. The bony landmark of the femur located
medially and posterior on the proximal end,
it is illiopsoas attachment.
5. What muscles laterally rotate the hip?
Knee Joint
Knee Joint
One of the most frequently injured joints in
the body.
Largest joint in the body and a synovial hinge
joint.
It mainly flexes and extends, but it does have
a rotational component as well.
Knee Joint
Patellofemoral joint- articulation between the
patella and the femur.
Patellas main job is to increase the
mechanical advantage of the quad muscle and
protect the knee joint.
Knee Joint
With a longer moment arm, there is more
angular force. With a shorter moment arm,
the force would be more directed to the joint
than the tendon.
Knee Joint
Q-angle- angle between the quadriceps
muscle and patellar tendon. It ranges from
13-18 degrees in normal individual in knee
extension. It is greater in females. Due to
our wider pelvis.
Lets graph our q-angles.
Knee Joint-Landmarks
Intercondylar eminence- double pointed
prominence on the proximal surface of the
tibial plateau.
Knee Joint-Landmarks
Medial and Lateral Condyle of the tibia-
proximal end of the bone just below the tibial
plateau.
Knee Joint-Landmarks
Tibial Plateau- proximal end including the
medial and lateral condoyles and
interdcondylar eminance. The top of the tibia.
Knee Joint-Landmarks
Tibial Tuberosity- large
projection at the proximal
end and anterior side,
where the patellar tendon
attaches.
Knee Joint-Landmarks
Patella- triangular shaped seasmoid bone
within the quadriceps tendon.
Knee Joint Structures
Cruciate Ligaments- within the joint capsule,
they cross. They are intracapsular ligaments
and named for their attachment on the tibia.
Knee Ligaments
Anterior Cruciate Ligament- It attaches to the
anterior side of the tibia just medial to the
medial meniscus. It attaches to the posterior
side of the femur. It prevents anterior
translation of the tibia on the femur.
Knee Ligaments
Posterior Cruciate Ligament- attaches to the
posterior side of the tibia. It attaches to the
anterior femur and prevents posterior
translation of the tibia on the femur.
Knee Ligaments
Medial Collateral
Ligament- Attached
to the tibia and
femur on the medial
side of the knee
joint. Also attached
to the medial
meniscus, so injury
to one can result in
injury to both.
Knee Ligaments
Lateral Collateral Ligament- attached from
the femur to the fibula on the lateral side of
the knee. Shorter and stronger than the
MCL.
Knee Joint Structures
Meniscus- medial and lateral meniscus are
two half moon, wedge shaped fibrocartilage
located on the superior tibia. They provide
shock absorption in the knee. Medial is more
often torn.
Knee Joint Structures
Bursa- fluid filled sac that reduce friction in a
joint. The knee has 13 due to all the tendons
and their vertical line of pull against bony
area.
Knee Structures
Popliteal space- area behind the knee that
contains important nerves and blood vessels.
The hamstrings and gastronemius make up
the diamond shaped boarder.
Knee Structures
Pes Anserine muscle group- made up of
Sartorius, Gracilis and semiTendinosus.
(SGT). They come from posterior to medial
anterior knee, there is a bursa under the
insertion.
Quiz #3
1. Name the three muscles that attach at the
medial anterior knee. They are know as the
Pes Anserine group and their abbreviation is
SGT.
2. What does ACL stand for?
3. What is the shock absorber of the knee?
Medial Collateral Ligament Sprain
Causes are blow to the
lateral knee or high speed
twisting motion.
Classified with three grade
scale based on signs
and symptoms
MOI is important
Medial Collateral Ligament Sprain
Signs and Sx Treatment
Limited ROM RICE and protect
Tenderness at either Ice and Interferential
insertion of MCL or Straight leg
along ligament length. strengthening initially.
Various levels of pain Immobilize if
and laxity to medial necessary
knee

Special Test
Valgus Stress Test
Lateral Collateral Ligament Sprain
Not as common as the
MCL sprain.
Caused by a medial force
to the knee joint or a
twisting.
Classified with 3 grades
like any other sprain.
Torn Anterior Cruciate Ligament
Can be a contact or non-contact injuy.
Can be a blow to the lateral or posterior knee.
Non-contact loaded
knee in combined
flexion, valgus
and rotation of the
tibia on the femur.
Torn Anterior Cruciate Ligament
Signs and Sx Treatment
Hear or feel a pop
Rapid effusion
Buckling of the knee
Guarding will occur
quickly so special tests
need to be done within
5 minutes of injury
Splinting, ice,
compressive wrap and
crutches.
Surgery for a ACL tear
in necessary
Not typically seen with
grades, but they do
occur
MRI is confirmation for
diagnosis
Torn Anterior Cruciate Ligament
Female ACL injuries happen 4-6x more often
than male ACL injuries.
This is due to
Biomechanical factors- use more quad than
hamstring. Land flat footed-dont know how to
jump
Hormonal influences-ligament may loosen
during cycle
Anatomic risk factors-Angle of the hips relative
to knees.
Knee Muscles
Popliteus- muscle responsible for unlocking
the knee or initiating knee flexion. It is on the
posterior side of the knee in the poplitial
space deep to the gastrocnemius.
Knee Muscles
Vastus lateralis- spans the quad laterally,
starts on the linea aspera and joins with the
others at the patellar tendon.
Knee Muscles
Vastus Intermedialis- deep to the
rectus femoris arises from the
anterior surface of the femur, it
blends with the other vasti
muscles along its length. All
extend the knee, only the rectus
flexes the hip. Why?
Knee Muscles
Rectus Femoris-
originates on inferior
illiac spine and decends
down the center
of the thigh, most
superficial muscle
of quad.
Meniscus Tear
Meniscus are cushions
in the knee joint that
help make it more
stable.
Medial meniscus is
attached to posterior
and medial side, it is
more often injured.
Lateral meniscus is
more freely moving,
less often injured.
Meniscus Tear
Causes of injury
Twisting of knee when meniscus gets trapped.
When the ligaments are torn, they are attached.
As people age the rubbery meniscus fray
Meniscus Tear
Signs and Sx
Popping, locking,
giving way of the knee
Pain in injury area
General knee swelling
Osgood-Schlatter
The femur is growing faster than
the quad muscle and creates a
traction on the tibial tuberosity
where the patellar tendon
attaches.
Affects males age 12-16
Affects females age 10-14
Osgood-Schlatter
Signs and Sx
Pain and swelling over tibial tuberosity
Increase pain and swelling with activity
Weakness of quadriceps
Visible lump
Pain to touch
Osgood-Schlatter
Treatment
Manage pain swelling and flexibility
Stretch 4x daily-emphasis on hamstrings
Avoid knee extension, squats, power clean
and plyo
Do body weight squats, SLR, hamstring curls
and calf raises.
Wear knee brace if needed.
Patellafemoral Problems
One of the most
challenging knee
injuries for both athlete
and health care
provider.
Typical complaint is
pain in front of the knee
(behind the knee cap),
with gradual onset.
The knee may give way
and have a grinding
noise.
Patellar Tendonitis
High force repetitive
injury usually a result of
jumping and/or abrupt
change of direction.
AKA jumpers knee
Patellar Tendonitis
Signs and Sx: Treatment
Anterior knee pain Modified activity to
inferior to patellar decrease impact
tendon Stretch Quads
Small amount of Ice after
swelling Massage/US before
Brace and Tape

Special Tests-
Tap Test
Clarks Sign
Knee Muscles
Vastus medialis- also comes from the linea
aspera and spans the thigh medially and
joints with quads at patellar tendon.
Knee Muscles
Semitendinosus muscle- longer and narrower
distal tendon that moves to the anterior tibia
with the grasillis and sartoris after spanning
the posterior medial thigh.
Knee Muscles
Semimembranosus muscle- runs down
medial side of the thigh deep to the
semitendinosus muscle and attaches to the
medial condyle of tibia.
Knee Muscles
Biceps Femoris- has two head and runs down
the thigh laterally on the posterior side. The
long head starts of the ischial tuberosity, the
short head on the linea aspera. Which head
flexes the knee and extends the hip?