17 1 Kinesiology for Manual Therapies Chapter 17

17 -1 Kinesiology for Manual Therapies Chapter 17 The Knee Joint Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -2 Learning Outcomes 17 -1 Define key terms. o 17 -2 Identify on a human skeleton selected bony features of the knee joint. o 17 -3 Describe the cartilaginous and ligamentous structures of the knee joint. o Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -3 Learning Outcomes (cont. ) 17 -4 Draw and label on a skeletal chart the muscles, including origins and insertions, and ligaments of the knee joint. ¡ 17 -5 Palpate the superficial knee joint structures and muscles, including origins and insertions, on a partner. ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -4 Learning Outcomes (cont. ) 17 -6 Demonstrate all the active and passive movements of the knee joint with a partner. ¡ 17 -7 Name and explain the actions and importance of the quadriceps and hamstring muscles. ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -5 Learning Outcomes (cont. ) 17 -8 List and organize the muscles that produce the movements of the knee joint and list their antagonists. ¡ 17 -9 Practice flexibility and strengthening exercises for each muscle group. ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -6 Introduction The knee joint affects posture through the position of the hip joint. ¡ The knee joint is vulnerable to injuries. ¡ The bone’s structure is designed to provide mobility and weight bearing. ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -7 Bones The tops of the medial and lateral tibial condyles are known as the medial and lateral tibial plateaus. ¡ The tibia bears most of the body’s weight in the knee joint. ¡ The fibula serves for an attachment site for muscles and ligaments. ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -8 Bones (cont. ) The patella is a sesamoid bone. ¡ Key bony landmarks include the tibial tuberosity, Gerdy’s tubercle, the medial and lateral femoral condyles, and the medial tibial condyle. ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -9 Bones (cont. ) Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -10 Bones (cont. ) Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -11 Joints The knee joint is the tibiofemoral joint and is classified as a ginglymus joint because it acts like a hinge performing flexion and extension. ¡ Ligaments provide stability for the knee joint and the medial and lateral menisci (cartilage) cushion the joint. ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -12 Joints (cont. ) Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -13 Ligaments of the Knee Joint The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are named because they cross within the knee between the tibia and femur. ¡ The ACL is often injured. ¡ The medial knee has the tibial medial collateral ligament (MCL) ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -14 Ligaments of the Knee Joint (cont. ) The lateral side of the knee the fibular collateral ligament (LCL) joins the fibula to the femur. ¡ A plica is an anatomical variant among some individuals that may be irritated or inflamed with injuries or overuse of the knee. There are over 10 bursae in the knee. ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -15 Movements Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -16 Movements (cont. ) Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -17 Movements (cont. ) Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -18 Muscles Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -19 Muscles (cont. ) Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -20 Muscles (cont. ) Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -21 Muscles (cont. ) Q Angle Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -22 Nerves The femoral nerve innervates the knee extensors. ¡ The knee flexors are innervated by the tibial division of the sciatic nerve. The biceps femoris short head is supplied by the peroneal nerve. ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

Individual Muscles of the Knee Joint – Anterior - Quadriceps The quadriceps consist of the rectus femoris, the vastus lateralis, vastus intermedius, and the vastus medialis. ¡ They all attach to the patella by the patellar tendon to the tuberosity of the tibia. ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -23

Individual Muscles of the Knee Joint (cont. ) – Anterior – Rectus Femoris Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -24

Individual Muscles of the Knee Joint (cont. ) – Anterior – Rectus Femoris Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -25

Individual Muscles of the Knee Joint (cont. ) – Anterior – Vastus Lateralis Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -26

Individual Muscles of the Knee Joint (cont. ) – Anterior – Vastus Lateralis Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -27

Individual Muscles of the Knee Joint (cont. ) – Anterior – Vastus Intermedius Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -28

Individual Muscles of the Knee Joint (cont. ) – Anterior – Vastus Intermedius Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -29

Individual Muscles of the Knee Joint (cont. ) – Anterior – Vastus Medialis Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -30

Individual Muscles of the Knee Joint (cont. ) – Anterior – Vastus Medialis Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -31

Individual Muscles of the Knee Joint – Posterior – Hamstrings Semitendinosus Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -32

Individual Muscles of the Knee Joint (cont. ) – Posterior – Hamstrings Semitendinosus Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -33

Individual Muscles of the Knee Joint (cont. ) – Posterior – Hamstrings Semimembranosus Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -34

Individual Muscles of the Knee Joint (cont. ) – Posterior – Hamstrings Semimembranosus Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -35

Individual Muscles of the Knee Joint (cont. ) – Posterior – Hamstrings Biceps Femoris Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -36

Individual Muscles of the Knee Joint (cont. ) – Posterior – Hamstrings Biceps Femoris Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved 17 -37

17 -38 Individual Muscles of the Knee Joint (cont. ) – Posterior Popliteus Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -39 Individual Muscles of the Knee Joint (cont. ) – Posterior Popliteus Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -40 Chapter Summary The bones, joints, ligaments, movements, muscles, and nerves of the knee joint are explored in this chapter. l Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -41 Chapter Summary (cont. ) Individual muscles of the knee joint are reviewed in depth with regard to palpation, origin, insertion, action, and innervation. ¡ Each muscle includes information with clinical notes, muscle specifics, clinical flexibility and strengthening. ¡ Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -42 Chapter Review ¡ The Chapter Review is divided into true and false, short answers, and multiple choice questions. ¡ The questions are designed for the students to test their knowledge. ¡ Worksheets are at the end of the text as an aid for learning. Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved

17 -43 Explore and Practice ¡ Students should utilize the questions and charts at the end of the chapter to help focus on the content of the chapter. Mc. Graw-Hill © 2011 by The Mc. Graw-Hill Companies, Inc. All rights reserved