Examination of the Knee - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungso... · 2016....
Transcript of Examination of the Knee - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungso... · 2016....
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Examination of the Knee
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Knee joint의 구성
- distal of femur + med, lat epicondyle of tibia
- meniscus : fibroscartliage
: knee joint에 내, 외측에 부착된 연골륜
: 외측 < 내측, 내측이 외상 받기 쉽다
기능해부학 functional anatomy
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http://www.eorthopod.com/images/ContentImages/knee/knee_anatomy/knee_anatomy01.jpg
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http://www.eorthopod.com/images/ContentImages/child/child_knee_blounts/child_knee_blounts_anatomy02.jpg
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Knee joint의 cartilage
반월상 연골의 형태
- medial & lateral meniscus
- 반달-쐐기형이며 fibrous cartilage
- 혈액공급이 없어 손상 시 회복 불능
- 외측 반월상연골의 모양은 “0” 형, 내측 “C”
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http://www.cartilagerestoration.org/sites/default/files/normal_knee_top_down.jpg
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http://www.mendmyknee.com/_img/meniscus-knee-joint-load.gif
Function of meniscus: shock absorption
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knee joint의 ligament
http://www.eorthopod.com/sites/default/files/images/knee_collateral_anatomy01.jpg
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1) Cruciate ligament
* anterior cruciate ligament
- 경골전면 내측반월에서 대퇴 후방외과에 부착
- 대퇴가 경골에서 후방으로 전위되는 것을 방지
- 경골이 대퇴에서 전방으로 전위되는 것을 방지
- 과도한 과신전 방지
knee joint의 ligament
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http://www.baseballprospectus.com/u/images/CD2.png
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knee joint의 ligament
1) Cruciate ligament
* posterior cruciate ligament
- 후경골에서 대퇴 전방 외측과에 부착
- 대퇴가 경골에서 전방으로 전위 방지
- 경골이 대퇴에서 후방으로 전위 방지
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http://www.eorthopod.com/sites/default/files/images/knee_anatomy04.jpg
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2) Collateral ligament
- frontal plane에서 안정성 제공
* 내측 측부인대(medial collateral ligament)
- femur의 내측상과에서 기시하여 경골 상단 연결 - 외전 방지
* 외측 측부인대(lateral collateral ligament) - femur의 외측상과에서 기시하여 비골두 연결 - 관절낭과 독립적으로 분리 - 내전방지
Knee joint의 ligament
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슬개인대(infrapatella ligament)
- quadriceps tendon 이 슬개골 하연에서 tibial tuberocity에 부착
- 전방 안정성
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Inspection
보행이 부드럽고 율동적인가
bursitis ; prepatella bursitis infrapatella bursitis pesanserine bursitis
근위축 : vastus medialis
Valgus angle ; 내반슬, 외반슬, 반장슬
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http://meded.ucsd.edu/clinicalmed/knee_surface_anatomy.jpg
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http://www.nature.com/nrrheum/journal/v7/n1/images/nrrheum.2010.195-f2.jpg
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https://edc2.healthtap.com/ht-staging/user_answer/avatars/754710/large/open-uri20121219-30492-w4u2sr.jpeg
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1) 내측면
① 내측경골 플라토 (Medial tibial plateau)
② 경골조면 (Tibial tubercle)
③ 대퇴골 내측과 (Medial condyle)
④ 내전근 결절 (Adductor tubercle)
Bony Palpation
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2) 외측면
① 외측경골 플라토 (Lateral tibial plateau)
② 외측결절 (Lateral tubercle)
③ 대퇴골외측과 (Lateral femoral condyle)
④ 대퇴골 외측상과 (Lateral femoral epicondyle)
⑤ 비골 골두 (Fibular head)
3)활차절흔과 슬개골
Bony Palpation
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Fibular head
Latera plateau
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Soft tissue palpation 1)제 1 구역 - 전면 (anterior aspect)
① 대퇴사두근 (Quadriceps femoris)
Rectus femoris
Vastus medialis, Vastus lateralis,
Vastus intermedius
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Soft tissue palpation 1)제 1 구역 - 전면 (anterior aspect)
② 슬개인대 (Infrapatella tendon)
- os good-schlatter syndrom e
- bursitis
③ 천슬개하 점액낭 (superficial infrapatellar bursa)
④ 전슬개 점액낭 (prepatella bursa) ; 주부
⑤ 아족점액낭(Pes anserine bursa)
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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
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http://physioworks.com.au/images/Injuries-Conditions/knee_bursitis.jpg
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Soft tissue palpation
2) 제 2 구역 - 내측 (medial aspect)
① 내측 반월판 (Medial meniscus)
② 내측 측부인대 (Medial collateral lig.)
③ Sartorius, Gracilis
, Semitendinosu)
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Soft tissue palpation 3) 제 3 구역 - 외측연 (Lateral aspect)
① 외측반월판 (Lateral meniscus)
② 외측측부인대 (Lateral collateral lig.)
③ 전상 경비인대 (anterosuperior tibiofiular lig.)
④ 대퇴이두근건 (Biceps femoris)
⑤ 장경인대 (Iliotibial tract)
⑥ 총비골신경(Common peroneal N.)
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http://www.eorthopod.com/iliotibial-band-syndrome/topic/63
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http://classconnection.s3.amazonaws.com/661/flashcards/1011661/jpg/sacral-plexus-tibial-nerve-common-fibular-nerve1333654508571.jpg
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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.) ; 가장 표층
③ 슬와정맥 (Popliteal vein) ; 신경 바로 밑
④ 슬와동맥 (Popliteal artery) ; 가장 심층
⑤ 비복근 (Gastrocnemius)
; 손상이 심할 경우 calcaneous gait
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http://arabbones.com/educations/Popliteal-Cysts_files/image018.gif