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Examination of the Knee joint
- 1. Examination of Knee Joint DrAbu Shuraih Sakhri
- 2. HISTORY • pain, • swelling,stiffness • mechanical symptoms (e.g. locking, giving way, click etc) • limp • deformity
- 3. • mechanism oftrauma • Position of knee at time of trauma • After trauma, was the patient able to continue playing • post trauma - weight bearing possible or not,
- 4. • what treatmenttaken, how long immobilised • pain – aggravated • giving way – aggravating factors • recurrent swelling of knee
- 5. • When didthe effusion occur after the trauma (if immediate .. think of # intraarticular if delayed, think of meniscal injury) • Any h/o Clicks, thuds, giving away? • Any h/o locking / unlocking • Difficulty in climbing stairs, squatting
- 6. • Other joints •Renal diseases
- 7. General examination • Ligamentouslaxity • Neurocutaneous markers • Fetures of rickets **
- 8. • Have examinedthe patient in standing sitting lying down position • From front side and back
- 9. • Attitude • GAIT •Inspection • Palpation • Movement • Measurement • Special test • Neurovascular ex (common peroneal) • Other joints
- 10. Attitude • Optimal position •Triple displacement – flexion, post. Subluxation, lateral rotn of tibia • Genu valgum • Genu varum • Genu recurvatum • locking
- 11. Inspection • Skin (scar,sinus ,discoloration) • Swelling (effusion,bursitis, Baker’s cyst, tumors,malunion) • Muscle wasting
- 12. Palpation • Local riseof temp • Tenderness – Anterior, medial and lateral joint line tenderness
- 13. collateral ligament • tendernessis characteristically present at its femoral attachment. • Tenderness over the ligament at the level of the joint without any tenderness at its bony attachments is suggestive more of an injury to the Menisci and less of the sprain of the collateral ligament.
- 14. • Tenderness atthe joint level midway between the ligamentum patellae and the tibial collateral ligament indicates torn anterior horn of the medial semilunar cartilage. • Tenderness posterior to the tibial collateral ligament is diagnostic of a torn posterior horn.
- 15. • effusion inthe knee joint – 'patellar tap' and – fluctuation tests
- 16. Fluctuation • pressing thesuprapatellar pouch with one hand and feeling the • impulse with the thumb and the fingers of the other hand placed on either side of the patella or the ligamentum patellae.
- 17. Patellar tap • elicitedby pressing the suprapatellar pouch with one hand driving whole of its fluid into the joint • so as to float the patella in front of the joint • With the index finger of other hand the patella is pushed backwards towards the • femoral condyles with a sharp and jerky movement. The patella can be felt to strike on the femur
- 18. swelling in thepopliteal fossa • expansile pulsation - Popliteal aneurysm • Transillumination test - Morrant-Baker cyst • compressible
- 19. Palpation of poplitealfossa • Swelling • Poplietal artery
- 20. Palpation • all thebones around the knee joint • Thickening and irregularity – patella, – lower part of the femur and – upper ends of the tibia and the fibula • pathology or tumour
- 21. Palpate the patella •Tracking • Margins • Push patella laterally and medially
- 22. MOVEMENTS • flexion • extension. •active and passive movements
- 23. MEASUREMENTS Circumference measurement- OFTHIGH from ASIS … quadriceps wasting • Intermalleolar distance • Intercondylar measurement
- 24.
- 25. Special Test for •Menisci • Collateral ligament • Cruciate ligament
- 26. McMurray’s test • detectany tear in the medial / lateral menisci • grasps the foot firmly with one hand and the knee with the other hand. • joint is completely FLEXED • The foot is now rotated externally and the leg abducted at the knee. • then the joint is slowly extended keeping the foot externally rotated and abducted. • PAIN OR CLICK – medial meniscus tear • Foot int.rotn+ leg adduction- lateral meniscus
- 27. • If theposterior end of the medial semilunar cartilage is torn • the patient will complain of pain at start • middle of the menisci is torn then - middle of extension • when the anterior horn is torn - felt almost at the end of extension.
- 28. Apley’s Grinding test •The patient lies prone on the table. • The clinician places his knee on the patient's thigh in order to fix the femur. • The knee joint is flexed to the right angle. • Now the clinician applies compression and lateral rotation • to the leg from the foot i.e. grinding. • medial semilunar cartilage. • If the patient complains of pain while the clinician • compresses and internally rotates the leg, there is a • tear in lateral semilunar cartilage.
- 29. ACL • ANTERIOR DRAWERTEST • Supine, 90 degree flexed knee • Hold upper tibia by two hands • Pull applied at upper end of tibia+ forward movmt in realtion to femoral condyles • Normal- glide up to 0.5cm • >0.5- lig laxity
- 30. Lachman test • 15-20degree flexion- knee • One hand support thigh just above the knee , other grasps the upper end of tibia • Extend of anterior glide indicate integrity of ACL
- 31. PCL Backward sagging ofupper end of tibia – lig injury POSTERIOR DRAWER TEST • How much it is possible to push the tibia backwards…
- 32. • Examination ofhip • Examination of foot and ankle • Distal neurovascular ex
- 33. In short • Inspection deformity,attitude, swelling , wasting, skin • Palpation T, tenderness,swelling, wasting • Movements • Measurements • Ligaments and menisci • Contralateral knee • Hip • Neurovascular
- 34.