Musculoskeletal Flashcards
position for the intermediate knee examination
patient lying flat
exposure for the intermediate knee examination
need to be able to see the knee joint and the quadriceps and calf muscles to evaluate for wasting
inspection for intermediate knee examination
scars (previous surgery or trauma) muscle wasting (disuse > arthritis, or LMN finding) deformities (valgus: knock knees, varus: bow legged)
what should you feel for in the intermediate knee examination?
temperature using the back of your hands, at the patellar, above and below the joint
warmth at the knee joint can be due to?
inflammatory condition such as osteoarthritis or septic arthritis which is an in infection in the joint associated with severe pain
list structures to palpate in the intermediate knee examination
Around the patella
Medial and lateral joint lines
The tibial tuberosity and head of the fibula
Popliteal fossa
what is an effusion?
what can it be caused by?
excess of synovial fluid, which can be caused by arthritis or damage to the internal structures of the knee such as the meniscus
is the tap method for small or large effusions?
large
is the sweep method for small or large effusions?
small
outline the tap method
ensure knee is extended > slide your non-dominant hand down the thigh to empty the suprapatellar pouch > keeping your non-dominant hand in place, press firmly over the patella with your dominant hand > in a moderate effusion you will feel a tap as the patella hits the femur
outline the sweep method
ensure knee is extended > with 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 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
flexion of the knee is handled by what muscles?
hamstrings: biceps femoris, semitendinosus, semimembranosus and (gracilis)
extension of the knee involves what structures?
extensor apparatus comprising of the: quadriceps muscles, quadriceps tendon, patella, patellar tendon and tibial tuberosity
damage to the extensor apparatus can cause what?
inability to straight leg raise
how to assess movement of the knee - active
ask the patient to flex and extend each knee as much as possible in turn > look for pain on movement and note the range of motion of each joint
pain on flexion and extension of the knee can be a sign of?
damage to the structures such as in a fracture or to the meniscus
reduced range of motion on flexion and extension of the knee can be due to?
arthritis
how to assess movement of the knee - passive
ask patient to relax legs > flex and extend each patient’s legs to the maximum extent > note ROM and pain > test extensor extensor compartment by lifting the patient’s foot with the patient’s leg relaxed
compare the range of motion from active and passive examinations
ROM is more in passive compared to active
how to assess hyperextension
comparing the angle between the thigh and lower leg > up to 10 degrees of hyperextension is normal provided it is the same on the other side
the ACL prevents?
anterior subluxation (dislocation)
the PCL prevents?
posterior subluxation
what to test for in ACL/PCL?
anterior draw in ACL
posterior sag in PCL
outline the examination of ACL/PCL
Flex the patient’s knee to 90 degrees > check hamstrings are relaxed + look for posterior sag, this causes a false-positive anterior drawer sign that should not be interpreted as ACL laxity > with your hands behind the upper tibia and both thumbs over the tibial tuberosity, pull the tibia anteriorly, Significant movement (compared with the opposite knee) indicates that the ACL is lax. Movement of > 1.5 cm suggests ACL rupture.
in examination of ACL/PCL, what indicates the ACL is lax?
Significant movement in one knee compared with the opposite knee
in examination of ACL/PCL, what indicates ACL rupture?
Movement of > 1.5 cm
what is often associated with ACL rupture?
medial ligament injury
medial and lateral collateral ligaments resist what type of stress?
valgus and varus stress
outline the test of the medial collateral ligament
ask patient to flex 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
what demonstrates injury to the medial collateral ligament?
Opening of the medial joint line
outline the test of the lateral collateral ligament
ask patient to flex 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 demonstrates injury to the lateral collateral ligament?
Opening of the lateral joint line
If the medial collateral ligament is damaged, it is more than likely that the ________________ is torn, due to their attachment.
medial meniscus
swelling in popliteal fossa can be due to?
Baker’s cyst
