Knee Assessment Flashcards
I am inspecting the knee for… (6)
- Deformities
- Asymmetry
- Swelling
- Redness
- Nodules
- Muscle Atrophy
Same as shoulder
I am palpating the… (4)
- Patella
- Patellar tendon
- Quadriceps tendon
- Infrapatellar bursa
I am palpating for… (3)
- Tenderness
- Bogginess
- Bone enlargement
Same as shoulder
Knee active and passive ROM (2)
- Flexion
- Extension
Just have them squat once
What 3 things are you assessing in the knee? (non-test)
- Patellar tracking (abnormal = patellar instability)
- Joint line tenderness (abnormal = torn meniscus or arthritis)
- Gait (describe abnormal gait)
Joint line tenderness must be palpated with a flexed knee
Muscle tests (non-special, 2)
- Flexion = Quads
- Extension = Hammies
Patellar special tests (2)
- Patellar apprehension sign (abnormal = patellar instability)
- Patellar grind test (abnormal = chondromalacia/PTFS)
Patellar apprehension sign
* Patient position: Patient lies supine with knee relaxed in approx 30° flexion. May put roller under knee to support it.
* Action: Displace the patella laterally by applying medial pressure.
* (+) finding: If patient contracts the quadriceps or is apprehensive due to pain, this is a positive test. Positive test indicates patellofemoral syndrome, patellar subluxation, patellar dislocation.
Patellar grind
* Patient position: Patient supine and the knee is fully extended.
* Action: Place one hand superior to the patella and gently push the patella inferiorly as you instruct the patient to contract the quadricep.
* (+) finding: Pain with this is considered a positive test. Grinding or clicking is indicative of chondromalacia (patellofemoral syndrome)
McMurray Test (2 variations)
- MEG = medial meniscus, externally rotated, valGus stress
- LIR = lateral meniscus, internally rotated, vaRus stress
Looking for a painful click
2 Stress tests
- Valgus = medial
- Varus = lateral
Flexion & Extension of 30deg
3 ACL tests
- Lachman test
- Pivot Shift test (FIG: fully extended, internal rotation, valGus force)
- Anterior Drawer test
Lachman’s Test
* Patient position: Patient is supine with knee flexed approx. 25-30 degrees. Patient is instructed to relax the quadriceps muscle.
* Action: Place one hand on the distal femur and one on the proximal tibia. Pull anteriorly on the tibia.
* (+) finding: increased anterior translation of the tibia indicates a partial or complete tear of the ACL
Pivot Shift Test
Generally done under anesthesia
* Patient position: Patient seated with knee in full extension.
* Action: Slowly flex the knee while applying a valgus stress and internal rotation.
* (+) finding: a subluxation will occur at 20-40° flexion, indicating dysfunction of the ACL. Usually with more severe Grade II or Grade III tears.
Anterior Drawer
* Patient position: Patient supine with hamstrings and quads relaxed and knee flexed to approx 90°.
* Action: Grasp proximal tibia with both hands and slide tibia anteriorly. May sit on patient foot to provide stabilization.
* (+) finding: anterior translation/joint laxity indicating ACL dysfunction
PCL test
Posterior drawer test
IT Band syndrome tests (2)
- Noble’s test (bending kNee)
- Ober’s test (On their side)
Nobel’s Test
* Patient position: Patient is supine with knee flexed to ~90 degrees.
* Action: Examiner then applies pressure with finger/hand to the lateral femoral condyle or 1-2 cm proximal to it as the patient’s knee is passively extended.
* (+) finding: tenderness over the lateral femoral condyle at approx 30 degrees of flexion indicates IT band syndrome
Obers Test
* Patient position: Patient lying on unaffected side. Support the affected knee and flex it to 90 degrees.
* Action: Then extend and abduct the hip. Then release the knee support.
* (+) finding: Failure of the knee to adduct (fall below horizontal level of the table) is a positive test, which indicates IT band or tensor fascia lata tightness.
