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Clinical Examinations > Knee Examination > Flashcards

Knee Examination Flashcards

1
Q

Stte the 9 stages of the knee examination

A
  1. Introduction
  2. General inspection
  3. Gait
  4. Closer inspection
  5. Palpation
  6. Movement (active & passive)
  7. Special tests
  8. Neurovascular assessment
  9. Completing the examination
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2
Q

What must you do in the introduction stage of your knee examination?

A
  • Wash hands
  • Introduce yourself
  • Gain consent
  • Offer chaperone
  • Ask if any pain
  • Position
  • Expose
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3
Q

How do you want your patient exposed for the knee examination?

A

Ideally only wearing underwear or short shorts so that can see whole leg

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4
Q

What position do you want your pt in for the knee examination?

A

Initially standing

Then supine at 45 degrees

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5
Q

What should you do in the general inspection stage of your knee examination?

A

General inspection of pt

  • Body habitus
  • Scars
  • Wasting of muscles

General inspection of surroundings

  • Walking aids
  • Prescriptoins
  • Supports/knee braces
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6
Q

What should you do in the closer inspection stage of your knee examination?

A

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
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7
Q

Discuss what you should do in the gait section of your knee examination

A

Ask pt to walk to end of room, turn around and walk back. Pay attention to:

  • Gait cycle
  • ROM
  • Limping
  • Leg length
  • Turning
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8
Q

What should you do in the palpation stage of your knee examination?

A

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
  • 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
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9
Q

Describe how to do the patellar tap test

A
  • 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
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10
Q

Describe how to do the sweep test

A
  • 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
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11
Q

What should you do in the move stage of your knee examination?

A
  • Active movement
    • ​Knee flexion
    • Knee extension
  • Passive movement
    • Knee flexion
    • Knee extension
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12
Q

How do you test passive knee extension?

A
  • Hold leg above ankle joint
  • Gently lift leg upwards
  • More than 10 degrees of hyperextension considere abnormal
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13
Q

What special tests should you do in the knee examination?

A
  • 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
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14
Q

Describe how to do the anterior drawer test

A
  • 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
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15
Q

Describe how to do the posterior drawer test

A
  • 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
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16
Q

Describe how to do Lachman’s test

A
  • 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
17
Q

Describe how to do the varus stress test

A
  • 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
18
Q

Describe how to do valgus stress test

A
  • 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
19
Q

What should you say to examiner after doing varus and valgus stress tests?

A

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

20
Q

Describe how to do McMurrays test for medial meniscus

A
  • 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
21
Q

Describe how to do McMurrays test for lateral meniscus

A
  • 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
22
Q

What should you do in the neurovascular assessment stage of knee examination?

A

??

23
Q

What should you do in the completing your examination stage of knee examination?

A
  • 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

Clinical Examinations (16 decks)

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