Week 3 - Hip and Knee examinations Flashcards
What do you LOOK for in a hip exam?
- Distress, swelling, deformity, change in skin, erythema, scars
- Muscle wasting of Quads and Glutes
- Stance and Posture
- Gait - strange walk, favouring one hip, use of walking aids
- Pelvic tilt/shorter leg - put hands on iliac crest
- Resting position
Describe an antalgic gait
Patient hurries off the affected side
What do you FEEL in a hip exam?
Presence of tenderness in:
Joint line - anterior groin just below midpoint of inguinal ligament
Greater trochanter - would suggest trochanteric bursitis
What do you MOVE in a hip exam?
Flexion Extension Abduction Adduction External rotation - foot crosses midline Internal rotation - hip goes towards midline
What are the degrees of movement in the hip movements?
Flexion - 110-120 Extension - 30 Abduction - 50 Adduction - 45 E rotation - 45 I rotation - 45
What do you measure in a hip exam?
True leg length - ASIS to medial malleolus
Apparent leg length - due to pelvic tilt could be different
What are the special tests for an hip exam and what do they measure?
Trendelenburg’s sign
- Patient stands on one leg only for 30 seconds. Hip of free side should remain slightly higher due to hip abduction action in the weight bearing leg
- POsitive sign if pelvis on non-weightbearing leg falls below the weight bearing
What would you do to complete a hip examination?
Neurovascular examination - arterial damage in leg pulses + neurological exam of the lower limb for nerve impingement
Examination of the lumbar spine and the knee
What do you LOOK for in a knee examination?
Look anteriorly, posteriorly and laterally/medially
- Distress, posture/symmetry, skin rashes
- Limp, pain when walking, use of walking aids
- Observation of standing knee alignment, including popliteal fossa
When supine
- Resting position
- Deformity
- Swelling
- Quadricep muscle wasting
- Skin changes - scar/rashes
What do you FEEL in a knee exam?
- Temperature of the joint - both knees at the same time
- Tenderness (full flexion + 30 degrees) - joint space, quadricep tendon, patella, patella tendon, tibial tuberosity, origin/insertion of medial and lateral collateral ligaments
- Swelling - patella tap/bulge test for effusion
- Swelling in popliteal fossa
- Patella movement
What do you MOVE in a knee exam?
Flexion
Extension
Crepitus
What are the degrees of movement in a knee exam?
- Flexion - 135 degrees
- Extension - 5 degrees
What are the special tests for the collateral ligaments?
Varus and Valgus stress tests
NEEDS TO BE DONE AT 30 DEGREES AS WELL
- One hand at knee, one at ankle on opposite side of the leg, and push/pull so that your hands are moving in opposite directions
What are the special tests for cruciate ligaments in the knee?
Lachman’s test
- one hand on back of thigh behind knee, other on back of leg distal to knee. Patient’s leg at 30 degrees. Push away with thigh hand, pull towards with leg hand. Tests ACL
Draw test
- For ACL with pull and PCL with push
- Sit on patient’s feet, legs at 90 degrees
- Pull or push sharply with hands either on anterior or posterior leg, just distal to the knee
- Observe for any movement of tibia
What are the special tests for the menisci of the knee?
McMurray’s test
- GO SLOW
- Knee into varus for medial, knee into valgus for lateral. Twist the tibia the opposite way at the ankle, and move the knee into flexion. As you extend the knee keeping it in valgus/varus, compress the leg and twist the tibia into the other direction
Apley’s grinding test
Pepper shaker, compress leg by pushing down on the foot, and twisting the tibia
