Knee Exam and Eval Flashcards
History
Specifics regarding mechanism Direction of force If twisting was involved Overuse? All other normal hx questions
If history says valgus force - ACL or PCL
ACL
If history says varus force - ACL or PCL
PCL
If history involves twisting
Menisci, ACL, PCL
If history involves noise, clicking, locking
very often meniscus or patella
If history invovles instability or giving way
often ACL or meniscus
If history involves child or growth spurt
common with patellafemoral pain or osgood schatters
CHECK VITAL SIGNS
:)
Lumbar scan
Observe and palpate
Gait
Neurological testing
Lumbar scan
Observation/palpation Gait AROM with overpressure Neuro exam Dermatomes/Myotomes/Reflexes PA testing
Lumbar Scan - Observation and Palpation
gait antalgia position of knee gross patella position effusion leg length discrepancy
Lumbar Scan - Gait
what is knee doing
Hip/foot position
Lumbar Scan - Neurological testing
scan for nerve root problem vs peripheral
Observation
Edema Patella position Muscle atrophy Femoral anteversion or retroversion (squinting patella, duck feet) Knee hyperextension or flexion Tibial torsion, position of ankle/foot
AROM/PROM with overpressure
Assesses willingness to move
Goniometry can be done actively and passively
Overpressure with eval of end feel
Knee AROM
flexion
extension
tibial IR and ER
What are you listening for with AROM
crepitus - very often patella femoral - look at tracking of patella
Must have ___ degrees of ROM to complete all functional motion
___ for stairs
120
110
Normal end feel of the knee - flexion
soft tissue approximation
Normal end feel of the knee - extension
capsular or springy if have tight hamstrings
Specific muscles to test
quads hams adductors gastroc soleus TFL glut med and max
Purpose of resisted motion
to determine if contractile or noncontracile problem/large or small lesion
Strong and painless resisted motion
normal or minor lesion
Strong and painful resisted motion
subacute or small lesion
Weak and painless resisted motion
serious lesion like neurological tumor, complete tear
Weak and painful resisted motion
major lesion, tear of mm all tendon
Special tests for effusion
Patella ballottement
Fluctuation test - test for moderate effusion
Stroking
Tape measure
Grade 0 - effusion
No wave produced on downstroke
Grade trace (effusion)
small wave on medial side with downstroke
Grade 1+ (effusion)
large bulge on medial side with downstroke
Grade 2+ (effusion)
Effusion spontaneously returns to medial side after upstroke
Grade 3+ (effusion)
so much fluid that is not possible to move the effusion out of the medial aspect of the knee
Clinical decisions related to effusion - 2+ effusion or more
exercises not progressed
Clinical decisions related to effusion - 2+ effusion persists after ice, elevation, compression
contact physician regarding NSAIDS or aspiration
Clinical decisions related to effusion - Effusion inc 2 graces
Activity decreased to level prior to the change in effusion
Clinical decisions related to effusion - trace or less effusion
Consider high level activity for return to sport
Special tests for ligaments - MCL
Valgus force at 0 and 30 degrees
0 should be no movement
at 30 for MCL laxity
With valgus force at 0 degrees if movement think…
MCL
ACL
PCL
medial knee capsule
Ligaments LCL
Varus force at 0 and 10-30 degrees
0 degrees no movement
30 degrees - LCL laxity
With varus force at 0 degrees if movement think…
LCL Lateral capsule Arcuate-popliteus complex ACL PCL
ACL - lachman's grades 0 1+ 2+ 3+
no anterior displacement
5mm translation
5-10mm translation
>10mm translation
ACL - lachman - watch out for
Hamstrings are protectors of ACL so be careful of false negative with hamstrings relaxed
Special tests for ACL
lachman
anterior drawer
Anterior drawer
grading same as lachmans
avoid false negative
Pivot shift
ACL deficient, patient complains of giving way, instability in WB
Determines if patient has dynamic instability of the knee
Special tests for PCL
Godfreys
Posterior drawer
Reverse lachmans
Special test for meniscus
joint line palpation
mcmurreys
apleys
McMurreys
you are trying to click, pop, or pain
Apleys
for meniscus
Functional test for meniscus
full knee squat
Some common thing with meniscal tear
- joint line tenderness
- hyperflexion with painful endfeel
- pos mcmurreys
- hx that relates to it
- swelling (sometimes dont have this)
Normal Q angle
15 degrees
Abnormal Q angle
greater than 20 degrees
Q angle measurement
ASIS to midpatella and tibial tuberosity and mid patella
Patella position - medial/lateral tilt
usually lateral
Patellafemoral articulating surfaces
looking at the articulating surfaces of the patella and see if they are irritated in pulling them close together
Apprehension test
patella
good for determining subluxation or dislocation
you are moving the patella into the position of how they sublux (mostly laterally)
Patella joint mobility - patellafemoral
assess all directions of motion, include compression and distraction
Medial and lateral translation should occur at 1/3 of surface of patella
Tibiofemoral - joint mobility
AP glide
Resting position
30 degrees flexion
Closed packed position
full extension with tibial ER
Capsular pattern
flexion > extension
Superior tibia-fibula joint =
AP glide
Flexibility
hamstrings obers rectus femoris gastrocnemius adductor
Functional hop tests - distance
single leg hop for distance
timed hop for dsitance
crossover hop
Lysholm knee scoring sclae
ACL or knee injury outcome measurement
Pittsurgh knee rules
blunt trauma or fall
Age less than 12 yo and greater than 50 yo
Cant WB for 4 steps
