MSK CAS Flashcards
When performing an intermediate knee exam what position does the patient lie in?
On the couch with their knee, quadriceps and calf muscles visible
What should you inspect for in an intermediate knee exam?
Scars
Muscle wastage
Knee deformities
What can scars indicate in a knee exam?
Previous injury and trauma
What can muscle wastage indicate in a knee exam?
Disease eg arthritis
When should a neuro exam be done in relation to a knee exam?
If muscle wastage is suspected to be due to LMN
What are the 2 knee deformities?
Varus and valgus
What is varus?
Bow legged
What is valgus?
Knock knees
What do we palpate for in a knee exam?
Temperature
Patella
Medial and lateral joint lines
Effusion
Where do you palpate for temperature in a knee exam?
Above patella, above and below the joint and always compare left to right
Why may temp be raised in a knee exam?
Due to inflammatory disease like osteoarthritis and septic arthritis
When must you look at the patient’s face and why?
During palpation to look for signs of pain, can indicate meniscal damage
Where might meniscal damage at the knee occur ?
Tibial tuberosity
Head of fibula
Popliteal fossa
What is a sign of Baker’s cyst?
Swelling at the popliteal fossa
What is effusion?
Excess synovial fluid?
What are the 2 methods to feel for effusion at the knee? When is each used?
Tap method- use for large effusions
Sweep method- use for small effusions
Describe the tap method for assessing effusions at the knee
Make sure patient’s knee is extended
Slide your non-dominant hand down the thigh to empty suprapatellar pouch
Press firmly over patella with dominant hand and you’ll feel a tap as the patella hits the femur
Describe the sweep method for assessing effusions at the knee
Make sure patient’s knee is extended
With the back of your non-dominant hand sweep upward on the medial side of the knee to empty the medial compartment
Keeping your non-dominant hand in place, sweep downward on the lateral side of the knee to empty the lateral compartment with the back of your dominant hand
If there is a small effusion you will see a ripple or bulge of fluid appears on the medial side of the knee from the lateral compartment
What muscles handle flexion of the knee?
Biceps femoris Semitendinosus
Semimembranosus
and (gracilis)
What muscles handle extension of the knee?
Quadriceps muscles Quadriceps tendon
Patella
Patellar tendon
Tibial tuberosity
What will damage to the knee extensors cause?
Inability to straight leg raise
What are the 2 ways movement at the knee is assessed?
Active and passive
How is active movement at the knee assessed?
Ask the patient to flex and extend each knee as much as possible in turn
Whilst the patient is doing this, look for pain on movement and note the Range of Motion (ROM) of each joint.
What can reduced ROM during active movement at the knee indicate?
Arthritis
How is passive movement at the knee assessed?
Ask the patient to relax their legs
Flex and extend each patient’s legs to the maximum extent
Test the extensor compartment by lifting the patient’s foot with the patient’s leg relaxed
Look for hyperextension by comparing the angle between the thigh and lower leg.
What angle of hyperextension is normal?
Up to 10 degrees of hyperextension is normal provided it is the same on the other side.
How should ROM differ in passive movement compared to active?
ROM should be more than compared to active movement
What are the 2 special tests in a knee exam?
Anterior draw for ACL and posterior sag for PCL
Medial and collateral ligaments
How is the anterior draw for ACL and posterior sag for PCL done?
Flex the patient’s knee to 90 degrees and maintain this position
Check that the hamstring muscles are relaxed and look for posterior sag (posterior subluxation of the tibia on the femur).
With your hands behind the upper tibia and both thumbs over the tibial tuberosity, pull the tibia anteriorly
What does posterior sag cause?
This causes a false-positive anterior drawer sign that should not be interpreted as ACL laxity
How is anterior draw positive?
Significant movement (compared with the opposite knee) indicates that the ACL is lax. Movement of > 1.5 cm suggests ACL rupture
How is the test for the medial knee ligaments done?
Ask the patient to flex their legs to 30 degrees
Place one hand on lateral aspect of the lower thigh
Place your other hand on the medial aspect upper calf with the fingers over the medial joint line
Provide a valgus stress with your hand over the thigh whilst feeling for the joint
opening in the medial joint line
How is the test for the collateral knee ligament done?
Ask the patient to flex their legs to 30 degrees
Place one hand on medial aspect of the lower thigh
Place your other hand on the lateral aspect upper calf with the fingers over the lateral joint line
Provide a varus stress with your hand over the thigh whilst feeling for the joint opening in the lateral joint line
What is the order for an intermediate knee exam?
- Positioning and Exposure
- Look: Looking for scars, knee deformity, muscle wasting
- Feel: temperature
- Around the patellar
- Medial and lateral joint lines
- The tibial tuberosity and head of the fibula
- Popliteal fossa
- Move: Active: Flexion and Extension
- Passive: Flexion and Extension
- Passive: Hyperextension
- Special Tests
- Anterior Draw and Posterior Sag
- Medial and Lateral Collateral ligaments
