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MBBS 3: Physical Examinations > Knee Examination > Flashcards

Knee Examination Flashcards

1
Q

Principles of knee examination?

A
  1. Introduction
  2. General observation
  3. Look
  4. Feel
  5. Move
  6. Special tests
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2
Q

Introduction?

A

Wash hands
Introduce yourself, explain your role
Confirm patient name and date of birth
Ask for permission and consent
Adequate exposure
Ask for pain
Position patient – standing

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3
Q

General observation?

A

Well/unwell
Bod habitus - obese
Any associated injuries
Any treatments - walking aid

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4
Q

Look: anterior inspection?

A
  1. Scars - previous surgery or previous joint trauma.
  2. Bruising -recent trauma or haemarthrosis
    e.g anticoagulants or clotting disorders such as haemophilia
  3. Swelling - effusion, joint arthropathy, septic arthritis, haemarthrosis
  4. Patellar position -Patellar dislocation or subluxation
  5. Quadriceps wasting:disuse atrophy or a lower motor neuron lesion.
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5
Q

Look: anterior inspection?

A
  1. Scars - previous surgery or previous joint trauma.
  2. Bruising -recent trauma or haemarthrosis
    e.g anticoagulants or clotting disorders such as haemophilia
  3. Swelling - effusion, joint arthropathy, septic arthritis, haemarthrosis
  4. Patellar position -Patellar dislocation or subluxation
  5. Quadriceps wasting:disuse atrophy or a lower motor neuron lesion.
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6
Q

Look: lateral + posterior inspection?

A
  1. Scars -past trauma or surgery.
  2. Muscle wasting -disuse atrophy or a lower motor neuron lesion.
  3. Popliteal swellings:Baker’s cyst or popliteal aneurysm (typically pulsatile)
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7
Q

Abnormalities that can be seen upon lateral and posterior inspection?

A
  1. Extension abnormalities - Cruciate ligament injury.
  2. Flexion abnormalities - Contractures
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8
Q

Valgus deformity of the knee?

A

tibia turned outward in relation to the femur, resulting in the knees ‘knocking’ together
= knock-kneed

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9
Q

Valgus deformity of the knee?

A

tibia turned outward in relation to the femur, resulting in the knees ‘knocking’ together
= knock-kneed

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10
Q

Types of knee deformities?

A
  1. valgus
  2. varus
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11
Q

Valgus deformity of the knee?

A

tibia turned outward in relation to the femur, resulting in the knees ‘knocking’ together
= knock-kneed

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12
Q

Varus deformity of the knee?

A

tibia turned inward in relation to the femur, resulting in a bowlegged appearance.
= bow-legged

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13
Q

Feel?

A
  1. Bony
    - Joint line tenderness, palpate medially or laterally
    - Patella, translation
  2. Tibia tubercle
  3. Temperature
    - Warm - inflammation
    - Cold – nerve, vascular damage
  4. Pulses
    - popliteal, dorsal pedis, posterior tibia
  5. Capillary refill time
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14
Q

Move?

A
  1. Active and passive ROM
  2. Flexion/Extension
    > Flexion 125-135 deg
    > Extension 0-10 deg
  3. Rotation
    > 10-15 deg internal and external tibial rotation
  4. Feel for joint crepitus
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15
Q

Motor Neurovascular assessment?

A
  1. knee flexion - sciatic nerve
  2. knee extension - femoral nerve
  3. foot plantarflexion - tibial nerve
  4. foot dorsiflexion - deep peroneal nerve
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16
Q

Sensory Neurovascular assessment?

A
  1. medial thigh - obturator nerve
  2. anterior thigh - femoral nerve
  3. posterolateral leg - sciatic nerve
  4. dorsal foot - peroneal nerve
  5. plantar foot - tibial nerve
17
Q

Neurovascular assessment : reflexes?

A
  1. patellar (L4)
  2. hypoactive / absent is concerning for L4 radiculopathy
  3. hyperactive may indicate UMN injury
18
Q

What are the special tests?

A

Lag test – Quads wasting
Lachman test – ACL injury
Anterior drawers test – ACL injury
Pivot shift test – ACL injury
Posterior drawer test – PCL injury
McMurray test – meniscus injury
Apleys test
Patellar Apprehension test – Patella dislocation

19
Q

Lachman test?

A
20
Q

Anterior drawer test?

A
21
Q

Pivot shift test?

A
22
Q

ACL injury tests?

A
23
Q

Posterior drawer test?

A
24
Q

Posterior sag test?

A
25
Q

Tests for Meniscal injury?

A

Varus stress – Lateral meniscus
Valgus stress – Medial meniscus
McMurray Test
Thessaly test
Apleys test

26
Q

McMurray test?

A
27
Q

Thessaly test?

A
28
Q

Apleys test?

A
29
Q

Patellar apprehension test?

A
30
Q

Patellar apprehension test?

A

MBBS 3: Physical Examinations (19 decks)

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