Knee physical examination

May 7, 2009 by David Fitzgerald | | Print
Filed under Resources

Observation

limb when walking

From behind:

ankle and knee varus/valgus

rotation of tibia in relation to femur

symmetry of gluteal folds and knee creases

Bakers cyst

From side:

hyperextension or flexion

level of patella

muscle wasting

From in front:

rotation or deviation of patellae

rotation of tibia in relation to femur

swelling

varus or valgus

patella height

quads bulk for muscle wasting

Functional tests and tests for other joints

squat (may overpress by bouncing)

lunge

step up

walking forwards an d backwards

jogging on spot

running

single leg stance

squat in single leg stance

single leg hops

jumps

Lumbar Spine examination.

combined movements

Neurological

muscle power (gastrocs)

SITTING

Observation

Tibia alignment

Active movements

active knee extension

rotation

Resisted movements

resisted isometric knee extension at 90º flexion and end range extension (critical angle)

resisted isometric knee flexion (critical angle)

SUPINE LYING

Observation

Palpation

temperature

tenderness

effusion

Effusion tests

minor effusion (Milking test: milk fluid inferiorly, then from lateral to medial. Tap fluid back to the lateral side which creates a fullness there)

moderate effusion (Tap test: for moderate effusion)

major effusion (Ballottable test: rebounding patella due to underlying fluid).

Neurological

muscle power, reflexes, sensation as appropriate.

Active movements

Hip and knee flexion

Knee extension

Tests for other joints

hip, ankle (as appropriate)

Neural tissue examination

SLR and any other tests as necessary

Passive movements

Flexion/Extension (hip and knee flexion) (overpressure for extension applied to femur above patella, on joint line and over upper end of tibia).

Internal rotation/External rotation of tibia (in flexion and extension) (can add compression or distraction)

Combined movements

Extension-abduction

Extension –adduction

Flexion-abduction-medial rotation

Flexion –adduction –lateral rotation

Passive accessory movements

Tibiofermoral joint

PA tibia (in full extension 90º flexion, full flexion)

AP tibia (in full extension 90º flexion, full flexion)

Medial glide/lateral glide tibia ( in full extension, 90º flexion, full flexion)

AP Femur

PATELLOFEMORAL JOINT

Observation