Knee Examination Flashcards
Stte the 9 stages of the knee examination
- Introduction
- General inspection
- Gait
- Closer inspection
- Palpation
- Movement (active & passive)
- Special tests
- Neurovascular assessment
- Completing the examination
What must you do in the introduction stage of your knee examination?
- Wash hands
- Introduce yourself
- Gain consent
- Offer chaperone
- Ask if any pain
- Position
- Expose
How do you want your patient exposed for the knee examination?
Ideally only wearing underwear or short shorts so that can see whole leg
What position do you want your pt in for the knee examination?
Initially standing
Then supine at 45 degrees
What should you do in the general inspection stage of your knee examination?
General inspection of pt
- Body habitus
- Scars
- Wasting of muscles
General inspection of surroundings
- Walking aids
- Prescriptoins
- Supports/knee braces
What should you do in the closer inspection stage of your knee examination?
Get pt to turn in 90 degree increments so you can exmaine the whole knee:
-
Anterior
- Scars, brusing, swelling, deformties, psoriasis plaques, patella position, varus or valgus deformity, quadriceps wasting
-
Lateral
- Extension (knee hyperextension can occur secondary to cruciate injury) or flexion abnormalities
-
Posterior
- Muscle wasting, popliteal swellings, scars
Discuss what you should do in the gait section of your knee examination
Ask pt to walk to end of room, turn around and walk back. Pay attention to:
- Gait cycle
- ROM
- Limping
- Leg length
- Turning
What should you do in the palpation stage of your knee examination?
Feel for:
- Temperature
-
Palpation with legs extended:
- Extensor mechanism
- Quadriceps tendon
- Patella
- Patella ligament
- Tibial tuberosity
- Palpate joint lines:
- Medial
- Lateral
- Patella tap
- Sweep test
- Extensor mechanism
-
Palpation with legs flexed to 90 degrees
- Extensor mechanism
- Quadriceps tendon
- Patella
- Patella ligament
- Tibial tuberosity
- Palpate joint lines:
- Medial
- Lateral
- Others:
- Head of fibula
- Popliteal fossa
- Extensor mechanism
Describe how to do the patellar tap test
- Knee fully extended
- Slide your left hand down thigh to upper border of patella to empty suprapatellar pouch
- Keep your left hand in position with your right hand press downwards on patella with finger tips
- If there is fluid present will feel distinct tap as patellar bumps against femur
Describe how to do the sweep test
- Pt has knee extended and is relaxed
- Slide left hand down thigh to upper border of patella to empty suprapatellar pouch
- Stroke medial side of knee joint to move away any excess fluid across to the lateral side of joint
- Now stroke lateral side of knee joint which will cause any excess fluid to move bak across to the emptied medial side of knee jiont causing appearance of a bulge or ripple on medial side
What should you do in the move stage of your knee examination?
- Active movement
- Knee flexion
- Knee extension
- Passive movement
- Knee flexion
- Knee extension
How do you test passive knee extension?
- Hold leg above ankle joint
- Gently lift leg upwards
- More than 10 degrees of hyperextension considere abnormal
What special tests should you do in the knee examination?
- Tests for ACL:
- Anterior drawer
- Lachmans
- Test for PCL:
- Posterior drawer
- Test for collateral ligaments:
- Varus stress test (lateral)
- Valgus stress test (medial)
- Test for menisci:
- McMurrays
Describe how to do the anterior drawer test
- Pt supine
- Ask to relax
- Flex knee to 90 degrees
- Wrap hand around proximal tibia with fingers around back
- Thumbs on tibial tuberosity
- Rest forearm on pts lower leg to fix its position
- Pull tibia anteriorly and feel for any anterior movement
Describe how to do the posterior drawer test
- Pt supine
- Ask to relax
- Flex knee to 90 degrees
- Wrap hand around proximal tibia with fingers around back
- Thumbs on tibial tuberosity
- Rest forearm on pts lower leg to fix its position
- Push tibia posteriorly
Describe how to do Lachman’s test
- Flex knee to 30 degrees
- Hold lower leg with dominant hand and put thumb on tibial tuberosity with fingers over calf
- With non-dominant hand hold thigh just above patella
- Use dominant hand to pull tibia forwards on femur whilst other hand stabilises femur
Describe how to do the varus stress test
- Extend pts knee
- Hold pts ankle between your elbow and side (ipsilateral side to leg you are testing)
- Place this hand ^ on medial aspect of knee
- With other hand, place palm over lateral aspect of lower limb with fingers reaching up to lateral knee joint line
- Push lower leg inward and tight outwards
- Observe for pain and palpate for gap at lateral knee joint line
Describe how to do valgus stress test
- Extend pts knee
- Hold pts elbow between your elbow & side (ipsilateral side to leg you are assessing)
- Place contralateral palm over lateral aspect of knee
- Place ipsilateral palm on medial aspect of lower limb with fingers reaching up to palpate medial joint line
- Push inwards with hand that is on lateral aspect of knee and outwards with hand this is on medial aspect of knee
- Observe for pain and palpate for any palpable gaps
What should you say to examiner after doing varus and valgus stress tests?
You would repeat if with knee flexed to 30 degrees as in this position cruciate ligament not taught therefore collateral ligament laxity can be more easily detected
Describe how to do McMurrays test for medial meniscus
- Pt supine
- Passively flex leg as far as possible
- Hold pts knee with your contralateral hand; thumb over medial aspect and fingers over lateral aspect
- Hold pts foot with your ipsilateral han
- Create varus stress by applying outward pressure with hand that is on foot and at same time slowly extend knee
- Presence of click and discomfrot suggests medial meniscus tear
Describe how to do McMurrays test for lateral meniscus
- Pt supine
- Passively flex leg as far as possible
- Hold pts knee with your contralateral hand; thumb over medial aspect and fingers over lateral aspect
- Hold pts foot with your ipsilateral han
- Create valgus stress by applying inward pressure with hand that is on foot and at same time slowly extend knee
- Presence of click & discomfort indicates lateral mensical tear
What should you do in the neurovascular assessment stage of knee examination?
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What should you do in the completing your examination stage of knee examination?
- Thank pt
- Dispode of PPE
- Summarise findings
- Further assessments & investigations:
- Full neurovascular examination of both lower limbs
- Examination of hip and ankle
- Further imaging if indicated e.g. x-ray, MRI
