Knee Examination

Question 1

Look:

What 2 deformities do you look for?

What muscle will be wasted in joint disease?

What do 3 small scars suggest?

What does a large midline scar suggest?

Answer 1

Valgus
Varus

Quads

Arthroscopy

Knee replacement

Question 2

Look:

WADES mneumonic is used. What does it stand for?

What else do you look at? - 3

How would you look at the popliteal fossa and hamstrings?

Answer 2

Wasting
Asymmetry 
Deformities 
Erythema 
Scars/swellings

Abnormal posture
Asymmetry
Skin changes

When the patient is standing

Question 3

Look:

What is used to determine whether genu valgum/varus is present?

Answer 3

Calculating the Q angle:

• Valgum - low angle
• Varum - large angle

Question 4

Feel:

What is the first thing you feel for?

THEN YOU FLEX KNEE TO 90 DEGREES!

What else do you feel for?

What do you feel for in the popliteal fossa?

THEN EXTEND KNEE!

What 2 further tests do you do to finish feel?

Answer 4

The temperature on both knees

Tenderness at:

• Border of patella
• Insertion of ligaments
• Joint line
• Tibial tubercle

Bakers cyst

Patellar tap test
Bulge (ripple) test

Question 5

Feel:

Patellar tap test:

• You slide a hand down the patient’s thigh. What does this do?
• What does it test for?

Bulge (ripple) test:

• Which side do you slide a hand over first?
• How does this show there if effusion?

Answer 5

Medial to lateral, then lateral to medial

Compresses suprapatellar pouch which forces effusion behind the patella.

Effusion

(1) The first move empties medial compartment of fluid

(2) Bulging happens as fluid re-enters the medial compartment

Question 6

Move:

NOTE THE DEGREE OF ACTIVE AND PASSIVE MOVEMENT!

What does crepitus on passive movement suggest?

Where should you place your other hand?

Answer 6

OA

On the knee itself so you can actually feel for crepitus

Question 7

Move:

GET PATIENT TO FLEX KNEES:

• Why do you look at the knees from the side?
• What do the posterior and anterior draw test for?

There is also a test for the collaterals!

Answer 7

Flex both knees to 90 degrees
Check

Looking for posterior sag or step-back of the tibia, suggesting PCL damage

The cruciate ligaments

Question 8

Function:

What do you look for when they are standing up?

Answer 8

Varus/valgus deformity

Pes cavus/planus