Knee Examination: Difference between revisions
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'''Observation from front''' | |||
• Weight distrubtion | |||
• Deformity (varus/valgus) | |||
• Swellings (loss of concavities) | |||
• Scars | |||
• Redness/rashes | |||
• Wasting (vastus medialis most prominent) | |||
[[File:Patellar Tracking.PNG|200px]] | [[File:Patellar Tracking.PNG|200px]] | ||
'''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== | ==References== | ||
[[Category:Knee and Leg]] | [[Category:Knee and Leg]] | ||
[[Category:Examination]] | [[Category:Examination]] |
Revision as of 19:27, 30 June 2021
Observation from front
• Weight distrubtion • Deformity (varus/valgus) • Swellings (loss of concavities) • Scars • Redness/rashes • Wasting (vastus medialis most prominent)
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)