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Knee examination

Follow the scheme below:

  • Inspection
  • Palpation  
  • Movement

Before starting

  • Introduce yourself
  • Explain what the examination entails
  • Ask permission to perform examination
  • Expose the patient appropriately - from waist down exposing both the lower limbs, but leaving the underwear on
  • Preserve dignity by using a blanket appropriately
  • Tell the patient to let you know if anything you do is uncomfortable
  • Remember - always watch the patients face 

Inspection

  • General observation
    • Does the patient look well?
    • Is there a walking aid?
    • Hands (Rheumatoid arthritis?)

Patient Standing

  • Remember to inspect from all sides (front, laterally and from behind):
    • Skin
      • Scars (previous injuries or surgical scars)
      • Sinuses
      • Ulcers
      • Colour - erythema, bruising
    • Deformity
      • Varus / valgus
      • Fixed flexion
      • Hyperextension (recurvatum) 
    • Limb length discrepanancy - characterised by a pelvic tilt
    • Knobbly knees (Osteoarthritis)
    • Swelling
      • Effusion?
      • Soft tissue? 
    • Muscle wasting - quadraceps?
    • Patella alignment - position

Patient Walking

  • Observe the patient walking.
    • Gait pattern. There are different types of gait:
      • Stiff knee
      • Antalgic
      • Varus thrust - collapse into more varus in stance loading
    • Range of movement  

Patient Lying down - supine with one pillow under the head

  • Deformity - fixed flexion (gap between bed and knee)
  • Quadriceps
    • Ask patient to contract quadriceps
    • Measure circumference of each thigh at a fixed distance from the tibial tuberosity if a difference has been observed
  • Detailed check:
    • Skin
      • Scars 
    • Effusion

Palpation

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