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Musculoskeletal > Clinical Knee Exam > Flashcards

Clinical Knee Exam Flashcards

1
Q

the knee is the most common site of …?

A

symptomatic osteoarthritis

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2
Q

what kind of cartilage lines the tibia and femur?

A

hyaline

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3
Q

what do the menisci do?

A

provide additional shock absorption and smoothly distribute forces - they are disc shaped

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4
Q

what are the medial and lateral collateral (fibular) ligaments?

A

they run down each side of the knee and provide side-to-side stability

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5
Q

what kind of stability do the cruciate ligaments provide?

A

front-to-back stability

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6
Q

where does the ACL run?

A

prevents tibia from sliding anteriorly; it is in front and goes from lateral to medial (lateral femoral epicondyle tp front of tibia

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7
Q

where does the PCL run?

A

behind ACL and medial to lateral (medial femoral condyle

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8
Q

what is the “twist” portion of the knee extension?

A

the tibia externally rotates on the femur - provides increased stability

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9
Q

what can excessive rotation cause?

A

meniscus tears, cruciate ligament injury and patellofemoral pain

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10
Q

what are overuse/non-acute knee injuries categorized by?

A

vague pains, increased pain with increased activity, and a history of recent physical activity

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11
Q

what is effusion?

A

collection of fluid inside the joint capsule

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12
Q

what are signs of subtle effusions?

A

warm-cold-warm test, loss of normal skin dimples around knee, and milking

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13
Q

what is milking?

A

stroke upward along the medial aspect of the patella pushing fluid towards the top and lateral aspects of the joint; gently push on the lateral aspect of the joint, if the is a small effusion, the fluid which was milked to the lateral aspect will be pushed back towards the medial area of the joint, causing medial skin to bulge

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14
Q

what is DDx for acute/trauma with effusion?

A

knee dislocation, patella dislocation, articular cartilage defect, cruciate ligament injury, collateral lig injury, meniscus tear, bony fracture

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15
Q

what is the DDx for acute/trauma without effusion?

A

collateral lig injury, popliteal cyst

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16
Q

what is the DDx for non acute with effusion?

A

meniscus tear, osteoarthritis, infection, gout, reactive arthritis

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17
Q

what is the DDx for non acute, without effusion?

A

patellofemoral syndrome, iliotibial band, pes anserine bursa, popliteal cyst

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18
Q

how do you do a lateral joint line palpation?

A

put both thumbs in the recesses inferolateral and inferomedial to patella and walk lateral thumb back towards popliteal fossa
should feel: anterior horn of lateral meniscus, laterall collateral ligament, and posterior horn of lateral meniscus

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19
Q

in which horn are meniscus tears more likely?

A

the posterior horn

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20
Q

what is the connection between the McMurray test and the meniscus?

A

the test grind and pinches the posterior horns of the meniscus

21
Q

best position to feel the lateral collateral ligament?

A

FABER figure 4

22
Q

where do the collateral ligaments usually tear?

A

never in the middle - should palpate the femoral and tibial attachments of the ligaments in order to see which end has torn off

23
Q

how do you do a medial joint line palpation?

A

walk your medial thumb back towards the popliteal fossa

should feel: the anterior horn of medial meniscus, posterior horn of the medial meniscus

24
Q

what tendon is lateral to the knee?

A

biceps femoris

25
Q

what tendons are on the medial knee?

A

semitendinosis and semimembranosus

26
Q

what is a Baker’s/popliteal cyst?

A

a collection of fluid in the popliteal fossa

27
Q

what can cause a Baker’s/popliteal cyst?

A

a meniscal tear, cartilage damage, arthritis

28
Q

where is the pes anserine and what is is made of?

A

it is just inferior to the medial joint line, it is a confluence of the tendons of sartoriis, gracillus, and semitendinosus

29
Q

what is under the pes anserine?

A

a bursa that can be irritated by overuse and can cause aching medial knee pain

30
Q

how do you palpate the pes anserine?

A

you find the anterior horn of the medial meniscus and then drop inferiorly about 2 inches on the tibia

31
Q

what is an antalgic gait?

A

limping

32
Q

what is varus?

A

knees out, feet in

33
Q

what is valgus?

A

knees in, feet out

34
Q

what does the McMurray’s test for?

A

meniscus tears

35
Q

how do you do a medial McMurray’s test?

A

one hand on plantar foot and one on the joint line, fully flex the knee, then EXTERNALLY rotate the tibia - heel medial
may add varus force for extra compression

36
Q

how do you do a lateral McMurray’s test?

A

one hand on plantar foot, fully flex knee, INTERNALLY rotate the tibia - heel moves laterally and provide valgus force

37
Q

what is the thessaly test?

A

patient stands on one leg with knee bent at 20 degrees, patient should twist their hips/trunk back/forth three times to rotate femur on the tibia
this will use the body weight to grind the menisci - pain at medial or lateral joint line is a positive test

38
Q

what are the anterior and posterior drawer tests?

A

flex knee to 90 deg and sit on the foot to stabilize
observe the starting position of the tibial tuberosity (should be anterior to femoral condyles)
grasp superior tibia and push and pull it

39
Q

what is the lachman’s test?

A

MOST SENSITIVE test for ACL injury
grasp thigh with proximal hand
flex knee to 15-20 degrees and allow slight external rotation of the hip
while stabilizing femur with proximal hand, pull the anterior tibia directly anterior with distal hand
intact acl feels like snapping the chain between two nunchucks
a torn acl has no discrete endpoints and allows more motion than the uninjured side

40
Q

what is the modified lachman test?

A

use knee to support thigh in 15-20 degrees of flexion and use proximal hand to stabilize patient’s thigh on your thigh, use your distal hand to pull tibia anteriorly

41
Q

what is the varus/valgus stress test?

A 
the varus test for LCL
the valgus tests for MCL
flex knee 20-30 degrees
use proximal hand to stabilize knee
grasp ankle with distal hand and apply valgus or vargus to knee
42
Q

what does the patellar tendon connect?

A

the quadriceps muscle to the tibia

43
Q

what does patellar tendon tenderness indicate?

A

acute or chronic patellar injury

44
Q

where does the patella sit?

A

inside the groove or trochlea of the femur

45
Q

what happens in the kneecap has been acutely dislocated?

A

it will often move laterally

46
Q

what is the patellar apprehension test?

A

push patella laterally - if pain or discomfort - postive patella apprehension test

47
Q

what is the patellar compression test?

A

when knee in full extension, place thumbs on anterior surface of patella and press firmly back into the femur - pain indicates a positive test

48
Q

what is retropatellar tenderness?

A

knee in full extension, displace patella laterally and palpate the undersurface of the superior lateral patella, repeat on medial side

49
Q

what is patellar shrug/clarke’s test?

A

with knee in full extension place web of hand above kneecap on quadriceps tendon and slightly compress the quad tendon and patella posteriorly and inferiorly
instruct patient to contract the quad tendon and patella will rise and strike the web of your hand, of this causes pain - positive test

Musculoskeletal (21 decks)

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