Knee Examinations

Question 1

Observations

Answer 1

Bumps/Bruises/Redness/Scars/Swelling/Muscle Wasting/Discoloration/Alignment

Swelling can be causes by various bursa around the knee joint (Pes anserine,Pre-patellar, Supra/Infra
Patellar) The menisci, The ligaments of the knee (ACL/PCL/MCL/LCL). Baker’s cyst in Popliteal Space

Extra-articular ; Usually localised non movable and feels like thick soft tissue, Localized to tendons, bursa, or specific
compartments,

 Intra-articular Effusion is usually diffuse, symmetric and associated with a loss of knee contour the resting position may be 25º of flexion. Compared with extra articular swelling, intra swelling can be moved about. ACL tear, meniscus tear, arthritis, fractures

Posterior swelling – Bakers cyst

Prominent Tibial Tuberosity - Osgood Schlatter

Alignment – Q Angle Normal Q angle – Males 13º, females 18 A lower angle may be associated with chondromalacia patella and patella alta, greater Q angle is associated with chondromalacia, subluxing patella, patellofemoral pain syndrome.
Valgus/Varus of the knee

Patello-femoral Angle (Q-angle);
The angle made between the rectus femoris and the patella ligament. It is measured with the patient supine with the quads relaxed. A line is drawn from the ASIS to the midpoint of the Patella. The angle formed by the intersection of these lines is the Q angle. Normal is 13 Degrees in Males and 18 Degrees for Females.

Question 2

Palpation

Answer 2

Patella –
Superior,lateral,Medial,inferior poles move the patella around if there is restriction coiuld be OA of patella
Quad ligament (Tendinopathy)
Patellar Ligament (Jumper’s knee)

Tibial Tuberosity (Osgood’s schlater’s bump)

Feel for Joint Space (Superior into Femoral Condyles, inferior into tibial plateaus – osteo chondritis dessicans)

Lateral side is lateral collateral ligament, medial slightly to this is Gerdy’s tubercle (Attachment of IT band)

Posterior palpation of Biceps femoris tendon (lateral),
Pes anserine bursa - semi t and semi membranous tendons (medial side).
Also popliteal pulse in popliteal space

Pes Anserine medial side of tibia (Insertion point for Gracilis, Semi-tendinous, Sartorious

Fibular Head (Lateral side) Also attachment side for lateral collateral ligament, Common site for Fx
Palpate - quadricep tendon/ligament, could be tendinopathy
Biceps distal tendon
Biceps femoris lateral on media side
Semimembanosus muscle
Smeitendinous muscle

Question 3

Active/Passive ROM

Answer 3

Flexion 130-160
Extension 0 to -5 degrees
Internal rotation 10-20
External Rot – 10-30
Internal and external rotation prone/supine
Patellar glide (sup/inf/lat/med)
Fib Head AP-PA

Question 4

RIMS

Question 5

Special Tests

Answer 5

Knee Fractures
Ottowa knee rules
1. Age > 55 years old
2. Tenderness at head of fibula
3. Isolated tenderness of the patella
4. Inability to bear weight (4 steps) immediately after injury
5. Inability to flex the knee past 90 degrees
Age plus 2 of the characteristics = indication of referral/e-ray to confirm fractur

PCL
Posterior Drawer
Posterior sag sign
Quadricep active test

ACL
Anterior drawer
Lachman test
Pivot shift test

MCL
Valgus stress test

*LCL
Varus stress test

Chondromalacia patella
Waldron test
Clarkes/Patella grind test

PLICA Syndrome
Patella stutter test

Osteochondritis dissecans
Wilsons test

ITB synbdrome
Noble compression test
Obers test

Swelling at knee (Effusion)
Patella tap test
Stroke/brush test