• 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)

© David for PhysioDigest - an educational resource for the musculoskeletal rehabilitation community, 2009. | Permalink | One comment | Add to del.icio.us
Post tags: examination, Knee, Musculoskeletal Assessment, tests

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