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Knee examination

Check distal neurovascular status

LOOK

  • Whilst standing and walking
  • Skin- scars, redness
  • Muscle- wasting of quads ( compare diameter of thigh if quads wasted )
  • Bone/joint- Effusion, Varus Valgus deformity( measure intermalleolar distance if valgus), Q angle
  • Remember to look in popliteal fossa
  • Knee & ankle postitions (hamstring tightness)
  • Walking - look for varus thrust = collapse into more varus in stance loading (dynamic varus due to medial compartment OA or lateral lig. laxity)

FEEL

  • Skin - Temperature, back of hand
  • Muscle- Ask patient to contract quads
  • Bone/joint- Effusion fluid displacement test, patellar tap test (may be negative if tense effusion)
  • Synovial thickening
  • Joint line tenderness (with knee bent)
    • Femoral condyles (with knee bent)
    • Patellar tendon
    • MCL,LCL
    • Under patellar facets
    • Popliteal swellings

MOVE

  • Active then passive-

  • Flexion (135 degrees normal)

  • Extension

  • Feel for crepitus

SPECIAL TESTS

Ligaments

MCL +LCL 

leg under arm, 2 hands, 10 degrees flexion to relax the posterior capsule (careful not to rotate knee)

MCL - valgus stress in extension & flexion. Opening in extension implies injury to the posterior oblique ligament (= combined ligamentous injury)

LCL - is only taut in full extension & lax in flexion



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