+Abii Marie Hey Abii, although there is some evidence in the literature that you are able to use the standard goniometer when measuring internal/external rotation in the knee joint, I doubt it's reliable/relevant for practice. In the literature, they place the patient in a chair with hips and knees bent to 90°. The foot is on a sheet of paper. The examiner projects a line from the calcaneal tuberosity ventrally to the toes and asks the patient to perform (lateral) rotation. The same projection line is done through the longitudinal axis of the second metatarsal and the angle between these two lines is recorded (www.routledge.com/products/9780415437219) When you use the goniometer you assess ROM in one joint over to fixed points. To assess the rotations, you would have to ensure that there is no motion coming from the ankle as well. In practice I would say that you will rarely encounter the need to assess rotations this specific. Also, the knee joint follows a capsular pattern of flexion before extension and these movements will be affected first. I hope this helps a bit. And thank you for your kind words. Where do you study?
I just saw this comment! I'm based in South West England. I'm now in my third year of study, currently revising for my final MSK placement. Still finding your videos useful! Thank you :-)
I'm struggling to see lateral patellar movement on knee extension and medial movement on flexion. I can see some movement this way on the tibial tuberosity. Am I looking in the wrong place?
Fully agree with you! It's very unreliable to properly see that in a patient and rather what the literature (in this case Magee) describes. It's easier to remember that the patella follows the tibia with flexion/extension and thus makes a lateral rotation with extension and a medial rotation with flexion around its longitudinal axis.
if active ROM of knee extension starts in supine, will not such posture induce a passive knee extension already? I thought the person should be seated to do knee extension?? Which one is correct?
Reason being that external (screw home mechanism) and internal rotation are passive movements of the knee that are controlled by the form of the knee, the anterior cruciate ligament, TFL and meniscus.
Hi Physiotutors,I have a quick question, is it possible to measure knee internal and external rotation with a goniometer? If so what would be the best position to have the patient in? Thank you for your videos, they are really helping me study my first year of physiotherapy!
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0:40 knee flexion
0:54 knee extension
1:48 external rotation
2:00 internal rotation
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+Abii Marie
Hey Abii,
although there is some evidence in the literature that you are able to use the standard goniometer when measuring internal/external rotation in the knee joint, I doubt it's reliable/relevant for practice.
In the literature, they place the patient in a chair with hips and knees bent to 90°. The foot is on a sheet of paper. The examiner projects a line from the calcaneal tuberosity ventrally to the toes and asks the patient to perform (lateral) rotation. The same projection line is done through the longitudinal axis of the second metatarsal and the angle between these two lines is recorded (www.routledge.com/products/9780415437219)
When you use the goniometer you assess ROM in one joint over to fixed points. To assess the rotations, you would have to ensure that there is no motion coming from the ankle as well.
In practice I would say that you will rarely encounter the need to assess rotations this specific. Also, the knee joint follows a capsular pattern of flexion before extension and these movements will be affected first.
I hope this helps a bit. And thank you for your kind words. Where do you study?
seems like during knee extension the patella moves medially and flexion it moves laterally... did you say it wrong at 1:40???
I just saw this comment! I'm based in South West England. I'm now in my third year of study, currently revising for my final MSK placement. Still finding your videos useful! Thank you :-)
This video helped me a lot.
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I'm struggling to see lateral patellar movement on knee extension and medial movement on flexion. I can see some movement this way on the tibial tuberosity. Am I looking in the wrong place?
Fully agree with you! It's very unreliable to properly see that in a patient and rather what the literature (in this case Magee) describes.
It's easier to remember that the patella follows the tibia with flexion/extension and thus makes a lateral rotation with extension and a medial rotation with flexion around its longitudinal axis.
if active ROM of knee extension starts in supine, will not such posture induce a passive knee extension already? I thought the person should be seated to do knee extension?? Which one is correct?
will it help to a patient with varicose veins behind the knees?
No, this is just ROM assessment
Good sir
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How would you assess active isometric knee internal and external rotation?
Thanks!
+Nicole Ellis simply put we wouldnt
Reason being that external (screw home mechanism) and internal rotation are passive movements of the knee that are controlled by the form of the knee, the anterior cruciate ligament, TFL and meniscus.
Hi Physiotutors,I have a quick question, is it possible to measure knee internal and external rotation with a goniometer? If so what would be the best position to have the patient in? Thank you for your videos, they are really helping me study my first year of physiotherapy!
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