Knee exam Flashcards
What type of joint is the knee?
Hinge joint
Name the different ligaments, cartilage and tendons in and around the knee joint?
Ligaments:
- anterior cruciate
- posterior cruciate
- medial collateral
- lateral collateral
- transverse
- patellar
Cartilage:
- medial semilunar
- lateral semilunar
Tendons:
1. quadriceps femoris
Name the different bursae within the knee joint.
- infrapatellar
- semimembranous
- gastrocnemius
- popliteal
have the suprapatellar pouch and subpopliteal recess
Name the extensors of the knee.
Quadriceps femoris:
- rectus femoris
- vastus medialis
- vastus intermedialis
- vastus lateralis
Name the flexors of the knee.
Hamstrings:
- biceps femoris (lateral)
- semimembranosus (medial)
- semitendinosus (medial)
What are the steps in examining the knee?
- introduction
- preparation
- look
- feel
- move
- special tests
- function
- summary + close
What is the correct positioning of the patient in a knee exam?
start standing and then supine
What are you looking for when assessing the knee?
- look anteriorly and posteriorly
- skeletal abnormalities - varus or valgus deformity
- muscle bulk (can measure with measuring tape + compare both sides)
- swelling - oedema + bursae
- skin - scars, redness, psoriasis
What are you feeling for when assessing the knee joint?
- temperature
- joint line - can you feel any tenderness, or any bone abnormalities
- swelling/effusions
- specific features of the joint
How can you assess for large, moderate and small effusions?
(a) large effusions: visible
(b) moderate effusions:
- patella tap: milk any fluid out of the supra patellar pouch and gently press the patella
- does it tap and spring back?
(c) small effusion:
- bulge sign: empty supra patellar pouch and keep it empty with one hand
- empty one para-patellar pouch (usually medial) with a stroking motion
- empty the other para-patellar pouch whilst observing the other side for a bulge of fluid to appear
What are the special tests for the knee?
- varus + valgus strain
- anterior + posterior drawer test
- Lachman’s test
- McMurray test
How do you perform the varus/valgus strain test and what is being assessed?
- knee straight
- leg ~20°
- varus (lateral): arm under leg with hand on medial side + push the ankle inwards
- valgus (medial): arm under leg with hand on lateral side + push ankle outwards
*assessing laxity and give of medial and lateral collateral ligaments
How do you perform the anterior + posterior drawer test and what is being assessed?
- hips at 45°, knees at 90°, feet flat on the bed
- fix foot and grip lower leg with thumbs on the tibial tuberosity
- check for give when pulling anteriorly and pushing posteriorly
- abnormal subluxation with the soft endpoint is a positive test
* assessing anterior cruciate then pulling
* assessing posterior cruciate when pushing
How do you perform Lachman’s test and what is being assessed?
- flex patient’s leg to 30°
- hold the lower leg with one hand with the thumb on the tibial tuberosity and the fingers on the calf
- with the other hand hold the thigh just above the patella
- use the hand holding the lower leg to pull the tibia forward not he femur whilst stabilising the femur
*significant anterior movement indicated ACL rupture/laxity
How do you perform McMurray’s test and what is being assessed?
- knee flexed to 90°
- one hand on top of the knee and the other on the sole of the foot
- externally rotate the tibia and apply a valgus force to the knee - lower the knee
- return knee to starting position
- internally rotate the tibia and apply a varus force to the knee - lower the knee
- return leg to resting position
- thud/click/pain on internal rotation = lateral meniscal tear
- thud/click/pain on external rotation = medial meniscal tear
