Knee Examination

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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)