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