knee examination Flashcards
what should be done on introduction? (5)
introduce yourself
seek consent
expose patient by asking patient to remove trousers
ensure patient is comfortable
ask the patient if they have any pain
what should be done on inspection?
inspect for any walking aids, wheelchairs, and analgesia (if pain)
what should be done on ‘look’
symmetry/alignment
fixed flexion deformity
varus and valgus
knee hyperextension
scarring
skin changes
swelling
muscle wastage
look at other angles
what are possible skin changes
eryhtema
bruising
nodules
psoriatic plaques
what are possible skin changes
eryhtema
bruising
nodules
psoriatic plaques
which muscles could have wastage
gluteus maximus
quadriceps
hamstrings
calves
what should be assessed for on ‘gait’
stride length
gait cycle
gait cadence
pathological gait features
what are pathological gait features
antalgic gait
foot drop
knee giving way
how should ‘feel’ be performed
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
how should temperature be felt for
feel over both knees and compare
use the back of your hand
compare to the temperatire above and below the knee
how to perform the patella tap test
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
how to perform the sweep test
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
which structures should be palpated with knee flexed at 90 degrees
quadriceps tendon
margins of the patella
patellar tendon
tibial tubercle
joint lines
colateral ligaments
hamstrings
swellings behind the knee
what can tenderness at patellar tendon indicate
tendonitis
rupture
what can tenderness at tibial tubercle suggest
osgood-schiatter disease
what can tenderness at joint lines suggest
fracture
injury to collateral ligaments or menisci
what can swellings behind the knee suggest
bakers cyts
very rarely a popliteal aneurysm
what should the patient perform at ‘move’
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
how should a patient perform active flexion and extension of knee
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
what are the key ranges for knee hyperextension
5-10 of hyperextension is normal
more than 10 consider for joint hypermobility syndrome or ligamentous knee injury
which special tests should be performed
posterior sag test
anterior draw test
posterior draw test
valgus/varus stress test
consider performing McMurrarys test
how to perform posterior sag test
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
how to perform anterior draw test
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
how to perform posterior draw test
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
how to perform varus valgus stress test
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
what and why do we do McMurrays test
test for meniscal damage
no longer recommended due to concerns it worsensknee injuryand has low daignostic sensiticvy
how to test neurovascular integrity
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
