Knee Exam Flashcards
Assess for Effusion
Warm-Cold Warm and Milking Effusion/Fluid Wave
Meniscus Test–McMurray’s
With knee in full flexion, externally and internally rotate then straighten. Pain or pop in medial or lateral joint line suggests meniscus tear. (heel points to meniscus being tested)
Meniscus test–Thessaly
Patients stands on one leg with knee bent to 20 degrees and twists trunk back and forth to grind the menisci. Pain at medial or lateral joint line is positive test.
Ligament test–Anterior and Posterior Drawer
Flex knee at 90 degrees and grasp superior tibia. Push tibia posteriorly and pull anteriorly to assess for function of ACL/PCL. Verify starting position of tibial tuberosity.
Ligament test–Lachman’s Test (most sensitive for ACL injury)
Grasp thigh and flex knee 15-20 degrees, allowing for slight external rotation of hip. Pull anterior tibia directly anterior. Intact ACL feels like snapping the chain between 2 nunchucks. Torn ACL has no discrete endpoint and allows more motion than uninjured side. (Modified Lachman is where you use your knee to support the thigh at 15-20 degrees of flexion).
Ligament test–Varus (LCL) and Valgus (MCL) Stress Test
Flex knee 20-30 degrees using one hand to stabilize the knee. Grasp ankle with other hand and apply varus or valgus strain to the knee. Pain or difference in laxity from side to side indicates collateral ligament injury. (performing these tests at full extension tests the cruciate ligaments and boney screw home mechanism of knee, not the collateral ligaments).
Patellar test–Patellar dislocation/Patellar apprehension
While the patient relaxes, push patella laterally. If patient experiences pain or sensation that patella will dislocate, this is positive patella apprehension test.
Patella test–Patellar Compression
With knee at full extension, place thumbs on anterior surface of patella and firmly press back into femur. Pain with compression is positive test.
Patellofemoral tests include:
patellar grind, retropatellar tenderness and patellar inhibition (test for patellofemoral irritation between the underside of the patella and femoral groove or trochlea)
Patella Test–Retropatellar tenderness
With knee at full extension, displace patella laterally while using other thumb to palpate undersurface of superior lateral patella. Then displace patella medially and palpate undersurface of superior medial patella. Tenderness of either facet should be noted as positive retropatellar tenderness.
Patella test–Patellar shrug/Clarke’s Test
With knee at full extension, place the web of your hand above the kneecap on quadriceps tendon and slightly compress the quad tendon and patella posteriorly ad inferiorly. Have patient contract their quadriceps while maintaining pressure on the quad tendon and patella. The patella should rise and strike the web of your hand. If firing of the muscles causes the patient retropatellar pain, this is a positive test.
Excessive rotation of the knee can predispose to:
meniscus tears, cruciate ligament injury, patellofemoral pain (remember that as the knee swings into terminal extension, the tibia “screws home”, actually externally rotates…the terminal twist)
Crossed finger cruciate ligament study tool
Cross your middle finger over index and place them over your knee (right hand right knee, etc). The middle finger represents the ACL going from lateral femoral condyle to front of tibia and the index finger represents the PCL going from medial femoral condyle to the posterior portion of tibia plateau.
An acutely injured knee with positive effusion include 6 diagnostic possibilities. What are they?
Cruciate ligament injury, collateral ligament injury, meniscus tear, fracture, patellar dislocation or complete knee dislocation.
How do the lateral collateral ligament and medial collateral ligament feel upon palpation?
The lateral collateral ligament feels like a round pencil-like structure. The medial collateral ligament feels like a broad, flat, multilayered, indiscrete structure.
