MSK - Knee Exam

Question 1

How would you explain and gain consent for an MSK knee exam?

Answer 1

• I’ve been asked to examin your knees today.
• this will involve having a look, feel and asking you to do a few movements.
• you will have to be exposed from the waist down and the examiner will act as a chaperone today
• IS THIS OK WITH YOU?
• Are you in any pain in your knees or anywhere else.

Question 2

What is the general layout of the MSK knee exam?

Answer 2

1) WIPE
2) Gen inspection
3) closer inspection of knees
4) Feel (temp, palpate joint, effusions)
5) move (Active, then passive)
6) Ant/post/lat/med ligament tests.
7) Neurovascular: Pulse (politeal, dorsalis pedis and posterior tibial) and sensation on dorsum and sole of foot

Question 3

What do you look for on general inspection of the patient and bedside in an MSK knee exam?

Answer 3

Bedside : analgesia, walking aids, knee brace / support

Patient : alert, looks comfortable and well, not in any pain.

Question 4

What do you look for on close inspection of the knee?

Answer 4

• symmetry and alignement
• swelling (popliteal bursa (baker’s cyst), effusion, arthritis)
• scars
• muscle wasting
• redness
• rash (psoriasis)
• Varus (bow legs) , Valgus (knock knees)
• knee flexion deformity
• GAIT - antalgic gait “limp”

Question 5

What do you feel for in a MSK knee exam?

Answer 5

1) temperature
2) palpate for tenderness of patella

3) palpate joint line (with knee flexed)
- Quadriceps tendon
- femoral condyles
- inferior pole of patella
- tibial head
- head of fibula
- patella tendon
- tibial tuberosity

4) feel behind knee for baker’s cyst.
5) Patellar tab
6) Sweep test

Question 6

how do you assess the movements of the knee in a knee MSK exam?

Answer 6

1) Active movement - flex knee as far as possible.
2) Passive movement - flex knee as far as possible
3) assess full flexion and extension of knees compare to each other.

Question 7

How do you check the stability of the knee ligaments?

Answer 7

1) look for posteror sag or stepback of the tibia (with knee flexed) - positive test - tibia is shifted towards bed - this is abnormal.
2) Anteror cruciate ligament Draw test - sit on foot, pull tibia towards you.
3) Posterior cruciate ligament draw test - sit on foot push tibia away from you.
4) Medial and collateral ligament test - with knee extended apply varus and valgus strain. If stable then repeat with knee flexed to 30’ to assess minor median and lateral collateral laxity.

Question 8

What are the end pieces to the knee MSK exam?

Answer 8

• Patellar apprehension test to assess patella dislocation that may have spontaneously relocated.
• measure quadriceps bulk 15cm above tibial tuberosity
• McMurray’s test for meniscal tears
• Examination of hip and ankle
• Xray

Question 9

What conditions can affect the knee?

Answer 9

• osteoarthritis of the knee
• rheumatoid arthritis
• septic arthritis
• gout
• torn meniscus
• ACL injury
• bone fracture
• knee bursitis
• loose body
• dislocated patella
• hip joint problems

Question 10

How would you treat osteoarthritis of the knee?

Answer 10

1) Conservative:
- weight loss
- stop smoking
- icepacks
- physiotherapy
- walking aids

2) Medical :
- NSAIDs
- simple analgesia
- intra-articular steroids

3) Surgical:
- total knee replacement