(CPA) musculoskeletal knee exam Flashcards
what position and exposure is required for the knee examination?
lying on the couch at a 45 degree angle
knee joint, quadriceps and calf muscles exposed
what are the components of the knee examination?
position & exposure
look
feel
move (active, passive)
special tests
how is movement of the knee joint tested?
active testing
passive testing
which special tests are carried out in the knee examination?
anterior draw for ACL
posterior sag for PCL
medial & lateral collateral ligament
in the ‘look’ component of the knee exam, what are you looking for?
scars (suggest previous trauma/surgery)
muscle wasting
varus knee deformity (bow-legged)
valgus knee deformity (knock knees)
swelling
what are knee scars suggestive of?
previous trauma/surgery of the knee joint
what is knee muscle wasting suggestive of and what must be done if this is observed?
muscle atrophy (maybe due to LMN lesion)
= must do a neurological examination
what is valgus?
lower leg deformity when the bone at the knee joint is angled OUT and therefore the knees ‘knock’ inwards
what is varus?
lower leg deformity when the bone at the knee joint is angled IN and therefore the knees face outwards
what causes knee muscle wasting?
due to disuse (especially if there is chronic pain on movement = arthritis)
in the ‘feel’ component of the knee exam, what are you feeling/palpating for?
temperature
quadriceps tendon
medial and lateral border of the patella
tibial tuberosity + head of the fibula
popliteal fossa
how do you feel for the temperature at the knee joint?
patient lying flat with knee joint exposed
use the back of your hands simultaneously and feel for temperature above the patella, at the patella and below
do it at the same time so you can compare the temperatures
what does a warm knee temperature suggest?
inflammatory condition (e.g. septic arthritis or osteoarthritis)
what does swelling of the popliteal fossa indicate?
Baker’s cyst (fluid-filled swelling of the tissue of the popliteal fossa)
what is a knee effusion?
occurs when excess synovial fluid accumulates in or around the knee joint
why do knee effusions occur?
arthritis
damage to internal structures (e.g. meniscus)
bursitis
which two feel tests are carried out in a knee examination?
patellar tap method
knee sweep test
describe how a patella tap test is carried out
ensure the patient’s knee is extended
slide your non-dominant hand down the thigh to empty the suprapatellar pouch
with the non-dominant hand in place above the knee joint, firmly press over the patella with your dominant hand
(moderate effusion = feel a tap as the patella hits the femur)
describe how a knee sweep test is carried out
ensure the patient’s knee is extended
with your non-dominant hand sweep upward on the medial side of the knee to empty the medial compartment
keeping your non-dominant hand in place, sweep downward on the lateral side of the knee to empty the lateral compartment, with your dominant hand
(small effusion = ripple/bulge of fluid appears on the medial side of the knee from lateral side)
what does the patella tap test detect?
for detecting large effusions
what does the knee sweep test detect?
for detecting small effusions
what is a positive patella tap test?
in moderate effusion = feel a tap as the patella hits the femur