Knee examination Flashcards
What are the first steps?
Introduce self
Confirm patient’s name and DOB
Explain procedure and gain consent
Ask if in any pain
What do you do after the introduction?
Patient stood up
General inspection of the joint ( front , back and sides)
Assess gait
What do you do after inspection stood up?
Ask patient to lie down
Inspect the knees in a flexed position
What do you do after lying down inspection of the knee?
Palpate the joint temperature
Palpate the joint straight and relaxed
Quadriceps tendon
Patella borders
Patella ligament
What do you do after palpating the knee relaxed?
Patellar tap test
With the patient’s knee fully extended, empty the suprapatellar pouch by sliding your left hand down the thigh to the upper border of the patella.
Keep your left hand in position and use your right hand to press downwards on the patella with your fingertips.
If there is fluid present you will feel a distinct tap as the patella bumps against the femur.
What do you do after the patella tap test?
Sweep test
Empty the suprapatellar pouch by sliding your left hand down the thigh to the upper border of the patella.
Stroke the medial side of the knee joint to move any excess fluid across to the lateral side of the joint.
Now stroke the lateral side of the knee joint which will cause any excess fluid to move back across to the emptied medial side of the knee joint. This causes the appearance of a bulge or ripple on the medial side of the joint indicating the presence of effusion.
What do you do after the sweep test?
Measure the quadriceps bulk - find tibial tuberosity and measure 20cm up
What do you do after measuring the quadriceps bulk?
Palpate the joint flexed
Patella ligament
Tibial tuberosity
Head of the fibula
Medial and lateral joint lines
Collateral ligaments
Popliteal fossa
What do you do after flexed palpation?
Active movement
Flexion
Extension
What do you do after active movements?
Passive movements
Flexion
Extension
What do you do after passive movements?
Anterior Drawer Test
Place fingers at back of the popliteal fossa and thumbs on the patella ligament.
Stabilise the foot
Pull the joint towards you
Posterior Drawer Test
In same position now push the tibia posteriorly
What do you do after assessing the cruciate ligaments?
Assess the medial and lateral collateral ligaments
Lift patients leg up and stabilise lower leg
Push on patients inner thigh
Push on patients lateral thigh
What do you do to finish the examination?
Present findings
Neurovascular examination of the lower limbs.
Examination of the hip and ankle
Further imaging if indicated (e.g. X-ray and MWI)
