Knee examination

Question 1

What is your mantra for a knee exam?

Answer 1

Lying: Look, feel, move, special test

Standing: look, function, neurovascular integrity

Question 2

What would you look for in a knee exam?

Answer 2

1. Age and general physical condition of patient (BMI, frailty)
2. Mobility aids
3. Knees: symmetry, muscle wasting, scars, redness, swelling, fixed flexion
4. Measure thigh circumference 10cm above patella and compare sides (hamstring or quad wasting)

Question 3

What scars could you see in a knee exam?

Answer 3

Small: arthroscopy

Big, anterior crossing: knee replacement

Question 4

What is redness a sign of?

Answer 4

Inflammation

Question 5

What is swelling a sign of?

Answer 5

Inflammation
Effusion
Baker’s cyst

Question 6

What is fixed flexion a sign of?

Answer 6

OA, knee pathology

Question 7

what would you feel for in a knee exam?

Answer 7

1. Temperature (superior to patella, medial and lateral joint lines)
2. With knee flexed to 90 degrees; palpate medial and lateral joint lines. Palpate patellar tendon insertion
3. With straight leg; palpate palellar border and quadriceps tendon. Palpate behind knee for swelling
4. Patellar tap
5. Sweep test for small effusions

Question 8

How would you move for a knee exam?

Answer 8

1. Assess ROM and pain on movement
2. Active movement: flexion, extension, hypertension, straight leg raise
3. Passive movement: flex and extend with hand on top of patella to feel for crepitus (look at patient’s face for discomfort)

Question 9

What special tests would you perform for a knee exam?

Answer 9

1. Posterior drawer test: PCL integrity
2. Anterior drawer test: ACL integrity
3. McMurray’s test: meniscal tear
4. Collateral ligament stress: MCL?LCL weakness
5. Patellar apprehension test: previous patellar dislocation

Question 10

How would you examine the knee of a patient while they’re standing?

Answer 10

1. Look
2. Function
3. Neurovascular integrity

Question 11

What would you look for in the knee with the patient standing?

Answer 11

Inspect front, sides and back

Look for deformity, muscle wasting

Varus deformity (bow-legged): OA, rickts
Valgus deformity (knock-kneed): OA, RA

Question 12

What function test would you do for knee examinations?

Answer 12

Ask patient to walk across room and back

Consider gait, symmetry, smoothness, normal heel stroke and gait cycle

Question 13

How would you assess the neurovascular integrity of the knee?

Answer 13

Sensation on dorsal foot and sole of the foot

Dorsalis pedis and posterior tibial, CRT in hallux

Question 14

How would you conclude a knee examination?

Answer 14

“I would like to examine the other knee”

“I would like the examine the hip and ankle, then go on to perform a full musculoskeletal assessment”

Investigations: x-ray, MRI, aspiration of effusion

Question 15

What are the muscles of the hamstring?

Answer 15

Semitendinosis
Semimembranosus
Biceps femoris

Question 16

What are the muscles of the quadriceps?

Answer 16

Rectus femoris
Vastus lateralis
Vastus intermedius
Vastus medialis

Question 17

How would you treat knee osteoarthritis?

Answer 17

Conservative: analgesia, physiotherapy, walking aids

Total knee replacement

Question 18

What meniscal injuries are common in the young and old?

Answer 18

Young: trauma to medial meniscus

Old: degenerative tear of lateral meniscus

Question 19

What trauma would lead to peroneal nerve injury?

Answer 19

Trauma to lateral leg at the level of the fibular head (being hit by a car bumper)