Basic Exam of the Knee Flashcards
What are the main steps in a knee exam?
Prepare patient
Hand hygiene
General inspection and observation of gait
Inspection with patient lying supine
Anterior palpation of knee joint
Lateral and posterior palpation of knee joint
Testing movements of knee
Examine anterior and posterior cruciate ligaments
Examine collateral ligaments
Complete exam
How do you prepare the patient?
Explain reason for exam In general what it involves Indicate both knees will be examined Both knees adequately exposed - Shoes and socks off for deformities at ankle
What should you be looking for in a general inspection?
Alignment of knees in standing position
What abnormalities in the alignment of the knees in a standing position may be observable?
Bowing = genu varum Knock-knees = genu valgus
What abnormalities may be apparent when observing a patient’s gait?
Limp due to
- Pain
- Deformity
Muscle wasting
Why might knee problems cause muscle wasting?
Limited use of surrounding muscle groups > reduced muscle bulk
Which muscle especially has a reduced muscle bulk because of knee problems?
Vastus medialis
Which part of the knee should special attention be paid to when observing gait?
Back of knee
What are you looking for when you are inspecting the knees whilst the patient is lying supine?
Scars Rashes Evidence of inflammation - Redness - Swelling Ask about pain
What are the steps for the anterior palpation of the knee?
Check temperature
Check for joint effusion by performing patellar tap
Check for joint effusion by performing bulge test
Palpate
How do you check the temperature of the knee?
Place back of hand on skin over patella
Should be slightly cooler than surrounding areas
What is joint effusion?
Fluid in joint
How does the knee appear if there is a large amount of fluid in the knee?
Swollen medial, lateral, and superior to patella
What is the patellar tap used to detect?
Lesser amount of fluid than visible
How do you perform the patellar tap?
Warn patient that test may be uncomfortable
Place hand above patella
Milk any fluid in suprapatellar bursa into subpatellar space
- Slide hand firmly down so it rests above patella
Maintain pressure at this position
With index and middle fingers of other hand, push patella down
If effusion present
- Patella will knock against femoral condyles > tapping sensation
- Patella feels as if bouncing in joint space
What is the bulge test used to detect?
Smaller effusions than those detected in patellar tap
How do you perform the bulge test?
Displace fluid from medial aspect of knee into superior and lateral aspects
- Stroke upwards on medial side of patella
Apply pressure on lateral side of patella
- Stroke downwards
Observe if any fluid pushed back/bulges into medial aspect
How do you palpate the anterior knee?
Systematically palpate around - Patella - Quadriceps insertion - Patellar tendon Examine for evidence of - Heat - Tenderness > periodically check patient's face - Swelling
With which knee should you start any of the tests?
Unaffected knee as baseline
How do you laterally and posteriorly palpate the knee joint?
Ask patient to flex their knees
Palpate along medial and lateral joint lines to detect tenderness and swelling
Ask patient to straighten their knees again
Palpate posterior aspect for tenderness and swelling
What is a common cause of swelling behind the knee?
Baker’s cyst
How do you check the range of movement of the knees?
Compare one side with other
Observe degree of extension when patient resting legs on examination couch
Test flexion
- Bend unaffected knee by sliding foot towards bottom = active flexion
- Gently push flexed knee = passive flexion
- Ask patient if this maneuver too uncomfortable
- Observe face whilst doing this
Test other side
What is the normal range of movement at the knee?
0 degrees = extension to 135 degrees = flexion
What is flexion usually limited by?
Opposition of calf against hamstrings
What does passive flexion test?
Extra amount knee can be flexed
How do you examine the anterior and posterior cruciate ligaments?
Patient flexes knee to 90 degrees Sit on couch and stabilise patient's leg by wedging foot under bottom Place hands behind patient's knee - Thumbs over tibial tuberosity Pull forward = anterior draw test Push backwards = posterior draw test
What indicates an anterior cruciate ligament injury in the anterior draw test?
Excessive movement of tibia against femur
What indicates a posterior cruciate ligament injury in the posterior draw test?
Excessive movement of tibia against femur
How do you examine the collateral ligaments?
Start with unaffected knee to establish normal degree of laxity
Support patient’s lower leg between your arm and body with knee slightly flexed
Test medial collateral ligament - apply valgus stress to knee
- Place one hand on lateral aspect of knee
- Use other hand to support ankle/calf
- Push inwards at knee with one hand
- Provide opposing force with other hand at ankle
Test lateral collateral ligament - apply varus stress to knee
- Place one hand on medial aspect of knee
- Use other hand to support ankle/calf
- Push outwards at knee with one hand
- Provide opposing force with other hand at ankle
What does laxity of the collateral ligaments indicate?
Damage
