Page 1 of 1: Knee Examination

sairauddin · Credits: 3823 My Scrapbook

Please explain step by step knee examination

bio75 · Credits: 235 My Scrapbook

1- inspection
2- palpation
a- knee flexed 90
b - knee slight flexed
c- knee extended
3- ROM--flection.extension
4-patella
5-effusion
6-sagg sign
7-drwer test
8-collateral legament
9-mc merry test

adrian · Credits: 2173 My Scrapbook

7-Always do Lachmann and pivots with drawers.

Kai1111 · Credits: 2036 My Scrapbook

Knee Exam

Introduce self, wash hands and explain to the patient that you are going to do a knee exam. This might involve a little pain if there is an injury. An important part of the exam, is learning where the pain is located with as much precision as possible. The patient may stop me at any point. Obtain consent for the exam. For all the tests, you should compare with other, non-involved knee.

Inspection:

1. Observe Gait:
a. note antalgia
b. note symmentry
c. Is the pt a heel to toe walker?

2. Observe standing w feet shoulder width apart.
a. Is there a varus or valbus deformity?
b. Is the pt flat footed, does she have a good arch?
c. Are knees swollen?
d. Is the pt athletic, overweight, other?

3. Have pt turn around and look at back/posterior legs.
Is there any Popliteal swelling, scoliosis, hip dysymetry?

Range of Motion/Strength & others

1. While pt still seated, have her extend her knee and view extensors
a. Note any atrophy
b. Assess strength by pushing down on lower extremity X3

2. Have pt lie down and pull out foot rest
a. Check leg lengths
b. Compare both knees and note swelling, scars, redness, calluses.
c. Have pt fully flex hip then knee, then extend; check active and passive.

Palpation

A. With legs extended

1. Compare temperature of both legs; above and below knees & knees themselves.
2. Palpate patella and note presence of ballotment, crepitance, mobility, pain w pressure . Feel around its edges.
3. Milk knee and look for effusion.
4. Do Patella Apprehension Test to r/o subluxation (http://www.youtube.com/watch?v=ALLi7dOXU8c)
5. Do Patella Grind Test – Press down on patella and have pt contract quadriceps mm.
6. Collateral Ligament Stress (med & lat)
7. Do Lachman’s Maneuver or Anterior Drawer to assess ant cruciate
8. To asses post cruciate, do Post Drawer and check for Post Sag Sign
9. Feel behind knee to r/o cysts or swellings, pulsitile masses.

B. With knee flexed 90 degrees and foot on table

1. Palpate the tibial plateau and identify the inf patellar tendon & tibial tuberosity – note tenderness, swelling, calluses
2. Palpate tibial plateau edge from midline to medial menisus – note tenderness, crep, swelling, etc.
3. Palp tibial plateau edge from midline to lateral meniscus/ lat-collat ligament
4. Do a McMurrays Test

daood · Credits: 296 My Scrapbook

A 38-year-old patient experiences sudden, severe pain in his left knee as he pivots on that leg to lift a couch up some stairs. He is able to ambulate initially but later develops locking relieved by shaking his leg gently. On examination, he has a small effusion, no erythema, nearly normal range of motion and slight joint line tenderness medially. There is no tenderness of the patella or head of the fibula. How would you evaluate this patient?

adrian · Credits: 2173 My Scrapbook

It's a typical case of acute rupture of anterior horn of left knee internal meniscus("bucket-handle")....

daood · Credits: 296 My Scrapbook

ACUTE KNEE INJURY FORM used by Canadian family physicians:

Anterior drawer test . Place patient supine, flex the hip to 45 degrees and the knee to 90 degrees. Sit on the dorsum of the foot, wrap your hands around the hamstrings (ensuring that these muscles are relaxed), then pull and push the proximal part of the leg, testing the movement of the tibia on the femur. Do these maneuvers in three positions of tibial rotation: neutral, 30 degrees externally rotated, and 30 degrees internally rotated. A normal test result is no more than 6 to 8 mm of laxity.

Lachman test . Place patient supine on examining table, leg at the examiner's side, slightly externally rotated and flexed (20 to 30 degrees). Stabilize the femur with one hand and apply pressure to the back of the knee with the other hand with the thumb of the hand exerting pressure placed on the joint line. A positive test result is movement of the knee with a soft or mushy end point.

Pivot test . Fully extend the knee, rotate the foot internally. Apply a valgus stress while progressively flexing the knee, watching and feeling for translation of the tibia on the femur.

McMurray test . Flex the hip and knee maximally. Apply a valgus (abduction) force to the knee while externally rotating the foot and passively extending the knee. An audible or palpable snap during extension suggests a tear of the medial meniscus. For the lateral meniscus, apply a varus (adduction) stress during internal rotation of the foot and passive extension of the knee.

daood · Credits: 296 My Scrapbook

THE FORM DIDNT GET POSTED?

adrian · Credits: 2173 My Scrapbook

Agree,this is by the book.In clinical practice,though most of patient are less available for clinical exam,to elicit all these maneuvers,and the presumptive diagnosis is shouted from the hallway.After minimal labs and ECG , send him for arthroscopy.

daood · Credits: 296 My Scrapbook

anterior cruciate ligament tear.

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