Joint exam Flashcards
What are the steps of a knee exam? (5)
- Gait
- Inspection
- Palpate knee
- Joint effusion
- Active movement
- Passive movement
What should be checked for in gait? (5)
- Normal heel strike/toe?
- Normal step height?
- Not broad based steps?
- Normal speed?
- Symmetrical?
What position should the patient be in to palpate for a knee exam? (2)
- Sit patient with legs in front of them
- Knee flexed to 90 degrees
What should be felt for in the knee? (6)
- Assess temperature and compare both
- Quadriceps tendon
- Borders of patella
- Patella tendon
- Tibial tuberosity
- Head of fibula and joint lines
How are large joint effusions assessed?
Patellar tap
Explain how to carry out a patellar tap (4)
- Empty suprapatellar pouch
- Sliding left hand down thigh to patella with fingertips
- Keep L hand in position, use R hand to press down on patella with fingertips
- Fluid = tap of patella against femur
How are small joint effusions assessed = bulge test? (4)
- Swipe fluid from medial knee to suprapatellar pouch
- Hold fluid in suprapatellar pouch with 1 hand on medial side
- Swipe down from suprapatellar pouch on lateral side with other hand
- Bulge/ripple on medial side of joint = effusion
What test is used to assess small joint effusions?
Bulge test
What is active movement assessment? What should be observed? (2)
Patient performing movement
- Restricted range of movement
- Signs of discomfort
What movements in the knee should be assessed in active movement? (2)
- Knee flexion
- Knee extension
What is the normal range of movement in active knee flexion?
0-140 degrees
What instruction should be given to the patient for knee flexion?
“Move your heel as close to your bottom as you can manage”
What instruction should be given to the patient for knee extension?
“Straighten your leg out as best as you can”
What is a passive movement test? What is being observed? (2)
Patients relaxes, you move joint freely
- Crepitus
- Restriction of movement
What deformities should be checked for in a knee exam? And what do they look like? (2)
- Valgus deformity ><
- Varus deformity <>
When palpating the knee what are the main things to check? (3)
- Quadriceps bulk/wasting: chronic knee condition
- Swelling
- Pain along joint lines
What passive movements in the knee should be tested?
- Knee flexion
- Knee extension
- Hyperextension
How should hyperextension in the knee be assessed?
Elevate both legs by heels
What is normal hyperextension in the knee?
Less than 10 degrees
What are the special tests of a knee exam? (2)
- Anterior/posterior draw test for ACL and PCL
- Medial and lateral collateral ligaments
Describe the anterior/posterior draw test for ACL and PCL
- Flex knee to 90 degrees
- Wrap hands around proximal tibia
- Fingers around back of knee
- Thumbs on tibial tuberosity
- Relax legs
- Pull tibia anteriorly - feel for anterior movement of tibia on femur
- Push tibia posteriorly - feel for posterior movement of tibia on femur
Why should the legs be relaxed in the anterior/posterior draw test for ACL and PCL?
Tense hamstrings can mask pathology
What does movement on tibia on femur suggest?
ACL/PCL laxity/rupture
How is the lateral coollateral ligament assessed for (LCL)? (6)
- Extend patient’s leg
- Patient’s ankle between inner upper arm and side
- Hand on knee medial aspect
- Other hand on calf (so hands on same side of leg)
- Push hands steadily in opposing directions to stress joint laterally
- Should be little movement
