Post on 24-Feb-2016
description
Knee Examination
Dr.Kholoud Al-Zain
Acknowledgment:Dr.Abdulaziz Alomar
General MSK Physical Examination Principles for Lower Examination
• Exposure• Bilateral limb examination• Anterior and posterior • Gait• LLD• NV examination• Joint above and joint below
Gait
• Antalgic gait
Knee Examination
• Look (Inspection)• Feel (Palpation)• Move• Special tests
Inspection (Look)
• Deformity• Scars• Swelling• Skin colour changes• Muscle wasting
Muscle wasting
Deformity Deformity
Scars
Localize Swelling
Defuse swelling (Effusion)
Feel (palpation)
• Temperature• Tenderness• Effusion
Tenderness
• Soft tissue• Bony prominences • Joint line
Surface anatomy
Joint line palpation
Effusion
Ballotment Milking
MOVE
Active ROM Passive ROM
ROM
• Flexion contracture• Extension lag
Special tests
• Ligaments (stability):– ACL (Anterior Cruciate Ligament)– PCL (Posterior Cruciate Ligament)– MCL (Medial Collateral Ligament)– LCL (Lateral Collateral Ligament)
• meniscus• Patellofemoral joint
ACL (anterior cruciate ligament)
Anterior drawer test• Excessive forward movement of the tibia on
the femur
Lachman’s test• The most sensitive test
for ACL rupture• Anterior Translation and
end point (soft vs. hard)
ACL (anterior cruciate ligament)
Pivot shift test:When positive, it is painfulIt needs experience to be
able to elicit it
ACL (anterior cruciate ligament)
PCL (posterior cruciate ligament)
Posterior drawer test• excessive backward
movement of the tibia in relation to the femur.
Sagging sign: • compare both knees in
90 degrees of flexion.• In the injured knee the
proximal tibia is displaced backwards compared to the other side.
PCL (posterior cruciate ligament)
MCL
Full extension 15 degree flexion
LCL
Full extension 15 degree of flextion
Meniscus
• Joint line tenderness:– Tenderness in the medial
joint line (medial meniscus)
– Tenderness in the lateral joint line (lateral meniscus)
• McMurrey’s test for medial and lateral meniscus
Patella apprehension test