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Knee Exam

Knee Exam

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Positioning: Patient standing then supine

The Patient

Around the Room

Mobility devices, sling, brace, etc.
General Features

Age, gender, general comfort, scars

Look

Assistance Devices

Stick, brace, sling, cast
Skin

Rashes, scars, erythema
Swelling

Over muscles, bones or joints
Bursae

Supra-, infra-, pre-patellar bursae, Baker's cyst
Muscles

Wasting, spasm, fasciculations
Deformities

Genu valgum, genu varum, genu recurvatum
Posture

Standing, sitting, squatting

Body position, centre of gravity
Gait

Posture, symmetry, rhythm, coordination, stride
Leg Length

True (ASIS → medial malleolus) and apparent

Feel

Temperature

Palpate with the back of the hand
Bony Landmarks

Femoral (epi)condyles, fibular head, patella, tibia
Muscles

Muscle bulk, tenderness, wasting, spasm
Joint Line

Tenderness, fullness
Ligaments

Medial & lateral collateral ligaments
Tendons

Biceps, semimembranosus, semitendinosus
Sounds on Knee Movement

Clicks, cracks, snaps, clunks
Pulses

Popliteal

Move

Active → Passive

Ask before stressing painful joints
Flexion

Closing the joint
130°
Extension

Opening the joint
5°
Internal Rotation

Rotate foot inwardly
10°
External Rotation

Rotate foot outwardly
20°

Special Tests - Patella

Patellar Tap

Sharply press the patella with 2-3 fingers
Bulge Test

Stroke hand medial, up & around to lateral patella
Patellar Apprehension

Apply laterally directed force on medial patella

Special Tests - Menisci

McMurray's Test - Medial

For medial menisceal tears

Supine, hip & knee flexed 45° - externally rotate foot and apply valgus force while extending knee
McMurray's Test

For lateral menisceal tears

Supine, hip & knee flexed 45° - internally rotate foot and apply varus force while extending knee

Special Tests - Ligaments

Anterior Draw Test

90°, stabilise foot, stabilise tibia, pull anteriorly
Posterior Draw Test

90°, stabilise foot, stabilise tibia, push posteriorly
Valgus Stress Test

Brace lateral knee at 30°, apply valgus force
Varus Stress Test

Brace medial knee at 30°, apply varus force

Bony Landmarks

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On this page:Bony Landmarks of the Knee

Bony Landmarks of the Knee

Patella - palpate the superior and inferior poles of the patella, noting its position and mobility.
Tibial tuberosity - palpate for the attachment of the patellar tendon. Note any tenderness, which may be indicative of avulsion fracture or inflammation of the insertion of the patellar tendon (Osgood Schlatter disease)
Femoral condyles - palpate the medial and lateral femoral condyles.
Gerdy's tubercle (lateral tubercle of the tibia) - palpate for the insertion of the ileotibial band.
Fibular head - palpate below the knee joint laterally for the fibular head. Note its position and mobility.

Last updated on January 1st, 2017

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Browne K, Kurtz CA. How to Perform a Comprehensive Examination of the Knee. JAAPA. 2009 Jun; 22(6): 20-25. Chatra PS. Bursae around the knee joints. Indian Journal of Radiology and Imaging. 2012; 22(1): 27-30. Couture JF, Al-Juhani W, Forsythe ME, Lenczner E, Marien R, Burman M. Joint Line Fullness and Menisceal Pathology. Sprts Health. 2012 Jan; 4(1): 47-50. Davis GJ, Malone T, Bassett FH. Knee Examination. Phys Ther. 1980; 60: 1565-1574. Espandar R, Mortazavi SMJ, Baghdadi T. Angular Deformities of the Lower Limb in Children. Asian Journal of Sports Medicine. 2010 Mar; 1(1): 46-53. Fritschy D, Fasel J, Imbert JC, Bianchi S, Verdonk R, Wirth CJ. The Popliteal Cyst. Knee Surg Sports Traumatol Arthrosc. 2006; 14: 623-628. Gupte C, St Mart JP. The Acute Swollen Knee: Diagnosis and Management. Journal of the Royal Society of Medicine. 2013; 106: 259-268. Johnson MW. Acute knee effusions: a systematic approach to diagnosis. American family physician. 2000 Apr;61(8):2391-400. Kastelein M, Luijusterburg PA, Wagemakers HP, Bansraj SC, Berger MY, Koes BW, Bierma-Zeinstra SM. Diagnostic Value of History Taking and Physical Examination to Assess Effusion of the Knee in Traumatic Knee Patients in General Practice. Arch Phys Med Rehabil. 2009 Jan; 90: 82-86. Loudon JK, Goist HL, Loudon KL. Genu Recurvatum Syndrome. JOSPT. 1998 May; 27(5): 361-367. Malanga GA, Andrus S, Nadler SF, McLean J. Physical examination of the knee: a review of the original test description and scientific validity of common orthopaedic tests. Arch Phys Med Rehabil. 2003; 84: 592-603. Rose REC. The Accuract of Joint Line Tenderness in the Diagnosis of Menisceal Tears. The West Indian Medical Journal. 2006; 55(5): 323. Stratford PW, Binkley J. A Review of the McMurray Test: Definition, Interpretation, and Clinical Usefulness. The Journal of Orthopaedic and Sports Physical Therapy. 1995 Sept; 22(3): 116-120. Tofts LJ, Elliot EJ, Munns C, Pacey V, Sillence DO. The Differential Diagnosis of Children with Joint Hypermobility: a Review of the Literature. Pediatric Rheumatology. 2009; 7(1). Zarins B, Rowe CR, Harris BA, Watkins MP. Rotational Motion of the Knee. Am J Sports Med. 1983 June; 11(3): 152-156.

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