EXAMINATION OF THE KNEE

1
EXAMINATION OF THE KNEE

• AND ASPIRATION TECHNIQUE
• C SNYCKERS

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INTRODUCTION

• The largest joint in the body
• subject to a great variety of traumatic and
  degenerative conditions
• Outwardly simple but is actually quite complex
• Not just a hinge joint.

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INTRODUCTION

• The tibia femoral joint is inherently unstable
• Relies heavily on ligaments for stability
• Patella is the largest sesamoid bone in the body
  acts as a fulcrum increasing mechanical
  advantage of quads.

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INSPECTIONSurface anatomy

• Anterior
• Patella
• Fracture
• Bipartite
• Infra-patellar tendon and Hoffas fat pad
• Rupture
• Tendonitis
• Tibial tubercle
• Osgood Schlatter
• avulsions

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INSPECTIONSurface anatomy

• Femoral condyles
• Pre-patellar bursa
• Bursitis
• Extensor mechanism
• Rectus femoris
• Vastus intermedius
• Vastus medialis (VMO)
• Vastus lateralis

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INSPECTIONSurface anatomy

• Medial
• Pes anserinus
• Say Grace before Tea
• MCL
• Lateral
• ITB (Gerdys Tuburcle)
• LCL

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INSPECTIONSurface anatomy

• Posterior
• Popliteal fossa
• Bakers Cyst
• Popliteal aneurism

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INSPECTIONLimb alignment

• INSPECTION
• Genu Valgum
• Intra-maleolar distance
• Genu Varum
• Intra-condylar distance
• Windswept deformity

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INSPECTIONPatella alignment

• Squinting patellae
• Increased femoral ante-version
• Increased external tibial torsion
• Q angle
• Anterior ASIS to center of patella
• Center of patella to tibial tubercle
• 14 in men, 17 in women
• Patella Alta
• Patella baja

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INSPECTIONGAIT

• Varus thrust
• Valgus thrust
• Recur vatum thrust
• Antalgic gait
• Stiff knee gait
• Flexed knee gait

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INSPECTIONRange of movement

• Extension Normal range
• Active 0
• Passive - 10 (prone hanging test)
• Flexion Normal range
• Active 0 - 130
• Passive 0 - 150

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PALPATION

• Be systematic
• Start and end at same spot
• Helpful system is to start anteriorly

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PALPATION

• Patella
• Infra-patella tendon
• Tibial tubercle
• Pes anserinus
• MCL
• Medial joint space and meniscus
• Medial femoral condyle
• VMO

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PALPATION

• Rectus femoris
• Vastus intermedius
• Vastus lateralis
• Lateral femoral condyle
• LCL
• Lateral joint space and meniscus
• ITB and Gerdys tubercle

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PALPATION

• REMEMBER TO CHECK POSTERIOR!!!
• Popliteal fossa
• Popliteal pulse

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MANIPULATION

• Muscle testing
• Oxford grading (out of 5)
• 5 normal power
• 4 weak power
• 3 against gravity
• 2 with gravity
• 1 - Flicker

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MANIPULATION

• Use
• Flex or extend
• Hold it there
• Keep it there
• Test
• Quads
• Hamstrings
• Check for atrophy
• Measuring tape (compare)

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SPECIAL TESTS

• PATELLA TAP
• Effusion
• FLUID THRILL
• Effusion
• PATELLA GRIND
• OA

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SPECIAL TESTS

• VALGUS STRESS TEST
• MCL (30 flexion)
• MCL, ACL and capsule (extension)
• VARUS STRESS TEST
• LCL (30 flexion)
• LCL, ACL and capsule (extension)
• GRADE LAXITY
• Gr I
• Gr II
• Gr III

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SPECIAL TESTS

• LACHMAN TEST
• ACL
• PCL
• GODFREYS TEST (drop off sign)
• PCL

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SPECIAL TESTS

• DRAWER TEST
• POSTERIOR PCL
• ANTERIOR ACL

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SPECIAL TESTS

• VARUS RECUVARTUM TEST
• Posterior lateral corner
• SQUAT TEST
• Meniscus
• APLEYS GRINDING AND DISTRACTION TEST
• Menisci

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SPECIAL TESTS

• MC MURRAYS TEST
• Medial meniscus
• Lateral meniscus

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KNEE ASPIRATION

• Sterile technique NB!!!!!
• Two fingers above and two fingers medial or
  lateral to superior pole of the patella
• Aim needle towards the tip of the patella below
  patella