Knee Exam

Question 1

what 4 things should you look for on knee inspection

Answer 1

skin - wounds, swelling, deformity
genu varum/genu valgus
gait
patella tracking

Question 2

what is genu varum

Answer 2

bow legged = legs curve outward
medial compartment narrowing

Question 3

what is genu valgum

Answer 3

knock kneed = legs curve inward
lateral compartment narrowing

Question 4

what should you palpate for knee exam

Answer 4

joint line
patella - facet pain
tibial tubercle
pes anserine bursae
patellar tendon
quad tendon
IT band
popliteal fossa

Question 5

how to palpate pes anserine bursae

Answer 5

inserts on fibular head

Question 6

how to assess for swelling

Answer 6

look at obvious - pre-petallar (on top of patella)

patella ballotting
milking (bulge) - sweep upwards on medial side and then sweep down from lateral side - bulge on medial aspect is positive

Question 7

which nerve?
knee flexion

Answer 7

sciatic N

Question 8

which nerve?
knee extension

Answer 8

femoral N

Question 9

which nerve?
foot plantarflexion

Answer 9

tibial N

Question 10

which nerve?
foot dorsiflexion

Answer 10

deep peroneal N

Question 11

which nerve?
medial thigh sensation

Answer 11

obturator N

Question 12

which nerve?
anterior thigh sensation

Answer 12

femoral N

Question 13

which nerve?
posterolateral leg sensation

Answer 13

sciatic N

Question 14

which nerve?
dorsal foot sensation

Answer 14

peroneal N

Question 15

which nerve?
plantar foot sensation

Answer 15

tibial N

Question 16

which pulses can you palpate

Answer 16

popliteal
dorsal pedis
posterior tibial

Question 17

how to grade pulses

Answer 17

0 - 4
3+ is normal

Question 18

how to grade reflexes

Answer 18

0 - 4
2+ is normal

Question 19

normal flexion ROM

Answer 19

0-135/140

Question 20

which special tests can you perform for ACL

Answer 20

Lachman’s test
anterior drawer
pivot shift

Question 21

Lachman’s test

Answer 21

most sensitive for ACL injury

patient lying down
one hand on thigh, one hand on calf
pull up with hand on calf (translate tibia)

Question 22

Pivot shift test

Answer 22

patient lying down
lift patient’s heel
internally rotate leg
apply valgus stress (hand on lateral side of knee and press laterally)
flex knee towards oppositve shoulder
clunk with flexion = ACL

Question 23

which special tests can you perform for PCL injury

Answer 23

posterior drawer
posterior sag
quadriceps active
reverse pivot shift

Question 24

posterior sag test

Answer 24

patient supine
hips at 45, knees at 90
posterior translation of tibia in relation to femur

this is more pronounced when pt presses heel into your hand

Question 25

quadriceps active test

Answer 25

patient supine hips at 45, knees at 90 look for posterior sag sign tell patient to flex quad - tibia with noticeably translate forward

Question 26

reverse pivot shift test

Answer 26

patient supine flex knee to 45, externally rotate, and apply valgus force (hand on lateral aspect on knee and press medially) extend knee clinking with extension = PCL injury

Question 27

which special tests can you perform for collateral ligaments

Answer 27

valgus stress varus stress

Question 28

valgus stress test

Answer 28

place hand on lateral aspect on knee and press laterally = MCL laxity at 30 degrees = MCL laxity at 0 degrees = MCL + cruciate ligament

Question 29

varus stress test

Answer 29

place hand on medial aspect of leg and press medially = LCL laxity at 30 degrees = LCL laxity at 0 degrees = LCL + cruciate ligament

Question 30

which special tests can be performed for meniscus

Answer 30

joint line tenderness mcmurrays test apleys compression test

Question 31

which test is most sensitive for meniscal tear

Answer 31

joint line tenderness

Question 32

mcmurrays test

Answer 32

place knee into flexion + IR and then extend knee (pain/pop = lateral meniscus) place knee into flexion + ER and then extend knee (pain/pop = medial meniscus)

Question 33

apleys comression test

Answer 33

patient prone place knee at 90 and stabilize thigh with your knee ER (pop/pain = medial meniscus) IR (pop/pain = lateral meniscus)

Question 34

what special tests can you perform for patellofemoral joint

Answer 34

patella displacement patella apprehension J sign patella grind test

Question 35

patella displacement test

Answer 35

translate patella medially and laterally (it should do this normally)

Question 36

patella apprehension test

Answer 36

relax quads and put your hand on medial aspect of patella and press patella laterally pain/apprehension = MPFL or medial retinacular injury

Question 37

J sign

Answer 37

extend knee from flexed position pt will have maltracking

Question 38

patella grind test

Answer 38

pt supine tell pt to activate quads while placing a compressive force on the patella when the knee is in full extension pain/inability to complete = positive

Question 39

what are special tests you can perform for the extensor mechanism?

Answer 39

straight leg raise

Question 40

straight leg raise

Answer 40

inability to perform = quad/patellar tendon injury