knee examination - old

Look

clues

· walking / mobility aids

· external appliances

· shoes

From front

· stand patient facing you

Deformity

· knee alignment

· physiological valgus

· valgus or varus deformity

· patellar rotation

· squinting patellae

· foot rotation

· symmetrical ER

Skin

· scars

· arthroscopy

· circulatory disturbance

· hair loss

· hyperpigmentation

· varicosities

· ulcers

· disuse / denervation

· dry skin

· dekeratinisation

Contours

Swelling

· suprapatellar

· general

Wasting

· quadriceps

· VMO

from lateral side

· turn affected side towards you

Deformity

· knee attitude

· flexion

· recurvatum

· foot position

· equinus

Skin

· scars

· tibial osteotomy

Contour

Swelling

· tibial tuberosity

from behind

Deformity

· hindfoot

· physiological valgus

Skin

· circulatory disturbance

· scars

Contour

Swelling

· popliteal fossa

Wasting

· hamstrings

· calf

from front

Leg length

· pelvis level

gait

· walk away

· walk towards briskly

Features

Antalgic

Lateral thrust

Stiff knee

Back knee

supine on couch

Look

Quads

· bulk

· tone

· circumference

Effusion

· wipe

· balottment

· patellar tap

Move

Passive extension

· lift both heels

· fixed flexion deformity

· recurvatum

Active extension

· straight leg raise

· quadriceps lag

Active flexion

· bend both knees

· range of flexion

knee flexed

· extend knee to 80^o

Feel

· sit on foot

· extensor mechanism

· tibial tuberosity

· patellar tendon

· inferior pole of patella

· medial joint line

· tenderness

· osteophytes

· lateral joint line

· tenderness

· osteophytes

· meniscal cyst

· MCL

· origin

· tendon

· insertion

· LCL

· origin

· tendon

· insertion

Move

· hand on knee

· crepitus

· meniscal cyst

knee extended

Collaterals

Full extension

· valgus stress

· no abnormal movement

· opening of joint

· correction of deformity (complete, incomplete)

· varus stress

30^o flexion

· valgus stress

· no abnormal movement

· opening of joint

· end point

· grade I, II, III

· correction of deformity (complete, incomplete)

· if abnormal, compare

· varus stress

Cruciates

Lachmann’s

· 15^o flexion with relaxation

· no abnormal movement

· forward movement of tibia on fibula

· end point

· grade I, II, III

knees flexed

Cruciates

Posterior sag

· bend both knees to 90^o

· palm on front of knee

Anterior drawer

· relax hamstrings

· foot in neutral

· no abnormal movement

· forward movement of tibia on fibula

McMurray

· full flexion and IR / ER

· click

patellofemoral

· knee at 20^o

· legs crossed or over bolster

Feel

· osteophytes

· tenderness

· medial facet

· lateral facet

· patellar grind

· up and down

· Clark’s test

· gentle pressure on superior pole

Special tests

Pulses

· dorsalis pedis

· normal

· diminished

· absent

· posterior tibial

· popliteal

· knee flexed

· pulse

· aneurysm

proximal joint

· hip ROM

· rotation in flexion

· Abd/Add in extension

Popliteal fossa

Prone

· masses

· flexion and extension