Knee

Question 1

Gait observation knee

Answer 1

Antalgic - (limp) - shortened stance phase, reduced flexion of knee
• Thrusting - knee appears to give way
• Foot-drop - damage to common peroneal nerve

Question 2

Function of knee

Answer 2

Squat test

• Ask the patient to squat down (not the older patient or obviously
  infirm!)
• Good overall function test of the knee

Question 3

Inspection of knee

Answer 3

Overall: are they able to stand and weight bear, alignment
SCWADS
S-welling : effusion, (Baker’s) cysts, inflammation, bursitis
C-olour : erythema, bruising, nodules
W-asting : quadriceps and gastrocnemius muscles
A-symmetry
D-eformity : varus/valgus, fixed flexion deformity, hyperextension, feet/ankles
S-cars : arthroscopy, knee replacement

Question 4

What are the 3 parts of the ‘feel’ section of the knee exam

Answer 4

1) temperature
2) effusion
3) structures

Question 5

Feel: effusion of the knee?

Answer 5

1) Patellar tap

2) sweep test

Question 6

Feel: structures of knee with STRAIGHT LEG, (3)

Answer 6

1) patella border
2) quadriceps tendon
3) swelling or tenderness

Question 7

Feel: structures of the knee with FLEXED LEG (3)

Answer 7

1) medial and lateral joint lines
2) patellar tendon
3) collateral ligaments

PJ COSY

Question 8

What things do you have to test for in movement of the knee

Answer 8

Flexion and extension

Question 9

Move: flexion of the knee

Answer 9

Active (they do it)
• “Can you bring you heel to your bottom please”
• RoM will reduce with age - is it normal for them?

• Passive (you do it) - If pain or reduced RoM actively
• GENTLY move the joint passively

Question 10

Move: extension of the knee

Answer 10

Fixed flexion deformity - inability to fully extend knee
• “Can you push the back of your knee into the bed please”
• Bone/tissue in the joint

If the knee bends the opposite way….
• Fix the thigh by pressing down on it and lift patients leg by the
ankle - normal for a knee to extend up to 5-10 degrees
Could it be ?Joint hypermobility syndrome

Question 11

What are all the separate special tests? (6)

Answer 11

1) Posterior sag
2) anterior drawer
3) posterior drawer
4) collateral ligament stress test
5) patellar apprehension test
6) mcmurrays test

Question 12

Special tests for crucial ligaments

Answer 12

Subluxation of the tibia from the femur

• Knee flexed to >90º with feet flat on couch
• Pain and/or lack of firm end-point implies tear in ligament
  • Posterior Sag (PCL)
• Knee appears to sag back
• Subtle sign, visualised on the anterior aspect of the knee
  • Anterior draw test (ACL)
• Gently fix foot by sitting on it - hold leg just below knee with
  thumbs at top of tibia - check hamstrings are relaxed then pull
  • Posterior draw test (PCL)
• As anterior draw test but push tibia backwards

Question 13

Special tests for collateral ligaments

Answer 13

Collateral ligament stress test

Pain or lack of firm end-point implies tear in ligament
- Hold knee with one hand and ankle with the other
- Flex the knee to about 30 degrees
• MCL
- Apply inward force the knee & outward force to ankle
• LCL
- Apply outward force to knee & inward force to ankle

Question 14

Joint above

Answer 14

Hip

Internal rotation in flexion

Question 15

Power test for knee

Answer 15

Extension of toes - common peroneal nerve

Flexion of foot - tibial nerve

Question 16

Sensation for knee

Answer 16

Dorsum of foot - common peroneal nerve
Sole of foot - tibial nerve

Question 17

Vascular for knee

Answer 17

Posterior tibialis

Dorsalis pedis