17-1 Kinesiology for Manual Therapies Chapter 17 The Knee Joint McGraw-Hill © 2011 by The McGraw-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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-3 Learning Outcomes (cont.) McGraw-Hill 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. © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-4 Learning Outcomes (cont.) McGraw-Hill 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. © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-5 Learning Outcomes (cont.) McGraw-Hill 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. © 2011 by The McGraw-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. McGraw-Hill © 2011 by The McGraw-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. McGraw-Hill © 2011 by The McGraw-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. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-9 Bones (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-10 Bones (cont.) McGraw-Hill © 2011 by The McGraw-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. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-12 Joints (cont.) McGraw-Hill © 2011 by The McGraw-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) McGraw-Hill © 2011 by The McGraw-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. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-15 Movements McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-16 Movements (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-17 Movements (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-18 Muscles McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-19 Muscles (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-20 Muscles (cont.) McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-21 Muscles (cont.) Q Angle McGraw-Hill © 2011 by The McGraw-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. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint – Anterior - Quadriceps 17-23 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. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Anterior – Rectus Femoris McGraw-Hill 17-24 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Anterior – Rectus Femoris McGraw-Hill 17-25 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Anterior – Vastus Lateralis McGraw-Hill 17-26 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Anterior – Vastus Lateralis McGraw-Hill 17-27 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Anterior – Vastus Intermedius McGraw-Hill 17-28 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Anterior – Vastus Intermedius McGraw-Hill 17-29 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Anterior – Vastus Medialis McGraw-Hill 17-30 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Anterior – Vastus Medialis McGraw-Hill 17-31 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint – Posterior – Hamstrings Semitendinosus McGraw-Hill 17-32 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Posterior – Hamstrings Semitendinosus McGraw-Hill 17-33 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Posterior – Hamstrings Semimembranosus McGraw-Hill 17-34 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Posterior – Hamstrings Semimembranosus McGraw-Hill 17-35 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Posterior – Hamstrings Biceps Femoris McGraw-Hill 17-36 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved Individual Muscles of the Knee Joint (cont.) – Posterior – Hamstrings Biceps Femoris McGraw-Hill 17-37 © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-38 Individual Muscles of the Knee Joint (cont.) – Posterior Popliteus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-39 Individual Muscles of the Knee Joint (cont.) – Posterior Popliteus McGraw-Hill © 2011 by The McGraw-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. McGraw-Hill © 2011 by The McGraw-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. McGraw-Hill © 2011 by The McGraw-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. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved 17-43 Explore and Practice McGraw-Hill Students should utilize the questions and charts at the end of the chapter to help focus on the content of the chapter. © 2011 by The McGraw-Hill Companies, Inc. All rights reserved