Musculoskeletal

Question 1

position for the intermediate knee examination

Answer 1

patient lying flat

Question 2

exposure for the intermediate knee examination

Answer 2

need to be able to see the knee joint and the quadriceps and calf muscles to evaluate for wasting

Question 3

inspection for intermediate knee examination

Answer 3

scars (previous surgery or trauma)
muscle wasting (disuse > arthritis, or LMN finding)
deformities (valgus: knock knees, varus: bow legged)

Question 4

what should you feel for in the intermediate knee examination?

Answer 4

temperature using the back of your hands, at the patellar, above and below the joint

Question 5

warmth at the knee joint can be due to?

Answer 5

inflammatory condition such as osteoarthritis or septic arthritis which is an in infection in the joint associated with severe pain

Question 6

list structures to palpate in the intermediate knee examination

Answer 6

Around the patella
Medial and lateral joint lines
The tibial tuberosity and head of the fibula
Popliteal fossa

Question 7

what is an effusion?

what can it be caused by?

Answer 7

excess of synovial fluid, which can be caused by arthritis or damage to the internal structures of the knee such as the meniscus

Question 8

is the tap method for small or large effusions?

Answer 8

large

Question 9

is the sweep method for small or large effusions?

Answer 9

small

Question 10

outline the tap method

Answer 10

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

Question 11

outline the sweep method

Answer 11

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

Question 12

flexion of the knee is handled by what muscles?

Answer 12

hamstrings: biceps femoris, semitendinosus, semimembranosus and (gracilis)

Question 13

extension of the knee involves what structures?

Answer 13

extensor apparatus comprising of the: quadriceps muscles, quadriceps tendon, patella, patellar tendon and tibial tuberosity

Question 14

damage to the extensor apparatus can cause what?

Answer 14

inability to straight leg raise

Question 15

how to assess movement of the knee - active

Answer 15

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

Question 16

pain on flexion and extension of the knee can be a sign of?

Answer 16

damage to the structures such as in a fracture or to the meniscus

Question 17

reduced range of motion on flexion and extension of the knee can be due to?

Answer 17

arthritis

Question 18

how to assess movement of the knee - passive

Answer 18

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

Question 19

compare the range of motion from active and passive examinations

Answer 19

ROM is more in passive compared to active

Question 20

how to assess hyperextension

Answer 20

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

Question 21

the ACL prevents?

Answer 21

anterior subluxation (dislocation)

Question 22

the PCL prevents?

Answer 22

posterior subluxation

Question 23

what to test for in ACL/PCL?

Answer 23

anterior draw in ACL

posterior sag in PCL

Question 24

outline the examination of ACL/PCL

Answer 24

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.

Question 25

in examination of ACL/PCL, what indicates the ACL is lax?

Answer 25

Significant movement in one knee compared with the opposite knee

Question 26

in examination of ACL/PCL, what indicates ACL rupture?

Answer 26

Movement of > 1.5 cm

Question 27

what is often associated with ACL rupture?

Answer 27

medial ligament injury

Question 28

medial and lateral collateral ligaments resist what type of stress?

Answer 28

valgus and varus stress

Question 29

outline the test of the medial collateral ligament

Answer 29

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

Question 30

what demonstrates injury to the medial collateral ligament?

Answer 30

Opening of the medial joint line

Question 31

outline the test of the lateral collateral ligament

Answer 31

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

Question 32

what demonstrates injury to the lateral collateral ligament?

Answer 32

Opening of the lateral joint line

Question 33

If the medial collateral ligament is damaged, it is more than likely that the ________________ is torn, due to their attachment.

Answer 33

medial meniscus

Question 34

swelling in popliteal fossa can be due to?

Answer 34

Baker’s cyst