KNee Flashcards
What are the two main goals in the evaluation of the joint evaluation?
- Determine if pain is caused by the joint, or if it is referred?
- To find the specific tissue that may be generating the pain
Vague symptoms of the knee may indication what sort of etiology?
Referred pain
Pain that radiates from the hip or lower back suggests what etiology?
Referred pain
Normal strength and ROM of the knee, but with pain, may indicate what sort of etiology?
Referred pain
What is the dermatome of the anterior knee?
L3, L4, and L5
The back of the knee is what dermatome?
S1 and S2
Knee effusion is indicative of what?
Intra-articular pathology
Locking of the knee is indicative of what?
Meniscal lesions or loose body
Pain with going downstairs indicates what?
Loads the extensor mechanism
A knee that “gives way” indicates what?
Ligamentous or meniscal injury
Grinding/popping/clicking indicates what?
Painful = damaged cartilage or menisci
Painless = ligamentous laxity
What is eccentric contraction?
When contraction brings about increased distance between O and I
Multiple joints affected indicates what?
either polytrauma or systemic issue
What are the six principles of joint physical exam?
- Inspect
- ROM
- Resistance/strength
- Ligaments
- joint surfaces and menisci
- Palpate
PROM evaluates what?
Ligaments and contractile tissues
When should palpation for tenderness be done?
After functional exam has identified potential locations of pain
Diffuse swelling of a joint usually indicates what?
Fluid within the joint
Diffuse swelling + muscle wasting = what?
longstanding OA
Diffuse swelling + redness or heat suggests what etiology?
Gout
Inflammatory arthropathy
Localized swelling of a joint is indicative of what?
Baker’s cyst
Inflamed bursa
What is considered normal ROM of the knee?
heel touching buttocks
What is the normal end feel of knee flexion?
Tissue approximation
Passive hyperflexion tests what structure?
Meniscus
What limits the extension of the knee?
PCL and posterior capsule
What is the capsular pattern of knee pain?/
Gross limitation of flexion and slight limitation of extension
What is a non-capsular pattern of the knee?
Lesion does NOT affect the entire joint
Problems with resisted flexion of the knee is suspicious for what? (wwo pain)
Hamstring pain or S1/S2 root (depends on if painful or not)
Weakness with extension of the knee is suspicious for what? (wwo pain)
Quad problem
L3 root lesion if painless
What are the two factors that we assess with ligaments?
Pain
Laxity
How do you perform the Lachman’s test? What does this test for?
Flex knee to 30, anteriorly move the tibia while stabilizing the femur.
Tests for ACL damage
How do you perform the anterior drawer test? What does this test for?
Flex knee to 90, add pressure from behind the knee, directed anteriorly, to assess for laxity
Assess the ACL
What are the three components of the unhappy triad?
MCL
ACL
Medial meniscus
Which meniscus is attached to the associated ligament?
Medial meniscus to the medial collateral ligament
What is the usual injury that causes the (unhappy) terrible triad?
Valgus force
What is the test for a PCL tear?
Posterior drawer test
What does the valgus stress test assess?
MCL
What does the varus stress test assess?
LCL
What does the McMurray’s test assess?
Lateral meniscus
How do you perform McMurray’s test?
Flex hip and knee, externally rotate the foot, and apply valgus stress. Then bring into extension
What indicates a positive McMurray’s test?
Pain or clicking with movement
What does the patellar tap (ballottement) assess?
Patellar effusion secondary to meniscal tear, infection, or other
What indicates a positive patellar tap test?
the patella will “tap” onto the femur
How do you perform the patellar tap test?
compress inferior and superior portions of the knee, to push fluid behind the patella
How do you perform the patellofemoral compression test? What does this assess?
Directly compress that patella posteriorly into the trochlear groove onto the femoral condyles
PFPS or chondromalacia patella
What is the Apley distraction test? What does this assess for?
Pt is prone. Flex knee to 90. Internal and external rotation of the tibia while applying traction
Assess for medial/lateral collateral ligaments
What is the Apley compression test?
Pt is prone. Flex knee to 90. Internal and external rotation of the tibia while applying compression
Assess for medial/lateral collateral ligaments
Why is palpation for tenderness assessed last?
Difficult to determine what it means
