Exam - Knees

From CambridgeNotes

General

  • Gait – limp?

Look (standing and lying)

  • Equal length?
  • Scars e.g. arthroscopy or open; Skin e.g. bruising
  • Swelling e.g. suprapatellar = effusion, blood or pus
  • Muscle wasting; Deformity – varum (ankle medial) or valgus (ankle lateral); Fixed flexion deformity (ask patient to push knees back)

Feel

  • Temperature: active inflammation or infection
  • Effusion: empty suprapatellar pouch every time
    • More fluid: patellar tap test – “click” if positive
    • Less fluid: fluid shift test – hollow fills out
    • N.B. if gross both tests may be negative
  • Joint line (tibiofemoral and patellofemoral); tender? localised? where? check ligament attachments

Move (and feel for crepitus!)

  • Flexion (N range of motion 0o-135o) and Extension (N = 0o) against resistance

Special tests: compare both sides!

  • Posterior cruciate ligament tested by flexing both patients knees and observing posterior sag; then test anterior cruciate ligament with anterior draw test (remember to do posterior first otherwise may generate false positive)
  • Collaterals: valgus and varus tests with knee slightly flexed
  • Menisci (McMurray’s): for medial meniscus feel medial joint line and position with knee and foot lateral then slowly flex and extend – repeat for lateral meniscus

Screen the hip

  • Rotation at 90o hip flexion
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