Khup Hmun (Knee Joint) a awm

01. Ruh Insiam dan (Mone Structure) awm dan

Chumi khup ruh hi ruh 4 a awm a, chungte chu femur, tibia, patella leh fibula te an ni.

Compartment 3 a awm a, chungte chu medial tibiofemoral compartment, lateral tibiofemoral compartment, leh patellofemoral compartment te an ni a, compartment 3 te hian synovial cavity an insem a ni.

02.Joint structure a ni

A chi: Carriage Joint a ni

Khup hian ruh 3 a nei a, chungte chu medial tibiofemoral joint, lateral tibiofemoral joint leh patellofemoral joint te an ni.

Tibiofemoral joint hian distal femur leh tibia a thlunzawm a, distal femur chu a taper a, medial femoral condyle leh lateral femoral condyle a siam a ni. Tibia hi a flat deuh a, mahse inclined meniscus hian projecting femoral condyles nen a inzawm hnai hle.

Femoral condyles te hi intercondylar fossa hmanga then a ni a, hei hi femoral groove emaw femoral talus emaw tia hriat a ni bawk.

Patella hi chi ruh, quadriceps muscle tendon chhunga innghat a ni a, trochanteric groove nen joint a siam a ni.

Quadriceps muscle mechanical gain tihpun nan a thawk a ni. Fibula lu hi khup capsule chhungah awm mahse a tlangpuiin weight-bearing articular surface angin a thawk lo. Femoral condyles leh tibial plateau te hian joint line an siam a.

03. Joint Stability a awm thei

Knee joint stability hi soft tissue hrang hrangin a vawng reng a, chu chuan joint chhungah cushioning protection a pe bawk.

Tibia leh femur hi khup ruh chhungah shock-absorbing hyaline cartilage in a khuh a.

-Disk ang chi lateral leh medial menisci hian shock absorption dang a pe a, khup chungah force te pawh joint pumpuiah a sem darh bawk.

-Anterior cruciate ligament (ACL) leh posterior cruciate ligament (PCL) te hian hmalam leh hnunglam leh flexion-extension movement te a ti nghet a.

-Medial collateral ligament leh lateral collateral ligament te hian khup chu an plane hrang hrangah an stabilise thin.

-Khup tichaktu structure dangte chu iliotibial bundle leh posterior lateral horn thenkhat te an ni.

04. Bursae leh Cystic Structure te

Khup chhehvelah hian cystic structure engemaw zat hmuh tur a awm tlangpui a, chung zingah chuan tendon sheath cyst leh synovial bursae te pawh a tel. Tendon sheath cysts hi benign abnormalities a ni a, dense fibrous connective tissue nen a inzawm a, mucus a awm bawk.

Popliteal cyst (chu chu Baker’s cyst) hi taksaa synovial cyst awm tam ber a ni. Gastrocnemius muscle medial head leh semimembranosus tendon inkar bursa atanga lo chhuak a ni. Popliteal cyst hi a tlangpuiin asymptomatic ni mahse khup intra-articular disorders nen a inzawm fo thin.

Khup hma lamah hian common bursae pali a awm a. Suprapatellar bursa hi khup capsule hnaih takah a awm a, rectus femoris tendon leh femur inkarah a awm a, puitling tam zawkah chuan khup joint nena a traffic a awm bawk. Prepatellar bursa hi patella hma lamah a awm a. Superficial infrapatellar bursa chu patellar tendon leh tibial tuberosity distal part-ah a chung lamah a awm a, deep infrapatellar bursa erawh chu patellar tendon distal part leh anterior tibial tuberosity inkar thuk takah a awm thung. Superficial bursa hi hman tam lutuk emaw, trauma emaw avanga inflamed a ni thei a, chu chu hun rei tak khup khup ang chi a ni a, khup-extension structure hman tam lutuk chuan infrapatellar bursa thuk tak chu a ti hring thei a, chu chu zuang leh tlan nawn leh emaw a ni thei bawk.

Khup medial aspect chu goosefoot bursa, semimembranosus bursa leh suprapatellar bursa te hian an thunun ber a ni. Goosefoot bursa hi lateral tibial collateral ligament tibial stop leh suture-a distal fusion tendons, thin femoral leh semitendinosus muscles inkarah a awm a ni. Semimembranosus bursa hi semimembranosus tendon leh medial tibial condyle inkar a ni a, suprapatellar bursa hi khup ruh chhunga bursa lian ber a ni a, patella chungah leh quadriceps muscle thuk takah a awm a ni.

05 Joint range of motion a awm thei

Active knee flexion tehna atan damlo chu prone position assume tir la, maximally knee chu heel chu gluteal groove hnaih thei ang bera awm turin flex tir rawh flexion angle pangngai chu 130° vel a ni.

Knee extension tehna atan damlo chu sitting position assume tir la, knee extension maximize rawh. Khup ke dinglam emaw neutral position (0°) atanga sei hi damlo thenkhat tan chuan thil pangngai a ni a, mahse hyperextension an ti thung. 3°-5° aia tam lo overextension hi presentation pangngai a ni. Hetiang range aia sang hyperextension hi knee retroflexion an ti a, a lan dan pangngai lo tak a ni.

Homas test hian quadriceps leh hip flexors te flexibility a test thin.

Hip flexion contracture a awm chuan draping lower extremity thigh chu examining table nen flush emaw downward emaw aiin ceiling lam a angle ang.

Examination table nena hanging thigh angle hian hip flexion contracture degree a tarlang a ni.

Quadriceps tightness a awm chuan drape ke hnuai lam chu examination table atanga angle hlaah a awm ang. Ground plumb line nena draping lower leg siam angle hian quadriceps tension degree a tarlang a ni.

06. Joint stability tehna

Posterior Drawer Test - Posterior drawer test hi damlo chu supine position-ah dahin, a hip natna chu 45°-ah flexed a ni a, khup chu 90°-ah flexed a ni a, ke chu neutral-ah dah a ni. Examiner chuan damlo proximal tibia chu a kut pahnih hmangin circular grip-in a man a, a kut pahnih kutpui chu tibial tuberosity-ah a dah bawk. Chumi hnuah chuan proximal tibia-ah backward force an hmang leh a. Tibia hnunglam atanga 0.5-1 cm aia tam a inthlak a, a hrisel lam aiin a hnunglam a inthlak danglam chuan khup hnunglam cruciate ligament chu a then emaw, a tear vek emaw a ni tih a tilang.

Quadriceps Active Contraction Test - Damlo ke (a tlangpuiin kea thut) chu a ti nghet a, damlo chu examining table-ah ke chu hmalam pan tir a tum tir (examiner kut dodalna laka), he maneuver hian quadriceps muscle a ti contract a, chu chuan posterior cruciate ligament deficient-ah tibia chu 2mm tal a hmalam a shift tir ang khup a ni.

Tibial External Rotation Test - Tibial external rotation test hmang hian hnunglam lateral corner hliam leh hnunglam cruciate ligament hliam awm leh awm loh hriat theih a ni. Tibia hi passive pawn lam hawiin khup flexion 30° leh 90° ah a inher a. Test hi a natna vei lam chu a hrisel lam aiin pawn lam atanga 10°-15° aia tam a inher chuan a positive a ni. Knee flexion 30°-a positive leh 90°-a negative chuan PLC hliam awlsam tak a ni tih a tilang a, flexion 30° leh 90°-a positive chuan posterior cruciate ligament leh posterolateral complex pahnih hliam a awm tih a tilang bawk.

07. Periarticular ligaments te chu a awm thei

Joint capsule ligament te chu a awm a

patellar ligament, medial patellar ligament, lateral patellar ligament te a ni

Intracapsular ligament te chu a awm a

hmalam cruciate ligament, hnunglam cruciate ligament

Extracapsular ligament te chu a awm a

medial collateral ligament, lateral collateral ligament, popliteal oblique ligament, fibular collateral ligament te a awm bawk

08. Innervation hmanga ruh (joint) a awm

Neurovascular Structure a ni a, a rilru a hah hle

Popliteal artery, popliteal vein leh tibial nerve (sciatic nerve chhunzawm zel) te awmna neurovascular bundle chu khup ruh hnung lamah a kal a.

Common peroneal nerve chu sciatic nerve lateral branch a ni.

09. Taksa inzawmkhawm

Hma lam Lateral a ni

Quadriceps hi rectus femoris, vastus medialis, vastus lateralis leh intermedius femoris te a ni.

Hnunglam lam hawi

Hamstrings a ni

biceps femoris, semitendinosus leh semimembranosus te a huam a;

Gastrocnemius a ni.

Anteromedial a ni

Tibialis hmalam a ni.

Khup ruh nghet taka vawngtu thau, quadriceps, suture ruh, hamstrings, thin femoral muscles, biceps femoris, semitendinosus, leh semimembranosus te pawh a tel.

10. Taksa enfiah

1. Mit hmanga enfiah

Damlo natna vei lam leh a sir lehlamah khup ruhte mobility leh symmetry enfiah la, localized swelling, vun rawng pangngai lo, leh kal dan pangngai lo, etc. a awm leh awm loh enfiah rawh

2. palpation tih a ni

a natna leh a hringna hmun, a thuk zawng, a zau zawng leh a awm dan enfiah la, damlo natna vei lam chu a theih ang anga rilru hahdam takin dah rawh.

3. Hnathawh tur (Mobilization).

Damlo active leh passive activity hmangin khup ruh (knee joint) mobility enfiah thin ang che.

4. A tehna

Limb segment tin sei zawng bakah a sei zawng zawng, limb sir vel, ruh inzawmna range, muscle chakna, sensation area hloh, etc. te teh la, record leh marking siam rawh.

5. special exam neih a ni

 - floating patella test: damlo khup ruh ah effusion a awm leh awm loh enfiah.

A kalphung enfiah

Suprapatellar bursa chu tui a awm khawm theih nan squeeze hnuah khup ruh chhungah tui a awm chuan, patella chu index finger hmangin zawi zawiin kan hmet a, pressure a chhuah hnuah chuan patella chu fluid buoyant force hnuaiah chunglam hawiin a float ang a, pressure a chhuah chuan patella hian buoyant force avang hian popping emaw floating sensation a nei ang

- Drawer test: cruciate ligament a chhiatna a awm leh awm loh enfiah.

Anterior drawer test: damlo chu khumah a muhil a, khup a flexion 90 °, khumah ke a flat a, a rilru a hahdam. Examiner chuan damlo ke chu a fix theih nan, kut chuan khup joint tibial end chu a chelh a, calf chu hmalam lamah a hruai a, chu chu tibia anterior displacement aiin healthy side 5mm a positive a, positive chuan anterior cruciate ligament injury a awm tih a tilang (Note: Lachman test hi khup flexion 30 °-a anterior drawer test a ni).

Posterior drawer test: damlo chu a hnungzang-ah a mu a, khup chu 90°-in a ben a, a kut pahnih chu khup ruh hnung lamah a dah a, a kutpui chu extensor lam hawiin a dah a, bawnghnute proximal end chu hnunglam hawiin a nawr leh a, a tibia chu positive angin a hnunglam hawiin a kal a, hei hian posterior cruciate ligament chu a then emaw, a pum emaw a rupture tih a tilang a ni.

- Grinding test: khup meniscus-a chhiatna a awm leh awm loh hriat chian nan.

Knee Joint Grinding Test: Knee joint-a lateral collateral ligament leh meniscus hliam awm leh awm loh enfiahna atana taksa enfiahna hmanraw hman a ni.

Damlo chu prone position-ah a awm a, a khup natna chu 90°-ah a flex a ni.

1. Rotational lifting test neih a ni ang

Examiner chuan damlo kekawr ipteah bawnghnute chu a hmet a, a ke pahnih hmangin a kekawrte chu a vawn a, bawnghnute chu bawnghnute longitudinal axis-ah a chawi sang a, chutih lai chuan internal leh external rotational movement a ti a khup sir lehlamah natna a awm chuan lateral collateral ligament injury a nih rinhlelh a ni.

2. Rotary compression test neih dan tur

Examiner chuan a kut pahnih hmangin a ke ruh natna ke chu a chelh a, chutiang chuan khup natna chu 90°-ah a inher a, bawnghnute chu ke chu chunglam hawia ding chungin a awm a ni. Tichuan khup ruh chu hnuai lam hawiin hrual la, bawnghnute chu chhung lam leh pawn lam hawiin a rualin her kual rawh. Khup ruh chhung leh pawn lam a na a awm chuan inner leh outer meniscus a chhia tih a tilang a ni.

Khup chu extreme flexion-ah a awm chuan posterior horn meniscus rupture rinhlelh a ni a; 90°-a a awm chuan intermediate rupture rinhlelh a ni a; straight position hnaih laiin natna a awm chuan anterior horn rupture rinhlelh a ni.

- Lateral stress test: damlo chu a lateral collateral ligament a chhiat leh chhiat loh enfiah nan.

Lateral knee stress test hi taksa enfiahna a ni a, khup lateral collateral ligaments te enfiah nan hman a ni.

Position: Damlo chu examination bed-ah supine-in a mu a, a ke ruh natna chu zawi zawiin an rukbo a, chutiang chuan a ke hnuai lam natna chu khum pawnah dah a ni.

Joint position: khup chu fully extended position-ah dah a ni a, 30° flexed position-ah dah a ni.

Force hman: A chunga khup position pahnih-ah hian examiner chuan damlo ke hnuai lam chu a kut pahnih hmangin a chelh a, medial leh lateral side-ah stress a pe a, chutiang chuan khup ruh chu passive takin abduct emaw adduct emaw a ni a, chu chu valgus leh valgus test te tih a ni a, a hrisel lam nen khaikhin a ni.

Stress application process-a khup ruh natna a awm a nih chuan, emaw, inversion leh eversion angle chu normal range atanga chhuak a nih a, popping sensation a awm a nih chuan, lateral collateral ligament-ah sprain emaw rupture emaw a awm tih a tilang. External rotation stress test positive a nih chuan medial straight direction a nghet lo tih a tilang a, medial collateral ligament, medial meniscus leh joint capsule-ah te lesion a awm thei bawk internal rotation stress test positive a nih chuan lateral straight direction a nghet lo tih a tilang a, lateral meniscus emaw articular surface cartilage emaw-ah hliam a awm thei bawk.

11. Khup thlalak (Knee Imaging) a ni

1. X-ray hmanga enfiah

ruh tliak leh ruh tliak (degenerative osteoarthropathy) enfiahna atan hman a ni. Weight-bearing (standing) position knee joint hmalam leh side view film hian ruh, khup joint gap leh a dangte a en thei.

2. Computer tomography (CT) hmanga tih a ni.

CT scan hian ruh lama harsatna leh ruh tliak (subtle fractures) te chu a hriat theih nan a pui thei a ni. CT scan chi khat bik chuan gout chu dik takin a hriat theih a, a ruh chu a hring lo a nih pawhin.

3. Ultrasound hmanga tih a ni

Sound wave hmangin khup chhung leh a chhehvela soft tissue structure awmte real-time image a siam thin. Ultrasound hian pathologic changes te chu a hmu thei a, chu chu ruh margin-a ruh mastoids, cartilage degeneration, synovitis, joint effusiona, popliteal fossa swelling, leh meniscal bulging te hi a ni.

4. Magnetic resonance imaging (MRI) hmanga thil tih theih a ni.

He test hian soft tissue hliam, ligament, tendon, cartilage leh muscle te hriat theihna a pui a ni.

Laboratory test: Doctor-in infection emaw inflammation emaw a rinhlelh chuan thisen test leh a chang chuan arthrocentesis°, laboratory analysis atana khup ruh atanga tui tlemte lakchhuahna tih a ngai mai thei.

12. Ruh natna thlentu tlangpui

1. Hliam kaihhnawih

ligament hliam, hmalam leh hnunglam cruciate ligament leh lateral collateral ligament strain leh tears te; meniscus hliam te; patellar tendonitis leh mittui tla te; ruh tliak leh a dangte.

2. Arthritis kaihhnawih

osteoarthritis, ruh ruh (joint cartilage) chhe leh chhe vanga lo awm; rheumatoid arthritis hi immune system-in ruhkawr a beih vang a ni a; gout hi uric acid sang tak atanga crystal lo awmin ruhkawr a nghawng vang a ni.

3. A chhan dang

synovitis avanga ruh natna leh hliam tuar; patellar harsatna, dislocation leh cartilage wear te; tumor-te chuan ruh (joint) a rawn lut a; inflammation, etc. avanga lo awm edema; hun rei tak chhunga dinhmun tha lo; iliotibial fascia syndrome hi inhnawh tawn nawn fo avanga khup pawn lam natna thlentu a ni.

13. Enkawl dan hman tlanglawn tak tak

1.Conservative hmanga enkawl dan

-Chawlhna leh braking

-Compress lum leh lum

-Drug therapy hmanga enkawlna

-Tisa lam enkawlna

-Exercise hmanga enkawlna

-Asistive device hman dan

2.Surgery neih a ni

-Arthroscopic hmanga operation tih a ni

-Arthroplasty tih a ni

3.Enkawlna dang

-Chinese damdawi hmanlai (TCM) .

-Injection hmanga enkawl a ni