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Knee Examination

Knee Examination. Kathy Rainsbury February 2008. How to diagnose a knee complaint - HISTORY. 1) Patient’s age + sex 2) Does the knee swell? 3) Is there a mechanical problem?. Age + sex. Swelling?. Effusion presence of pathology which must be investigated

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Knee Examination

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  1. Knee Examination Kathy Rainsbury February 2008

  2. How to diagnose a knee complaint - HISTORY • 1) Patient’s age + sex • 2) Does the knee swell? • 3) Is there a mechanical problem?

  3. Age + sex

  4. Swelling? • Effusion • presence of pathology which must be investigated • XS synovial (inflammatory) fluid/ blood/ pus • Absence of effusion • Does not exclude pathology, but less likely. • Long-standing meniscus lesions/ OA

  5. Mechanical problem? • Hx of initial injury ‘mechanism’ • Degree + direction + incapacity • Knee ‘give way’? • Going down stairs/ jumping : cruciate ligament • Twisting/ walking/ uneven ground: meniscus • Knee ‘locks’? • NEVER locks in full extension • Full flexion but limited extension – FB + meniscal (‘click’) • Pain • When? Localise?

  6. Investigations • Examine other joints (? Rheumatoid/ psoriasis + other inflammatory arthropathies) • Aspiration + culture of fluid • Bloods • Xray joint (? use) • CXR (if ? TB) • MRI • EUA • Arthroscopy

  7. Examination • Look • Measure • Feel • Move

  8. Surface anatomy

  9. Surface anatomy 2 10 1 - Joint line 5

  10. Inspection (ant. + post.) • Symmetry • Swelling/ bruising/ scars/ rash/ deformity/ wasting/ bursae • (Heat) • Patella position – quads/ extensor apparatus intact?

  11. Measure • Quads circumference

  12. Palpate • Effusion – patellar tap • Fluid displacement • Tenderness • Bend knee – joint line • Collateral ligaments • Tibial tubercle • Femoral condyles

  13. Move • Active + passive • Extension – 0 deg (? Hyperextension) • Flexion – 135 deg

  14. Move - instability • 1) Valgus stress test (+ve if medial lig torn) • 2) Varus stress test ( +ve lat lig torn) • 3) Anterior Drawer test (+ve if ant cruciate torn) • Or Lachman test • 4) Posterior Drawer test (+ve if post cruciate torn)

  15. Instability - rotatory • MacIntosh test / pivot shift test (difficult if patient not under anaesthesia)

  16. Menisci • Feel for clicks, listen for crepitus • McMurrays test – medial + lateral menisci • (or Apley’s grind test)

  17. And finally… • Gait • Genu varum ‘varus my pig?’ • Genu valgus varus valgus

  18. http://www.youtube.com/watch?v=fNUGyNYVhqE • http://www.youtube.com/watch?v=IwBW-X4n1fU

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