REMS Knee

Question 1

What do you inspect for?

Answer 1

• Muscle wasting
• Scars
• Colour changes
• Joint swelling
• Skin rash
• Valgus/varus deformity
• Flexion deformity- where knee cannot straighten on the couch

Question 2

What do you feel for?

Answer 2

• Temperature from mid-thigh to knee using back of hand, comparing one with the other
• Palpate for any tenderness along the joint line with the knee flexed
• Palpate for any tenderness around patella, patellar tendon and tibia tuberosity
• For Baker’s cyst behind the knee in the popliteal fossa between the hamstring muscles

Question 3

How do you assess for effusion?

Answer 3

• Patellar tap- slide one hand down the thigh to push fluid out of supra-patellar pouch
• Push firmly on patella- does it tap against femur

Question 4

How else can you assess for effusion?

Answer 4

• Cross fluctuation test for small effusion
• Firmly stroke the medial side of the knee joint upwards to move fluid into joint cavity and supra-patellar pouch
• Then stroke the supero-lateral aspect of the knee downwards- watch medial side for a bulge of fluid if there is an effusion

Question 5

What movements do you assess for?

Answer 5

• Flexion and extension passively and actively, feeling for crepitus in passive movements
• Test integrity of extensor mechanism by asking patient to lift extended leg off bed

Question 6

How do you assess function of knee?

Answer 6

• Anterior draw test
• Position the knee at 90 degrees and look for posterior sag
• Assess medial and lateral collateral ligament stability by flexing the knee at 15 degrees and alternatively stressing the joint line on each side

Question 7

What do you look for in a standing/walking patient?

Answer 7

• Varus/valgus deformity

- Antalgic or stiff knee gait§

Question 8

What types of gait are there?

Answer 8

• Antalgic (mechanical injury)
• Festinating (Parkinson’s)
• Shuffling (Parkinson’s)
• Spastic (pyramidal tract lesion)