knee examination

Question 1

look (both knees)

Answer 1

standing

• limb alignment - valgus or varus
• quadricep/hamstring muscle mass
• popliteal fossae - baker’s cysts

gait
- pace, symmetry, abnormalities, antalgic gait(2nd to pain)

lying
- erythema, skin chnages, swelling

Question 2

feel (knees flexed)

Answer 2

temperature
tibial tuberosity
patella tendon
medial + lateral joint line
medial + lateral collateral ligaments
popliteal fossa
bursa - supra-, pre-, infrapatellar and popliteal

Question 3

move

Answer 3

active flexion 0-140 degrees
passive flexion 0-140 degrees

–> feel for crepitus

extension - passive +/- heel height testing

Question 4

effusion tests

Answer 4

small = medial gutter sweep - empty from medial side then sweep back round from lateral, will see effusion appear

large = patella tap - sweep down thigh, maintain pressure, tap over patella

Question 5

meniscal tests

Answer 5

Steinman’s test - pressure on area of joint line tenderness, hold heal in other hand

• • medial -> rotate foot externally
• • lateral -> rotate foot internally

heel height test - restricted extension in meniscal tear + history of locked knee - prone on bed, hang heels over

Question 6

cruciate ligament tests

Answer 6

collateral ligament testing - palpate for tenderness, abduct hip and hang leg off side then exert valgus then varus force
tender when - relaxed = sprain
laxity on valgus (lateral side of thigh) = medial tear, varus = lateral tear

posterior drawer test (PCL)
Lachman’s test (ACL) - one hand on thigh, other thumb on tibial tuberosity, quickly pull tibia anteriorly

Question 7

patella dislocation + OA tests

Answer 7

patella apprehension tests - push patella laterally and begin to flex knee + watch face

patella grind test - wiggle patella + reported discomfort

Question 8

suspected rupture to extensor mechanism

Answer 8

straight leg raise - dorsiflex ankle + raise leg, apply resistence superior to the knee