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Knee Examination Kathy Rainsbury February 2008. How to diagnose a knee complaint - HISTORY 1) Patients age + sex 2) Does the knee swell? 3) Is there a.

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Presentation on theme: "Knee Examination Kathy Rainsbury February 2008. How to diagnose a knee complaint - HISTORY 1) Patients age + sex 2) Does the knee swell? 3) Is there a."— Presentation transcript:

1 Knee Examination Kathy Rainsbury February 2008

2 How to diagnose a knee complaint - HISTORY 1) Patients age + sex 2) Does the knee swell? 3) Is there a mechanical problem?

3 Age + sex Age GroupMalesFemales 0-12Discoid lateral meniscus 12-18Osteochondritis dissecans Osgood-Schlatters 1 st patella dislocation 18-30Longitudinal meniscal tearsRecurrent dislocation patella Chondromalacia patellae Fat pad injury 30-50Rheumatoid arthritis 40-55Degenerative meniscus lesions 45+Osteoarthritis

4 Swelling? Effusion – presence of pathology which must be investigated –XS synovial (inflammatory) fluid/ blood/ pus Absence of effusion –Does not exclude pathology, but less likely. –Long-standing meniscus lesions/ OA

5 Mechanical problem? Hx of initial injury mechanism –Degree + direction + incapacity Knee give way? –Going down stairs/ jumping : cruciate ligament –Twisting/ walking/ uneven ground: meniscus Knee locks? –NEVER locks in full extension –Full flexion but limited extension – FB + meniscal (click) Pain –When? Localise?

6 Investigations Examine other joints (? Rheumatoid/ psoriasis + other inflammatory arthropathies) Aspiration + culture of fluid Bloods Xray joint (? use) CXR (if ? TB) MRI EUA Arthroscopy

7 Examination Look Measure Feel Move

8 Surface anatomy

9 Surface anatomy Joint line 5 1

10 Inspection (ant. + post.) Symmetry Swelling/ bruising/ scars/ rash/ deformity/ wasting/ bursae (Heat) Patella position – quads/ extensor apparatus intact?

11 Measure Quads circumference

12 Palpate Effusion – patellar tap Fluid displacement Tenderness –Bend knee – joint line –Collateral ligaments –Tibial tubercle –Femoral condyles

13 Move Active + passive Extension – 0 deg (? Hyperextension) Flexion – 135 deg

14 Move - instability 1) Valgus stress test (+ve if medial lig torn) 2) Varus stress test ( +ve lat lig torn) 3) Anterior Drawer test (+ve if ant cruciate torn) –Or Lachman test 4) Posterior Drawer test (+ve if post cruciate torn)

15 Instability - rotatory MacIntosh test / pivot shift test (difficult if patient not under anaesthesia)

16 Menisci Feel for clicks, listen for crepitus McMurrays test – medial + lateral menisci (or Apleys grind test)

17 And finally… Gait Genu varum varus my pig? Genu valgus varus valgus

18 NYVhqEhttp://www.youtube.com/watch?v=fNUGy NYVhqE X4n1fUhttp://www.youtube.com/watch?v=IwBW- X4n1fU


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