Knee

Question 1

List the 3 taught knee points and describe their location

Answer 1

Knee points

1. GB34

On the lateral aspect of the leg, inferior to the head of the fibula and anterior to the neck 2 cun below the lateral knee joint line.

2. SP9

On the medial aspect of the leg, 2 cun below the medial knee joint line, posterior to the tibia and anterior to the soleus and gastrocnemius, at the apex of the curve between the shaft and the tibial condyle.

3. BL40

At the midpoint of the Popliteal crease between the tendons of biceps femoris and semitendinosus.

Question 2

GB34 location and needling technique

• Location
• Insertion
• Depth

Answer 2

GB34 location and needling technique

Location

On the lateral aspect of the leg, inferior to the head of the fibula and anterior to the neck 2 cun below the lateral knee joint line.

Insertion

lateral to medial, towards the interosseous space

Depth

1-1.5 cun

Question 3

List relevant GB34 anatomy

• Muscles (2)
• Nerves (1; deeper - 3)
• Vessels (2)

Answer 3

GB34 anatomy

Muscles

1. peroneus longus
2. peroneus brevis

Nerves

1. lateral sural nerve L4-S1 in the skin
   * Deeper*

common peroneal (anterior division of sciatic nerve) L4-S2 Three branches:

1. deep peroneal nerve (anterior compartment) L4-S2
2. superficial peroneal nerve (lateral compartment) L5-S2
3. recurrent articular nerve (lateral aspect of knee joint)

Vessels

1. & 2. inferior lateral genicular artery and vein

Question 4

List 5 neuroanatomical indications for GB34

Answer 4

GB34 indications

Nb Sympathetic Switch, special point for musculoskeletal disorders

1. Often used in conjunction with SP 9 to treat the entire knee joint (peripheral nerve stimulation dealing with all the soft tissues in the knee)
2. Pain and inflammation of the lateral aspect of the knee joint,
3. Ligament strain/sprain
4. chondromalacia
5. patellofemoral syndrome.

Question 5

SP9 location and needling technique

• Location
• Insertion
• Depth

Answer 5

SP9 location and needling technique

Location

On the medial aspect of the leg, 2 cun below the medial knee joint line, posterior to the tibia and anterior to the soleus and gastrocnemius, at the apex of the curve between the shaft and the tibial condyle.

Insertion

perpendicular, medial to lateral

Depth

1-1.5 cun

Question 6

List relevant SP9 anatomy

• Muscles (5)
• Nerves (1; deeper - 1)
• Vessels (6)

Answer 6

SP9 anatomy

Muscles

1. sartorius insertion
2. gracilis insertion
3. semitendinosus insertion
4. plantaris
5. popliteus

Nerves

1. saphenous nerve L3-4 in the skin
   * Deeper*
2. tibial nerve L4-S3

Vessels

1. & 2. posterior tibial artery and vein
2. & 4. medial inferior genicular artery and vein
3. great saphenous vein
4. genu suprema artery

Question 7

List 3 neuroanatomical indications for SP9

Answer 7

SP9 indications

1. Pain in the muscles of the leg
2. Sprain/strain/arthritis of the medial aspect of the knee joint
3. Tendonitis of popliteal and plantaris

Question 8

BL40 location and needling technique

• Location
• Insertion
• Depth

Answer 8

BL40 location and needling technique

Location

At the midpoint of the Popliteal crease between the tendons of biceps femoris and semitendinosus.

Insertion

posterior to anterior, perpendicular to the skin, (possible to insert intra- articularly if using a long enough insertion). Flex the knee slightly to take tension off the posterior neural and vascular structures.

Depth

1 - 1.5 cun

Question 9

List relevant BL40 anatomy

• Muscles (3)
• Nerves (2)
• Vessels (3)

Answer 9

BL40 anatomy

Muscles

1. biceps femoris
2. semitendinosus
3. gastrocnemius

Nerves

1. posterior femoral cutaneous nerve S1-3 in the skin
2. tibial nerve L3-S4 (continuation of the line of the sciatic nerve)

Vessels

1. femoropopliteal vein
2. & 3. popliteal vein and artery

Question 10

List 5 neuroanatomical indications for BL40

Answer 10

BL40 indications

Nb. Parasympathetic Switch

1. Increases ROM of the knee
2. Hamstring tendonitis
3. Baker’s cyst
4. Low back pain (with or without sciatica)
5. Achilles’ tendonitis