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Knee Examination: Difference between revisions

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'''Observation from front'''
'''Observation from front'''


• Weight distrubtion
* Weight distrubtion
• Deformity (varus/valgus)
* Deformity (varus/valgus)
• Swellings (loss of concavities)
* Swellings (loss of concavities)
• Scars
* Scars
• Redness/rashes
* Redness/rashes
• Wasting (vastus medialis most prominent)
* Wasting (vastus medialis most prominent)


[[File:Patellar Tracking.PNG|200px]]
[[File:Patellar Tracking.PNG|200px]]
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'''Observation from lateral side'''
'''Observation from lateral side'''


• Hyperextension deformity
* Hyperextension deformity
• Fixed flexion deformity
* Fixed flexion deformity
• Swellings (e.g. meniscal cyst)
* Swellings (e.g. meniscal cyst)


'''Observation from behind'''
'''Observation from behind'''


• Muscle wasting (e.g. calf)
* Muscle wasting (e.g. calf)
• Swelling (e.g. semimembranosus bursa, ruptured bakers cyst)
* Swelling (e.g. semimembranosus bursa, ruptured bakers cyst)


'''Gait'''
'''Gait'''


• Limp (decreased stance phase – painful, or equal stance phase – non painful e.g. from flexion contracture)
* Limp (decreased stance phase – painful, or equal stance phase – non painful e.g. from flexion contracture)
• Shoulder tilts to the painful side
* Shoulder tilts to the painful side
• Heel strike, stance, toe off
* Heel strike, stance, toe off


'''Screening for internal derangement'''
'''Screening for internal derangement'''


• Squatting
* Squatting
• Duck walk
* Duck walk


'''Palpation of muscles (knee extended)'''
'''Palpation of muscles (knee extended)'''
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'''Patella'''
'''Patella'''


• Patella (margin, muscle and tendon insertions. Push patella medial side and palpate medially and inferior pole, push laterally and palpate laterally and inferior pole)
* Patella (margin, muscle and tendon insertions. Push patella medial side and palpate medially and inferior pole, push laterally and palpate laterally and inferior pole)
• Patella apprehension test (push laterally and flex 30-40 degrees, rule in and out instability)
* Patella apprehension test (push laterally and flex 30-40 degrees, rule in and out instability)


'''OA'''
'''OA'''


• Crepitus/grind test (push down on patella and flex/ext, look for pain with crepitus rather than crepitus alone)
* Crepitus/grind test (push down on patella and flex/ext, look for pain with crepitus rather than crepitus alone)


'''Fluid'''
'''Fluid'''


• Swipe test
* Swipe test
• patella tap
* patella tap


'''Palpation from side'''
'''Palpation from side'''


• Knee is now flexed
* Knee is now flexed
• Landmarks (lower pole patella is right in joint margin between medial femoral condyle, flat tibial plateau, lateral femoral condyle)
* Landmarks (lower pole patella is right in joint margin between medial femoral condyle, flat tibial plateau, lateral femoral condyle)
• Feel for sore meniscus, capsule, osteophytes along line
* Feel for sore meniscus, capsule, osteophytes along line
• Tibiofibula joint subluxation
* Tibiofibula joint subluxation


'''Further palpation of landmarks'''
'''Further palpation of landmarks'''


• Tibial tubercle
* Tibial tubercle
• Gerdeys tubercle (iliotibial band insertion)
* Gerdeys tubercle (iliotibial band insertion)
• Adductor tubercle
* Adductor tubercle
• Medial epicondyle femur, MCL, medial condyl tibia
* Medial epicondyle femur, MCL, medial condyl tibia
• Lateral epicondyle femur, LCL, head of fibula
* Lateral epicondyle femur, LCL, head of fibula
• Popliteal artery
* Popliteal artery


'''Movements'''
'''Movements'''


• Do all as active, passive and resisted  
* Do all as active, passive and resisted  
• Knee flexion
* Knee flexion
• Knee extension
* Knee extension
• Quads lag/extensor lag
* Quads lag/extensor lag


'''Ligaments'''
'''Ligaments'''


• Stress varus/valgus (rule out MCL)
* Stress varus/valgus (rule out MCL)


'''Cruciates'''
'''Cruciates'''


• Ski jump sign (posterior sag)
* Ski jump sign (posterior sag)
• Anterior drawer (rule in ACL)
* Anterior drawer (rule in ACL)
• Pivot shift test (rule in ACL)
* Pivot shift test (rule in ACL)
• Lachman test (rule out ACL)
* Lachman test (rule out ACL)
• Posterior drawer
* Posterior drawer


'''Meniscus'''
'''Meniscus'''


• Thessaly test (rule in + out meniscus)
* Thessaly test (rule in + out meniscus)
• Bounce test/snap test (poor)
* Bounce test/snap test (poor)
• Apley grind test (poor)
* Apley grind test (poor)
• McMurrays (poor)
* McMurrays (poor)


==References==
==References==
[[Category:Knee and Leg]]
[[Category:Knee and Leg]]
[[Category:Examination]]
[[Category:Examination]]

Revision as of 19:28, 30 June 2021

This article is a stub.

Observation from front

  • Weight distrubtion
  • Deformity (varus/valgus)
  • Swellings (loss of concavities)
  • Scars
  • Redness/rashes
  • Wasting (vastus medialis most prominent)

Patellar Tracking.PNG

Observation from lateral side

  • Hyperextension deformity
  • Fixed flexion deformity
  • Swellings (e.g. meniscal cyst)

Observation from behind

  • Muscle wasting (e.g. calf)
  • Swelling (e.g. semimembranosus bursa, ruptured bakers cyst)

Gait

  • Limp (decreased stance phase – painful, or equal stance phase – non painful e.g. from flexion contracture)
  • Shoulder tilts to the painful side
  • Heel strike, stance, toe off

Screening for internal derangement

  • Squatting
  • Duck walk

Palpation of muscles (knee extended)

Patella

  • Patella (margin, muscle and tendon insertions. Push patella medial side and palpate medially and inferior pole, push laterally and palpate laterally and inferior pole)
  • Patella apprehension test (push laterally and flex 30-40 degrees, rule in and out instability)

OA

  • Crepitus/grind test (push down on patella and flex/ext, look for pain with crepitus rather than crepitus alone)

Fluid

  • Swipe test
  • patella tap

Palpation from side

  • Knee is now flexed
  • Landmarks (lower pole patella is right in joint margin between medial femoral condyle, flat tibial plateau, lateral femoral condyle)
  • Feel for sore meniscus, capsule, osteophytes along line
  • Tibiofibula joint subluxation

Further palpation of landmarks

  • Tibial tubercle
  • Gerdeys tubercle (iliotibial band insertion)
  • Adductor tubercle
  • Medial epicondyle femur, MCL, medial condyl tibia
  • Lateral epicondyle femur, LCL, head of fibula
  • Popliteal artery

Movements

  • Do all as active, passive and resisted
  • Knee flexion
  • Knee extension
  • Quads lag/extensor lag

Ligaments

  • Stress varus/valgus (rule out MCL)

Cruciates

  • Ski jump sign (posterior sag)
  • Anterior drawer (rule in ACL)
  • Pivot shift test (rule in ACL)
  • Lachman test (rule out ACL)
  • Posterior drawer

Meniscus

  • Thessaly test (rule in + out meniscus)
  • Bounce test/snap test (poor)
  • Apley grind test (poor)
  • McMurrays (poor)

References

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