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English > Examination Of The Knee > Flashcards

Examination Of The Knee Flashcards

1
Q

What are the bones of the knee ?

A

Patella = knee cap attach on the patellofemoral groove
Femur with femoral condyles resting on the top of the tibia
Tibia with tibial plateau where the condyles rest
Fibula attach with a small joint next to the tibia

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2
Q

What are the ligaments of the knee ?

A

Medial and lateral collateral ligaments = main ligament of the knee, prevent it from moving from side to side.
Anterior and posterior cruciale ligaments : control front/back motion of the knee
Lateral and medial meniscus = special ligaments : allow the force from the weight of the body on a larger surface to prevent the degeneration of cartilage

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3
Q

What are the tendons of the knee ?

A

Quadriceps tendon : connect quadriceps and patella. It blends into patellar tendon.
Patellar tendon : connect patella and tibia
Hamstring tendon : to the inside of the knee form the ischial tuberosity

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4
Q

What are the nerves of the knee ?

A

Sciatic nerve split above the knee forming the tibial nerve (back of knee) and the common peroneal nerve (outside of the knee towards feet)

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5
Q

What is the Q-angle ?

A

A small angle formed by the line from the patella to ASIS and the line from the patella to the tibial tubercule.

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6
Q

What are the different position of the knee ?

A

Valgus alignement : knock knee toward the midline
Varus alignement : bow legs

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7
Q

Ventral side of the knee, what do you inspect ?

A

Level of the femoral condyles
Contour of the quadriceps and adductors
Position of the knee : extended, flexed, half flexed (bonnette)
Alignment : varus, valgus (normally slight varus)

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8
Q

Lateral side of the knee; what do you inspect ?

A

Normally completely extended leg or slight hyperextension.
One straight line between the trochanter major, head of fibula and lateral malleolus.
Assess swelling, contour of tensor fascia and iliotibial tract muscles.

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9
Q

Dorsal side of the knee, what do you inspect ?

A

Level of the femoral condyles
Popliteal fossa
Swelling or discoloration
Contour of hamstring and triceps surae muscles

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10
Q

Gait, what do you inspect ?

A

Symmetry
Stride lenght
Loading on the right and left side
Flexion contracture of the knees

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11
Q

Step of active movement of the knee

A

Patient supine.
Bend the knee heel against buttock then extend the knee.
Inspect the course of movement and range. Occurrence of pain or crepitus

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12
Q

Step of passive examination of the knee

A

Patient supine.
Slide the knee cranially with their heel on the table by grasping the ankle.
Grasp the ankle, straighten the knee.
Flex knee and hip to 90°, stabilise knee and hold calcaneus. Rotate lower leg externally and internally.

Inspect course of movement and range, occurrence of pain or crepitus. Note the end feel and the range of motion.

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13
Q

Step of isometric test of knee

A

Can be done supine or seated.
Hold the calcaneus and ask patient to pull heel toward their buttock. (Supine : knee bend 90° heel on examination table)
Hand on the shin and ask patient to extend their knee. (Supine : knee flexed 30-60°, forearm under it with hand over the other knee)

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14
Q

Muscle flexors of the knee

A

Gracilis, sartorius, biceps femoris, semitendinous, semimembranosus, gastrocnemius

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15
Q

Muscle extensor of the knee

A

Quadriceps femoris

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16
Q

Palpation of the patellar ligament ?

A

Using fingertips, palpate from the tibial tuberosity to the inferior pole of the patella.

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17
Q

Palpation of the collateral ligaments of the knee ?

A

Lateral : flex the knee 30°, heel on table. Rotate the hip externally and palpate.
Medial : same. Rotate internally the hip and palpate

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18
Q

Can you palpate the bursae of the knee ?
What are the bursae of the knee ?

A

Only if it is present.
Suprapatellar, prepatellar and infrapatellar.

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19
Q

Palpation the patella ?

A

Knee extended, palpate medial and lateral edge of patella.
Posterior edge is palpable by moving the patella medially/laterally then palpate around the medial/lateral edge to the underside.

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20
Q

Palpation of tibial tuberosity ?

A

One finger palpates medial joint space to the front of the knee. Elevation felt below the tibial plateau.

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21
Q

Palpation of head of fibula ?

A

Knee 90°. Palpate caudally from lateral joint space. 3 cm elevation palpable on the lateral side of knee.

22
Q

What kind of specific test exist for the knee ? What do they test ?

A

Hydrops test : test if there’s too much fluid in the knee

Knee stability test : done in case of suspicion of knee instability or lesion of cruciale ligament

Test for meniscus pathology, if several test are positive the probability will be higher.

Test for patellofemoral abnormalities

23
Q

What are the 2 hydrops test ?

A

Patellar tap test / ballotement test / dancing knee sign

Brush test / stroke sign / sweep test / bulge sign

24
Q

Step of the patellar tap test ?

A

Patient supine with knee extended relaxed
Grasp knee proximal to the joint and suprapatellar recess : collect all the fluid under your hand.
Push the fluid downward to put it under the patella.
Use 2 finger of the over hand and push the patella down perpendicularly.

Dancing knee positive : the patella can be pushed downward it will ‘bounces’

25
Q

Step of the brush test ?

A

Palm of hand at the medial joint space.
Sweep all the fluid cranially (medially) keep hand fixed.
Empty the lateral recess by sweeping distally

Bulge sign positive : medial recess fills again
Observe the recess : pouch slightly elevated or dimpled ==> minimal fluid present

26
Q

What are the different knee stability test ?

A

2 methods to test the collateral ligaments
- Valgus test : medial ligament
- Varus test : lateral ligament

To test the cruciale ligaments :
- Lachman test : anterior cruciale ligament
- Drawer sign : anterior and posterior cruciale ligament
- Posterior sag sign, gravity sign, Godfrey’s test : anterior and posterior cruciale ligament

27
Q

Step to test the collateral ligament of the knee : medial

A

Upper leg off the examination table. To test the laxity of the medial collateral ligament, compress the lateral meniscus.
- patient abduct leg slightly
- use hand to support the thigh laterally
- grasp ankle with other hand, flex the knee 20-30°
- move lower leg into valgus position

28
Q

Step to test the collateral ligament of the knee : lateral

A

Upper leg on the examination table. To test the laxity of the lateral collateral ligament, compress the medial meniscus.
- patient abduct leg slightly
- place hand medially of the vastus medialis muscle
- hold ankle, move leg into varus position

29
Q

Step of the Lachman test :

A

Supine position : can be done with the heel off or on the examination table
- abduct leg slightly
- knee flexed 20°
- grasp proximal femur with one hand and the dorsal side of the tibia with the other
- move tibia ventrally and femur dorsally

30
Q

Result of the Lachman test :

A

Positive test : considerable translation between the femur and tibia
=> weakness of the ACL

Negative test : sudden firm blockage due to tightening of an intact ACL

31
Q

Step of the drawer sign of the knee :

A

ACL : patient supine
- flex knee 90° with flat foot on the table
- rest your tight on the patient foot
- grasp popliteal fossa and place thumbs on the tibial plateau
- pull proximal tibia ventrally in relation to the femur

PCL :
- same but move the tibia dorsally

32
Q

Result of the drawer test of the knee :

A

ACL, positive sign : abnormal forward movement
=> weakness of ACL

PCL, positive sign : abnormal backward movement
=> weakness of PCL

33
Q

Why do you do a posterior sag sign ?

A

It is indicated in case of a positive anterior or posterior drawer test to confirm the result.

34
Q

Step of posterior sag sign :

A

Knee and hip flexed 90°
- support both legs
- view the contour of the tibial tuberosity at knee level

35
Q

Result of posterior sag sign

A

Positive sign : tibial tuberosity sags dorsally on the affected side.
=> PCL weakness

36
Q

What are the indication for the Mc Murray test ?

A

If several of the previous test are positive the presence of meniscus pathology is higher thus it is important to do this test to confirm.

Indicated for :
- rotation trauma of the knee
- painful passive rotation
- locking / blocking of the joint
- pain on compression of collateral ligament

37
Q

Step of Mc Murray test :

A

Supine patient, knee flexed 90°
- grasp joint space medially and laterally
- hold calcaneus
- move knee and hip into maximum flexion

Medial meniscus test :
- rotate hip knee and foot in external rotation
- extend the hip and knee

Lateral meniscus test :
- rotate hip knee and foot in internal rotation
- extend hip and knee

38
Q

What are the different test for patellofemoral abnormalities ?

A

Patellofemoral pain syndrome test

Patellar dislocation test

Patellar tendinopathy (Jumper’s knee) : occurs in young athlete

39
Q

Step and result of the patellofemoral pain syndrome test :

A

Grasp upper patella and ask patient to extend the knee
Exert pressure and try to move patella downward

Positive sign : pain and crepitus occur when the patella is moved

40
Q

Step and result of patellar dislocation test :

A

Knee flexed 30° then extend knee muscle
Exert pressure on medial side of the patella

Positive sign : Patella can be moved over the lateral femoral condyles

41
Q

Step and result of patellar tendinopathy :

A

Single leg decline squat on a 25° incline.
Positive sign : pain occurs due to the pressure put on the patella

42
Q

What is the Ottawa knee rules ?

A

A list of things that increase the chance of a knee fracture. A radiography should be requested if the patient following a knee trauma fulfill some of those.

43
Q

List of the Ottawa knee symptoms :

A
  • Age > 55 y
  • Localise tenderness at the head of the fibula
  • Isolated tenderness of the patella
  • Inability to flex the knee 90°
  • Inability to walk 4 steps immediately after the trauma
44
Q

What are the signs indicating osteoarthritis of the knee ?

A
  • age > 45 y
  • pain in the knee related to activity
  • short/long lasting morning stiffness
  • reduced flexion/extension
  • crepitus on movement
  • joint space sensitivity
  • widening of the bone of the knee joint
45
Q

Why would you test circumference ?

A

If atrophy is found on inspection or if the patient complaints of loss of strength.

46
Q

Step of circumference measurement of knee :

A

Supine and relaxed patient :
- choose point 15 cm proximal of the lateral joint space of the knee
- mesure the upper leg perpendicular to its axis at that point
- compare left and right

47
Q

What should you pay attention to while testing the collateral ligament of the knee ?

A

Not to rotate the hip while putting the knee into valgus, varus position.

48
Q

You can also test the collateral ligament in a knee extension. What is then the significance of result ?

A

Abnormal mobility : lesion of posterior cruciale ligament or of the dorsal capsule should also be considered additionally with the collateral ligament rupture.

49
Q

Is the drawer sign completely reliable ?

A

If prior to the test the tibia was situated too far dorsally due to weakness of the posterior cruciale ligament the test will not be reliable.
It will cause a false negative PCL test and a false positive ACL test.

50
Q

What kind of test is there for meniscus pathology ?

A

McMurray test
Local tenderness on palpating the joint space
Blockade in full extension

51
Q

Result of McMurray test ?

A

Positive : recognisable painful clunk is heard/felt in the joint space while the knee is being extended.

52
Q

Which test are more reliable for the cruciate ligament ?

A

The Lachman’s test is more reliable for the anterior cruciale ligament

English (34 decks)

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