knee examination

Question 1

what should be done on introduction? (5)

Answer 1

introduce yourself
seek consent
expose patient by asking patient to remove trousers
ensure patient is comfortable
ask the patient if they have any pain

Question 2

what should be done on inspection?

Answer 2

inspect for any walking aids, wheelchairs, and analgesia (if pain)

Question 3

what should be done on ‘look’

Answer 3

symmetry/alignment
fixed flexion deformity
varus and valgus
knee hyperextension
scarring
skin changes
swelling
muscle wastage
look at other angles

Question 4

what are possible skin changes

Answer 4

eryhtema
bruising
nodules
psoriatic plaques

Question 4

what are possible skin changes

Answer 4

eryhtema
bruising
nodules
psoriatic plaques

Question 5

which muscles could have wastage

Answer 5

gluteus maximus
quadriceps
hamstrings
calves

Question 6

what should be assessed for on ‘gait’

Answer 6

stride length
gait cycle
gait cadence
pathological gait features

Question 7

what are pathological gait features

Answer 7

antalgic gait
foot drop
knee giving way

Question 8

how should ‘feel’ be performed

Answer 8

ask person to lay on couch
feel for temperature over the knees
perform patella tap test
perform sweep test
palpate structures with knee at 90 degrees

Question 9

how should temperature be felt for

Answer 9

feel over both knees and compare
use the back of your hand
compare to the temperatire above and below the knee

Question 10

how to perform the patella tap test

Answer 10

used to identify larger effusions
slide left hand down patients thigh arriving just before patella
using right hand push down patients patella with finger tips
test is positive when a tap is felt as the patella hits the femur

Question 11

how to perform the sweep test

Answer 11

test is used to identify smaller effusions
slide left hand down pts thigh arriving just before patella
slide hand over the medial side of the knee joint
slide hand over lateral side of the knee joint
test is positive if a bulge is seen over medial side of knee after lateral side is swept

Question 12

which structures should be palpated with knee flexed at 90 degrees

Answer 12

quadriceps tendon
margins of the patella
patellar tendon
tibial tubercle
joint lines
colateral ligaments
hamstrings
swellings behind the knee

Question 13

what can tenderness at patellar tendon indicate

Answer 13

tendonitis
rupture

Question 14

what can tenderness at tibial tubercle suggest

Answer 14

osgood-schiatter disease

Question 15

what can tenderness at joint lines suggest

Answer 15

fracture
injury to collateral ligaments or menisci

Question 16

what can swellings behind the knee suggest

Answer 16

bakers cyts
very rarely a popliteal aneurysm

Question 17

what should the patient perform at ‘move’

Answer 17

active flexion and extension of knee
fix patients thigh to the bed and lift up lower leg to check extensiion
perform passive flexion and extension

Question 18

how should a patient perform active flexion and extension of knee

Answer 18

ask pt to bring heel to bottom as far as they can and ask them to fully straighten out leg and press back of knee into couch

normal range of flexion is 130
normla range of extension is 0

Question 19

what are the key ranges for knee hyperextension

Answer 19

5-10 of hyperextension is normal
more than 10 consider for joint hypermobility syndrome or ligamentous knee injury

Question 20

which special tests should be performed

Answer 20

posterior sag test
anterior draw test
posterior draw test
valgus/varus stress test
consider performing McMurrarys test

Question 21

how to perform posterior sag test

Answer 21

place knees at 90 with feet together and on couch
inspect knees for any sag posteriorly when compared with each other
sag indicates PCL injury

Question 22

how to perform anterior draw test

Answer 22

sit on pts foot
grab proximal end of lower leg with both hands - fingers on hamstrings thumbs on patella
firmly pull lower leg towards you
postive test if leg shifts forward indicating ACL injury

Question 23

how to perform posterior draw test

Answer 23

sit on patients foot
grab proximal end of lower leg
asks patient to relax their leg
firmly push lower leg away from you
posiive test if leg shifts backwards indivating PCL injury

Question 24

how to perform varus valgus stress test

Answer 24

ask pt to extend leg
hold ankle in one hand and stabilse nee with other
flex knee to 30
apply force to medial then lateral aspects of lower leg
pain or lag of fixed end range indicates collateral lig damage

Question 25

what and why do we do McMurrays test

Answer 25

test for meniscal damage
no longer recommended due to concerns it worsensknee injuryand has low daignostic sensiticvy

Question 26

how to test neurovascular integrity

Answer 26

ankle dorsiflexion for deep peroneal nerve and branch of commmon peroneal nerve
ankle plantarflexion for tibial nerve and branch of sciatic nerve
dorsum of foot sensation for common personeal nerve
plantar surface of foot for tibial nerve
palpate tibial and dorsalis pedis pulses