Knee examination

Question 1

In the knee examination, what do we GENERALLY INSPECT?

Answer 1

Surrounding area:
Walking aids
Specialist shoes

Patient:
Signs of pain
Systemically well
Body habitus

Question 2

In the knee examination, what do we LOOK for?

Answer 2

Gait:
Comment on heel-strike, toe-off phases of gait cycle
Antalgic
Thrusting
High-stepping associated with foot drop

Functionality:
Get patient to squat - don’t do this in elderly or ill patients

Inspection:
Overall alignment and willingness to weight bear
Deformity - valgus/varus of knee? fixed flexion deformity? hyperextension? valgus/varus of ankle? abnormal arch?
Scars - arthroscopy? knee replacement?
Wasting - quadriceps? gastrocnemius?
Swelling - effusion? inflammation? bursitis? baker’s cyst?
Skin changes - erythema? bruising? nodules?

Question 3

In the knee examination, what do we FEEL for?

Answer 3

Temperature:
Above, over, below, medially and laterally

Effusion:
Patellar tap test
Sweep test

Structures of knee (knee bent at 90 degrees):
Quadricep tendon
Patella border
Patella tendon
Tibia tubercle
Joint line - if pain, suggests meniscal damage or OA
Collateral ligaments
Hamstring for tenderness
Swelling behind knee - effusion? inflammation? bursitis? baker’s cyst?

Question 4

In the knee examination, what MOVEMENTS do we assess?

Answer 4

Active and passive knee flexion

Knee extension - push knee down into bed

Check for joint hypermobility syndrome in knee:
Extension of 5-10 degrees is normal

Question 5

In the knee examination, what SPECIAL TESTS do we perform?

Answer 5

Test for cruciate ligament tear/rupture (knee flexion at >90 degrees, sat on foot):
If tear, may not be tibial subluxation but just pain
Posterior sag test - PCL
Anterior draw test - ACL
Posterior draw test - PCL

Test for collateral ligament tear/rupture (passive knee flexion at 30 degrees):
If tear, may not be tibial subluxation but just pain
MCL - knee in and ankle out
LCL - knee out and ankle in

Question 6

In the knee examination, what JOINT ABOVE do we test?

Answer 6

Hip:

Hip flexion with internal rotation

Question 7

In the knee examination, what NEUROVASCULATOR do we assess?

Answer 7

Power:
Toe extension - common peroneal nerve
Plantarflexion - tibial nerve

Sensation:
Dorsum of foot - common peroneal nerve
Sole of foot - tibial nerve

Vascular:
Posterior tibialis and dorsalis pedis