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Knee Examination

This document provides an overview of how to examine the knee. It describes examining the knee in different positions including standing, sitting, supine, and prone. Key areas to examine include looking for deformities, gait abnormalities, swellings, discoloration, and wasting of the quadriceps muscle. Important tests involve feeling for temperature differences, tenderness along joint lines and attachments, and examining range of motion and laxity through special tests like the drawer test, Lachman's test, and McMurray's test. Measurements of Q-angle, patellar height and width, and quadriceps girth are also recommended. The hip and lymph nodes should also be examined to fully evaluate the knee.

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Wasim R. Issa
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435 views40 pages

Knee Examination

This document provides an overview of how to examine the knee. It describes examining the knee in different positions including standing, sitting, supine, and prone. Key areas to examine include looking for deformities, gait abnormalities, swellings, discoloration, and wasting of the quadriceps muscle. Important tests involve feeling for temperature differences, tenderness along joint lines and attachments, and examining range of motion and laxity through special tests like the drawer test, Lachman's test, and McMurray's test. Measurements of Q-angle, patellar height and width, and quadriceps girth are also recommended. The hip and lymph nodes should also be examined to fully evaluate the knee.

Uploaded by

Wasim R. Issa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Knee Examination

Dr.Wasim R. Issa
Look
Position
Standing
Siting
Supine
Prone
Look : Standing
Normally : knees are in slight valgus position
(about 7 deg in women and 5 deg in men).

Deformities :
Genu Valgum (Knock Knees)
Genu Varum(Bow Legs)
Genu Recurvatum
Flexion deformity
Windswept deformity
Cavus foot
Patellofemoral abnormality
Flat foot

Gait :

Antalgic gait >>> knee arthritis


Quadriceps avoidance gait .
Hand to knee gait in quadriceps weakness
Signs with the patient in Supine
position
Swellings
Diffuse
localize

Discoloration around the knee joint

bruising >> trauma of soft tissue or


ligaments around the knee joint.

Scars .

Sinuses >>> infections.

Quadriceps >> wasting and loss of bulk.


Look in popliteal area for any
obvious swelling

- Bakers cyst
- Gastrocnemius-
semimembranosus bursa
- Popliteal artery aneurysm
- Lymphadenopathy
- Soft tissue tumors
Feel
Temperature:
- proximal to distal
- Comparison

- Tenderness:
- Knee flexed at 90, examined for
- Tenderness along the medial & lateral joint line
- Localised tenderness around the joint line indicates injuries to the
meniscus,collateral ligament and fat pad injuries.

- Knee extremely flexed


- Tenderness over medial femoral condyle just medial to patellar lig
- (osteoarthritis dessicans of medial femoral
epicondyle)
Knee extended:

- Tibial tuberosity
- Osgood schlatters disease
- acute avulsion injuries of the patellar ligament.
- femoral condyle
- Tibial condyle
- Patellar tendon >> tendonitis
- Attachement site of collateral ligaments
PATELLA:
trauma cases to look for fractures.

Displace the patella medially and laterally and


palpate the articular surfaces.
Tenderness is found in Chondromalacia patellae.

Move the patella in all the directions.


Reduced mobility is found in Retropatellar arthritis.

Tenderness over the lower pole of patella is found


in Sinding-Larsen-Johansson disease.
Pulses
Knee dislocation

ABI
At least 0.9
Move
First active movement and

then passive movement

Normal Range of Motion:

- Flexion : 0 135/140
- Extension : 0 5 (hyperextension)
- Adduction : 0 5
- Abduction : 0 5
- Internal rotation : 5 7 or 10
- External rotation : 5 7 or 10
MEASURE
a. For position of patella:

Flex knee at 30

Measure height of patella (H) & length of patellar tendon


(L)

Findings:

- L= H : normal
- L H : patella alta
- L H : patella baja
b. Q-angle:

Patient sitting on edge of couch

Leg full extension

2 lines
- ASIS to centre of patella
- Centre of patella to tibial tuberosity

Measure angle (normally 14 in male & 17 in


female)

Increase in angle : valgus deformity (predisposing


factor for chondromalacia)
c. Girth of Quadriceps femoris:

Measure 15 20 cm above the margin of base of


patella

23
SPECIAL TESTS:

1. For joint effusion

a. Patellar tap

b. Bulge test

c. Juxta patellar hollow test


Patellar tap:
The Bulge test:
patellar hollow test:
2. For stability of joint:

a. For cruciate ligaments

i) Anterior cruciate ligamnent (ACL)


Anterior drawer test
Lachmans test

ii) Posterior cruciate ligament (PCL)


Posterior drawer test
Sag test

iii) Complex ligament injury


Pivot shift test
Anterior & Posterior drawer test:
Lachman test:

30
Sag test:

31
Macintosh's Pivot Shift Test:
b. For collateral ligaments:

i) Varus valgus stress test (in flexion)

ii) Varus valgus stress test (in extension)

iii) Appleys distraction test

c. For meniscal injury:

i) Mcmurrays test

ii) Thassalys test

iii) Appleys grinding test


Varus valgus stress test

Apleys distraction test:


Apleys grinding test:
McMurrays test:

37
Thessaly test:

38
Do not forget
Hip examination
LNs
THANK YOU

40 Knee Examination/ Sunil Baniya

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