COLLATERAL DAMAGE TO KNEE LIGAMENTS

PRINCIPLE: INJURY VERIFICATION THROUGH RESISTED AND PASSIVE TESTING A therapist should begin the assessment of a client by obtaining a complete history of the injury, including a description of the location of the pain, any traumatic event that led to the injury and any factors that aggravate or relieve the pain. The therapist can further verify the injury through palpation and by applying a series of simple tests to the region. These tests will help the ther- apist pinpoint the location of injured structures, evaluate the severity of the injury and develop a rationale for a treatment plan.

A resisted test is an isometric contraction against resistance that does not involve movement of the limb. This type of test primar- ily tests for injury to muscles and tendons (ie. those structures which initiate movement). It also tests for weakness when there is disc pressure on the nerve. A passive test is when the client behaves like a rag doll and does not assist during the movement that the therapist takes the client through. Passive tests primarily check for injury to ligaments, joints and bursas, structures that do not initiate movement.

Application: Verification of collateral ligament knee injuries One of the clearest signs of a collateral ligament injury in the knee is the location of the pain. If you know how to palpate these lig- aments, you can find the precise source of the pain. The lateral collateral ligament is easy to find. When a person crosses their legs, the lateral collateral becomes taut and sticks right out at the lateral knee. To find it place your finger on the head of the fibula just below the lateral knee while the legs are crossed and move superiorly until you come to the attachment on the femur.

The medial collateral ligament is a little trickier to find because the ligament is flattened against the bone. To locate it let the person lie supine and bend the knee so that the foot is on the table. Place your finger at the inferior pole of the patella - this puts you at the joint line. Slide your finger medially in the crevice of the joint line ninety degrees until you reach the ligament. It is relatively close to the skin surface. Injuries to this ligament often occur at the joint line in the middle of the ligament.

Resisted tests should not cause pain in cases of collateral liga- ment injuries, since the resistance tests active structures such as muscles rather than the ligaments. The following list offers one palpation test and four passive tests to help you assess whether the collateral ligaments of the knee are injured.

TESTS Testing for heat Place the back of your hand alternately on the inner side and then outer side of both knees and compare their relative heat. If there is active inflammation and swelling in one knee, there is usually a heat differential.

Figure 2a+b: Testing for heat differential on medial and lateral aspects of the knee

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