Knee Examination

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Knee Examination Prepare patient • Introduction • Position with knees & thighs exposed General Principles of Joint Exam Check if any pain, then look, feel, move, measure & compare with other side, & assess function. Look General inspection • Obvious other joint disease Knees • Quadriceps wasting • Skin – Scars, swelling • Deformities – incl fixed flexion (look for gap under knees when lying down), valgus (e.g. RA) or varus (e.g. OA) Feel Quadriceps bulk Warmth, swelling over knee Patellar tap for large effusion (compress suprapatellar bursa with other hand) Bulge sign for small effusion (compress suprapatellar bursa with one hand and run other hand up lat & medial sides of knee looking for fluid wave on opposite side) Joint line tenderness Move Passive movements: Place a hand over the knee & note any crepitus & ROM. • Flexion (135º) • Extension (5º) Active flexion/extension of knee - look for subluxation of patella Ligament laxity: • Med/lat collateral ligaments ( ≤5º). Stress at 30º. • ACL ( ≤5-10º): Lachman: (95% sens, knee flexed ~30º, distal femur fixed & proximal tibia pulled anteriorly - intact ACL should stop with "firm endpoint"), Pivot shift (75%). Anterior draw (60%) • PCL ( ≤5-10º): Posterior draw, Godfrey’s sign (affected tibia sags when supine if legs passively lifted into 90º flexion at hip & knee.) • Meniscal: Bragard’s (point tenderness along jt line), McMurray’s test Patellar apprehension test if recurrent patella dislocation suspected: • Push patella laterally whilst flexing knee. Stop if patient’s face shows apprehension (impending dislocation) Reposition patient prone Check popliteal fossae for Baker’s cysts (knees extended) Can perform Apley’s grind test (not sens/spec) in this position for meniscal tear (fix thigh, flex knee and rotate leg by pressing down & turning foot – clicking of pain make test positive) Function Ability to stand from sitting position with arms folded. Gait .

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