Knee MSK Assessment

Question 1

Components of knee exam

Answer 1

• Inspection
• Palpation
• Active ROM
• Passive ROM
• Patellar tracking
• Joint line tenderness
• Gait
• Muscle tests
• Special tests

Question 2

Muscle tests

Answer 2

• Quadriceps
• Hamstring

Question 3

Special tests

Answer 3

• Patellar Apprehension test
• Patellar grind test
• McMurray
• Valgus stress
• Varus stress
• Lachman
• Pivot shift test
• Anterior drawer
• Posterior drawer
• Noble’s
• Ober’s

Question 4

Inspection

Answer 4

I am inspecting for
* deformities
* asymmetry
* swelling
* redness
* muscle atrophy
* etc

Question 5

Palpation

Answer 5

• Anterior and posterior
• “I am palpating for tenderness, bogginess, and bone enlargement, etc.”
• Patella
• Patellar tendon
• Quadriceps tendon
• Infrapatellar bursa
• Soft tissue areas

Question 6

Active ROM

Answer 6

Flexion and extension

describe what you are looking/feeling for

Question 7

Patellar tracking

Answer 7

• Flex and extend knee and observe movement of patella bilaterally
• Abnormal movement = patella instability

Question 7

Passive ROM

Answer 7

Flexion and extension

describe what you are looking/feeling for

Question 8

Joint line tenderness

Answer 8

• Perform palpation and describe what abnormal result means
• Pain = torn meniscus or arthritis

Question 9

Gait

Answer 9

• Assess gait and describe one abnormal gait
• Trendelenburg = sway towards opposite side of muscle weakness

Question 10

Muscle test - quadriceps

Answer 10

• Have patient extend leg against resistance

Question 11

Muscle test-hamstring

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Answer 11

• Patient prone, place knee in 90 degree flexion
• Ask to flex against resistance

Question 12

Special test- patellar apprehension sign

Answer 12

• Patient supine with knees in 30 degree flexion
• Displace knee laterally by applying medial pressure
• What it means: patellofemoral syndrome, patellar subluxation, patellar dislocation

Question 13

Special test: patellar grind test

Answer 13

• Patient supine and knee fully extended
• Place one hand superior to the patella and gently push the patella inferiorly as you instruct the patient to contract the quadricep
• What it means: pain, crepitus indicates chondromalacia/patella femoral syndrome

Question 14

Special test: mcmurray

Answer 14

• Patient supine
• Examiner on side of patient with one hand on heel while other is on the joint line
• External rotation: valgus stress and slowly extending the leg = assess medial meniscus
• Internal rotation: varus stress and slowly extending knee = assess lateral meniscus
• What it means: click, popping, or pain = meniscus injury

Question 15

Special test: valgus stress test

Answer 15

• Abduct and flex knee to 30 degrees
• Apply lateral (valgus) pressure
• • Medial joint laxity = MCL injury

Question 16

Special test: varus stress test

Answer 16

• Abduct and flex knee to 30 degrees
• Apply medial pressure
• Lateral joint laxity = LCL injury

Question 17

Special test: Lachman

Answer 17

• Patient supine with knee flexed approx 25-30 degrees. Patient instructed to relax the quadriceps muscle
• Place one hand on distal femur and one on proximal tibia. Pull anteriorly on tibia
• Increased anterior translation of tibia –> partial or complete tear of ACL

Question 18

Special test: pivot shift test

Answer 18

• Generally under anesthesia
• Patient seated with knee in full extension
• Slowly flex the knee while applying a valgus stress and internal rotation
• Subluxation will occur at 20-40 degree flexion, indicating dysfunction of the ACL. Usually with more severe Grade II or III tears

Question 19

Special test: anterior drawer test

Answer 19

• Patient supine with hamstrings and quads relaxed and knee flexed to 90 degrees
• Grasp proximal tibia with both hands and slide anteriorly
• Anterior translation/joint laxity indicates ACL dysfunction

Question 20

Special test: posterior drawer test

Answer 20

• Patient supine
• Hamstrings and quads relaxed and knee flexed to approx 90 degrees
• Grasp proximal tibia with both hands and slide tibia posteriorly. May sit on patient foot to provide stabilization
• Posterior translation/joint laxity –> PCL dysfunction

Question 21

Special test: Noble’s test

Answer 21

• Patient supine
• Knee flexed to 90 degrees
• Examiner applies pressure with finger/hand to lateral femoral condyle or 1-2 cm proximal to it as patient’s knee is passively extended
• Tenderness over lateral femoral condyle at 30 degrees of flexion = IT band syndrome

Question 22

Special test: Ober’s test

Answer 22

• Patient lying on unaffected side
• Support affected knee and flex it to 90 degrees
• Extend and abduct hip then release knee support
• Failure of knee to adduct is positive –> IT band or tensor fascia lata tightness