EXAMINATION OF THE KNEE AND ASPIRATION TECHNIQUE C SNYCKERS

INTRODUCTION The largest joint in the body subject to a great variety of traumatic and degenerative conditions Outwardly simple but is actually quite complex Not just a hinge joint.

INTRODUCTION The tibia femoral joint is inherently unstable Relies heavily on ligaments for stability Patella is the largest sesamoid bone in the body – acts as a fulcrum increasing mechanical advantage of quads.

INSPECTION Surface anatomy Anterior: – Patella Fracture Bipartite – Infra-patellar tendon and Hoffa’s fat pad Rupture Tendonitis – Tibial tubercle Osgood – Schlatter avulsions

INSPECTION Surface anatomy – Femoral condyles – Pre-patellar bursa Bursitis – Extensor mechanism Rectus femoris Vastus intermedius Vastus medialis (VMO) Vastus lateralis

INSPECTION: Surface anatomy Medial: – Pes anserinus “Say Grace before Tea” – MCL Lateral: – ITB (Gerdy’s Tuburcle) – LCL

INSPECTION: Surface anatomy Posterior: – Popliteal fossa Baker’s Cyst Popliteal aneurism

INSPECTION: Limb alignment INSPECTION: – Genu Valgum Intra-maleolar distance – Genu Varum Intra-condylar distance – Windswept deformity

INSPECTION: Patella alignment Squinting patellae – Increased femoral ante-version – Increased external tibial torsion Q angle – Anterior ASIS to center of patella – Center of patella to tibial tubercle – 14° in men, 17° in women Patella Alta Patella baja

INSPECTION: GAIT Varus thrust Valgus thrust Recur vatum thrust Antalgic gait Stiff knee gait Flexed knee gait

INSPECTION: Range of movement Extension: Normal range – Active : 0° – Passive: - 10° (prone hanging test) Flexion: Normal range – Active: 0° - 130° – Passive: 0° - 150°

PALPATION: Be systematic Start and end at same spot Helpful system is to start anteriorly

PALPATION: Patella Infra-patella tendon Tibial tubercle Pes anserinus MCL Medial joint space and meniscus Medial femoral condyle VMO

PALPATION: Rectus femoris Vastus intermedius Vastus lateralis Lateral femoral condyle LCL Lateral joint space and meniscus ITB and Gerdy’s tubercle

PALPATION: REMEMBER TO CHECK POSTERIOR!!! Popliteal fossa Popliteal pulse

MANIPULATION: Muscle testing – Oxford grading (out of 5) 5 – normal power 4 – weak power 3 – against gravity 2 – with gravity 1 - Flicker

MANIPULATION: Use: – “Flex or extend” – “Hold it there” – “Keep it there” Test: – Quads – Hamstrings Check for atrophy – Measuring tape (compare)

SPECIAL TESTS: PATELLA TAP: – Effusion FLUID THRILL: – Effusion PATELLA GRIND – OA

SPECIAL TESTS: VALGUS STRESS TEST: – MCL (30° flexion) – MCL, ACL and capsule (extension) VARUS STRESS TEST: – LCL (30° flexion) – LCL, ACL and capsule (extension) GRADE LAXITY: – Gr I – Gr II – Gr III

SPECIAL TESTS: LACHMAN TEST: – ACL – PCL GODFREY’S TEST: (drop off sign) – PCL

SPECIAL TESTS: DRAWER TEST: – POSTERIOR: PCL – ANTERIOR: ACL

SPECIAL TESTS: VARUS RECUVARTUM TEST: – Posterior lateral corner SQUAT TEST: – Meniscus APLEY’S GRINDING AND DISTRACTION TEST: – Menisci

SPECIAL TESTS: MC MURRAY’S TEST: – Medial meniscus – Lateral meniscus

KNEE ASPIRATION: Sterile technique NB!!!!! Two fingers above and two fingers medial or lateral to superior pole of the patella Aim needle towards the tip of the patella below patella