Knee Examination

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Knee Examination

• Kathy Rainsbury
• February 2008

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How to diagnose a knee complaint - HISTORY

• 1) Patients age sex
• 2) Does the knee swell?
• 3) Is there a mechanical problem?

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Age sex
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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

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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?

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Investigations

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

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Examination

• Look
• Measure
• Feel
• Move

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Surface anatomy
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Surface anatomy 2
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- Joint line
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Inspection (ant. post.)

• Symmetry
• Swelling/ bruising/ scars/ rash/ deformity/
  wasting/ bursae
• (Heat)
• Patella position quads/ extensor apparatus
  intact?

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Measure

• Quads circumference

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Palpate

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

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Move

• Active passive
• Extension 0 deg (? Hyperextension)
• Flexion 135 deg

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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)

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Instability - rotatory

• MacIntosh test / pivot shift test (difficult if
  patient not under anaesthesia)

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Menisci

• Feel for clicks, listen for crepitus
• McMurrays test medial lateral menisci
• (or Apleys grind test)

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And finally

• Gait
• Genu varum varus my pig?
• Genu valgus

varus
valgus
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• http//www.youtube.com/watch?vfNUGyNYVhqE
• http//www.youtube.com/watch?vIwBW-X4n1fU