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Knee Exam

Knee Exam

The patellar bulge test is used to assess for an effusion of the knee joint, by attempting to move the fluid to one side of the knee.

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

Patellar Bulge Test

Overview

The patellar bulge test is used to assess for an effusion of the knee joint, by attempting to move the fluid to one side of the knee.
- How to Perform
- Extend the knee joint. Milk the fluid from the lateral side of the knee, to the suprapatellar pouch, into the medial side of the knee. Gently press onto the fluid-filled medial side of the knee.
- Abnormal If
- The fullness migrates to the lateral side of the knee when the medial side is pressed.
- Causes of Knee Effusion
- Trauma - ligament tear, menisceal tear, intra-articular fracture, patellar dislocation
- Arthritis - osteoarthritis, psoriatic arthritis, reactive arthritis, IBD-related arthritis, gout, pseudogout
- Infection - septic arthritis, tuberculosis, Lyme disease, syphilis
- Blood - haemarthrosis
- Malignancy - osteosarcoma

Last updated on November 25th, 2019

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Read More...

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