Knee physical examination

May 7, 2009 by   Print
Filed under Resources

Knee - 200 px wideObservation

  • 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

  • alignment, slide, tilt, rotation, A/P tilt

Passive Accessory

  • Distraction/Compression
  • Medial glide/lateral glide
  • Oblique glides
  • Longitudinal cephalad/Longitudinal caudad
  • Rotation (done in comparable range)

Superior Tibiofibular joint

  • PA/AP (fibula on tibia)(can use in compression)
  • cephalad/caudad

Orthopaedic tests for specific structures

* as appropriate

  • Medial and lateral collateral
  • Anterior and posterior cruciate (Lachmans)
  • McMurrays
  • No touch test
  • Pivot shift

Palpation

  • medial ligament
  • lateral ligament
  • menisci
  • coronary ligament
  • patella retinaculum
  • patella tendon
  • nerves
  • joint line

PRONE LYING

Palpation

  • temperature
  • tenderness
  • effusion
  • capsule
  • joint line

Neurological

  • muscle power, reflexes, sensation as appropriate

Passive accessory movements

  • P/A fibular
  • P/A tibia

Orthopaedic tests for specific structures

  • as appropriate
  • Appleys

SIDE LYING

Superior tib/fib joint

Accessory movements

  • Longitudinal caudad/Longitudinal cephalad (palpate joint while inverting and everting ankle)
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Comments

One Response to “Knee physical examination”
  1. Thanks for the great post about knees. I’m looking forward to reading a lot more of your site in the future.

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