Knee Examination
Kathy Rainsbury
February 2008
How to diagnose a knee complaint - HISTORY
• 1) Patient’s age + sex
• 2) Does the knee swell?
• 3) Is there a mechanical problem?
Age + sexAge Group Males Females
0-12 Discoid lateral meniscus Discoid lateral meniscus
12-18 Osteochondritis dissecans
Osgood-Schlatter’s
1st patella dislocation
18-30 Longitudinal meniscal tears Recurrent dislocation patella
Chondromalacia patellae
Fat pad injury
30-50 Rheumatoid arthritis Rheumatoid arthritis
40-55 Degenerative meniscus lesions Degenerative meniscus lesions
45+ Osteoarthritis Osteoarthritis
Swelling?• Effusion
– presence of pathology which must be investigated
– XS synovial (inflammatory) fluid/ blood/ pus
• Absence of effusion– Does not exclude pathology, but less likely.
– Long-standing meniscus lesions/ OA
Mechanical problem?
• Hx of initial injury ‘mechanism’– Degree + direction + incapacity
• Knee ‘give way’?– Going down stairs/ jumping : cruciate ligament– Twisting/ walking/ uneven ground: meniscus
• Knee ‘locks’?– NEVER locks in full extension– Full flexion but limited extension – FB + meniscal (‘click’)
• Pain– When? Localise?
Investigations
• Examine other joints (? Rheumatoid/ psoriasis + other inflammatory arthropathies)
• Aspiration + culture of fluid• Bloods• Xray joint (? use)• CXR (if ? TB)• MRI• EUA• Arthroscopy
Examination
• Look
• Measure
• Feel
• Move
Surface anatomy
Surface anatomy 2
10
- Joint line
5
1
Inspection (ant. + post.)
• Symmetry
• Swelling/ bruising/ scars/ rash/ deformity/ wasting/ bursae
• (Heat)
• Patella position – quads/ extensor apparatus intact?
Measure
• Quads circumference
Palpate• Effusion – patellar tap
• Fluid displacement
• Tenderness– Bend knee – joint line– Collateral ligaments– Tibial tubercle– Femoral condyles
Move
• Active + passive
• Extension – 0 deg (? Hyperextension)
• Flexion – 135 deg
Move - instability
• 1) Valgus stress test (+ve if medial lig torn)
• 2) Varus stress test ( +ve lat lig torn)
• 3) Anterior Drawer test (+ve if ant cruciate torn)– Or Lachman test
• 4) Posterior Drawer test (+ve if post cruciate torn)
Instability - rotatory
• MacIntosh test / pivot shift test (difficult if patient not under anaesthesia)
Menisci
• Feel for clicks, listen for crepitus
• McMurrays test – medial + lateral menisci
• (or Apley’s grind test)
And finally…
• Gait
• Genu varum ‘varus my pig?’ • Genu valgus
varus
valgus
• http://www.youtube.com/watch?v=fNUGyNYVhqE
• http://www.youtube.com/watch?v=IwBW-X4n1fU