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