Knee examination

Question 1

What is the exposure for knee exam?

Answer 1

lower limbs exposed - keep underwear on

Question 2

In which MSK exams is body habitus important to inspect for and why?

Answer 2

Hip and knee because increased mechanical load can cause osteoarthritis in hip and knee

Question 3

What scars may you see on the knee?

Answer 3

Arthroscopy port entry site

midline scar from knee replacement

Question 4

What should you check for from the front of knee exam?

Answer 4

Valgus/Varus deformity
Patellar position
Knee swelling

Question 5

Describe a valgus deformity

Answer 5

The tibia is turned outward in relation to the femur

Question 6

Describe a varus deformity

Answer 6

The tibia is turned inward in relation to the femur

Question 7

What should you check on inspection from the side?

Answer 7

Knee hyperextension

Fixed flexed deformity at the knee

Question 8

What may cause hyperextension in the knee?

Answer 8

Cruciate ligament

Question 9

What should you look for on inspection of the knee from behind?

Answer 9

Scars
Muscle wasting
Popliteal swellings

Question 10

What can cause popliteal swelling?

Answer 10

Baker cyst

Question 11

Where do you measure the quadriceps?

Answer 11

20cm above the tibial tuberosity

Question 12

What might a hot knee joint suggest?

Answer 12

Septic arthritis
Inflammatory arthritis
Gout
Pseudogout

Question 13

What might tenderness on palpation fo the medial and lateral border of the patella mean?

Answer 13

Patellofemoral arthritis

Question 14

What might pain on palpation of the patellar tendon mean?

Answer 14

Tendonitis or rupture

Question 15

What things can cause joint effusion?

Answer 15

Ligament rupture (e.g. anterior cruciate ligament), septic arthritis, inflammatory arthritis and osteoarthritis

Question 16

What might tenderness of the medial and lateral joint lines (inc the collateral ligaments) demonstrate?

Answer 16

1. Fracture
2. Meniscal injury e.g. meniscal tear
3. Collateral ligament injury (e.g. rupture)

Question 17

What might tenderness over the tibial tuberosity suggest?

Answer 17

Osgood-Schlatter disease

Question 18

What can popliteal fossa palpation demonstrate? (2)

Answer 18

Popliteal cyst (Baker's cyst) 
Pulsatile mass = popliteal aneurysm

Question 19

What is the normal ROM of active knee flexion?

Answer 19

0-140 degrees

Question 20

What is the normal ROM of active knee extension?

Answer 20

180 degrees

Question 21

What is the normal ROM of PASSIVE knee flexion?

Answer 21

0-140 degrees

Question 22

What are the special tests for knee examination?

Answer 22

1. Posterior sag sign
2. Anterior drawer test
3. Posterior drawer test
4. Lachman’s test
5. Varus stress test
6. Valgus stress test
7. McMurray’s test

Question 23

What is a positive posterior sag sign and explain the pathophysiology

Answer 23

The posterior cruciate ligament prevents the backwards displacement of the TIBIA or forward sliding of FEMUR
Hence, if the PCL is ruptured the tibia can sag posteriorly in relation to the femur

Question 24

What does Lachman’s test assess?

Answer 24

Laxity or rupture of the ACL

Question 25

What is the test for a meniscal tear?

Answer 25

McMurrays

Question 26

What are menisci?

Answer 26

Fibrocartilagenous tissue which function to stabilise the knee joint and distribute friction between the femur and tibia

Question 27

How can one injury their menisci?

Answer 27

Sudden twisting of the knee

Question 28

What are the symptoms of a meniscal tear?

Answer 28

Sudden onset pain
Popping sensation
Locking
Instability of the knee joint

Question 29

How do you complete a knee examination

Answer 29

Neurovascular examination of both lower limbs
Examination of the joint above (the hip)
Examination of the joint below (ankle)
Further imaging