Lecture Notes on Knee Anatomy and Palpation

Introduction to the Knee Lab Section

• Introduction to the knee unit.
• Importance of palpation before special testing.
• Observation of anatomical structures on a skeleton first, then on a patient.
• Lab sheet organized into different sections for anterior, posterior, medial, and lateral palpations.

Anterior Structures of the Knee

• Patella
  • Located deep within the patellar tendon.
  • Four surfaces to palpate: inferior pole, superior pole, lateral facet, and medial facet.
• Patellar Ligament
  • Connects bone to bone, attaches from inferior pole of patella to tibial tuberosity.
• Quadriceps Tendon
  • Attaches from mid shaft of femur, across the patella, to tibial tuberosity.
  • Patellar ligament is part of quadriceps tendon.

Posterior Structures of the Knee

• Popliteal Fossa
  • Houses popliteal artery, important for palpation.
• Hamstring Muscles
  • Attach to pelvis, control knee motions.
• Gastrocnemius
  • Proximal attachment to posterior tibia, important to palpate.

Medial Structures of the Knee

• Joint Line
  • Gap between tibia and femur, contains meniscus.
• Collateral Ligaments
  • Medial Collateral Ligament (MCL) / Tibial Collateral Ligament.
  • Lateral Collateral Ligament (LCL) / Fibular Collateral Ligament.

Lateral Structures of the Knee

• Gerdy’s Tubercle
  • Distal attachment site for the iliotibial band (IT band).
• Vastus Lateralis
  • Part of the quadriceps muscle group.

Importance of Palpation Techniques

• Use flat-handed sweeps for better anatomy feel.
• Importance of positioning in palpation.
• Differentiate between anatomical and clinical palpation.

Range of Motion (ROM) and Goniometry

• Knee Flexion: 130 to 150 degrees is normal.
• Knee Extension: 0 degrees is normal.
• Use of a goniometer to measure ROM.

Manual Muscle Testing (MMT)

• Purpose: Determine if muscle group is compromised.
• Muscles Tested:
  • Biceps Femoris (lateral side): External rotation and knee flexion.
  • Semitendinosus and Semimembranosus (medial side): Internal rotation and knee flexion.
  • Quadriceps: Knee extension.
  • Sartorius: Complex motions including internal rotation, knee flexion, abduction, and hip flexion.

Techniques for MMT

• Ensure correct hand placement and patient positioning.
• Test both sides for comparison.
• Focus on maintaining ergonomic clinician positions.

Conclusion

• Transition from skeleton to live patient examination.
• Importance of proper palpation, ROM assessment, and MMT before moving to special testing.