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History and examination of the knee Mark Blyth Consultant Orthopaedic Surgeon Glasgow Royal Infirmary.

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Presentation on theme: "History and examination of the knee Mark Blyth Consultant Orthopaedic Surgeon Glasgow Royal Infirmary."— Presentation transcript:

1 History and examination of the knee Mark Blyth Consultant Orthopaedic Surgeon Glasgow Royal Infirmary

2 PAIN Patellofemoral Poorly localised Anterior Antero-medial Antero-lateral Posterior Bilateral Worse stairs, hills, sitting, start up, squatting Medial/lateral joint line Well localised Single finger Referred pain From hip From spin e SWELLING Effusion Suprapatellar swelling Both hands Not effusion Infrapatellar swelling Single finger Fragmentary Hard lump Localised to joint line Extra-articular Location Bursae, meniscal cysts etc GIVING WAY Unstable ligament Knee gives out Pivoting sensation Signif after effect – swelling and disability No pattern Difficulties with uneven ground PFJ/ pain quads inhibition Preceding ant knee pain Frequent No after effects Ass PFJ activities Hyperextension sensation Ass patellar click Patellar instability History of patellar dislocation Patellar clunk Swelling possible

3 LOCKING True meniscal locking Block to extension Med/lat localised pain Unlock several minutes +/- swelling Ass squatting Rotation to relieve Pseudolocking PFJ Occurs at 30 0 Transient Frequent No swelling Loose body Not activity specific Not transient Knee immobile several minutes Poss palpable fragme nt HISTORY OF INJURY Cruciate injury Heard/felt pop Immed swelling Contact/ non-contact sport Stopped playing Complex ligament injury High energy mechanism Contact sport Swelling disproportionate to pain Meniscal injury History of squatting Twisting injury Delayed swelling PFJ injury Direct blow patella Immed swelling

4 Ant/post drawer Lachmans MCL/LCL laxity PLC laxity Pivot shift Joint line tenderness Postmed and lat tendernesss LOOKFEELMOVETEST STAND SIT SUPINE EXTN SUPINE HIP EXAMINATION NEUROVASCULAR EXAMINATION Walk Ant/post Alignment Scars/sinuses Wasting Swelling/effusion Patellar tracking on extension Lag on extension Flexion contracture Scars/sinuses Wasting Swelling/effusion Crepitus on extension Quads mechanism tenderness Confirm passive ROM Squatting Kneeling Pain on resisted extension Foot lift test Patellar stress test Patellar restraint test

5 Ligament evaluation ACL Difficult in the acute phase/ anxious patient +/- EUA Lachman (Jonsson 1982, Torg 1976) Beware PCL false positive Pivot shift may be negative

6 PCL Posterior drawer test at 90 0 Grade 1 0-5mm (tibial condyles anterior) Grade mm (condyles in line) Grade 3 10+mm (tibial condyles posterior) Grade 3 suspect collateral injury

7 Valgus stress at 30 0 Grade 10-5mm Grade 25-10mm Grade 310+mm Grade 3+Valgus in extn MCL/posteromedial corner Grade 3+ suspect posteromedial corner and cruciate injury

8 Varus stress at 30 0 Grade 10-2mm Grade 25-10mm Grade 310+mm Dial test at 30 0 onlyPosterolateral corner at PCL+posterolateral corner Reverse pivot shift test Hughstons hyperextension ext rotation test LCL/posterolateral corner Grade 2+3 suspect posterolateral injury

9 Clinical examination Inverted J sign Perch point 30 0

10

11 Clinical examination Q angle > 20 degrees significant

12 Thank you


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