Knee exam

Question 1

What are you looking for on inspection in a knee exam?

Answer 1

• Walking aids
• Scars
• Swelling
• Patellar position
• Valgus/varus knee deformity
• Quadriceps wasting
• Extension/flexion abnormalities

Question 2

What are you looking for in a patients gait in a knee exam?

Answer 2

• Abnormalities in gait cycle
• Reduced range of movement
• Limping (antalgic gait)
• Difficulty turning
• Toeing angle
• Height of steps

Question 3

How do you palpate the knee in a knee exam?

Answer 3

• Compare the temperature of both knees (increased = septic/inflammatory arthritis)
• Palpate around the patella for tenderness
• Palpate behind the knee for popliteal swellings or cysts
• Palpate the joint line and patellar tendon for tenderness (with the knee bent)
• Asses for effusion

Question 4

How do you test for effusion in a knee exam?

Answer 4

Patellar tap:
- empty the suprapatellar pouch by sliding one hand down the thigh to the upper border
- with the other hand press downwards on the patellar, feel for a tap (fluid present)
Sweep test:
- sweep one hand up the medial side of the joint (to move fluid to the lateral side)
- sweep the other hand down the lateral side, and any excess fluid will bulge back into the medial side

Question 5

How do you assess the range of movement in a knee exam?

Answer 5

Active and passive:
- flexion (140 degrees)
- extension (180 degrees)
* test for hyperextension of more than 10 degrees

Question 6

What special tests are needed in a knee exam?

Answer 6

Posterior sag:
- ask the patient to flex their knee to 90 degrees with their foot on the bed
- inspect from the lateral side for evidence of a posterior sag (PCL rupture)
Anterior drawer test:
- ask the patient to flex their knee to 90 degrees with their foot on the bed
- wrap your hands around the proximal tibia and rest your forearms on the lower leg
- pull the tibia anterior (significant movement = ACL laxity or rupture)
Collateral ligament tests:
- flex the knee to 20 degrees
- hold the patient heel with one hand and the other on the medial/lateral aspect of the knee
- gapping when pressing from the medial side (varus stress) suggests lateral collateral ligament laxity/rupture
- gapping when pressing from the lateral side (valgus stress) suggests medial collateral ligament laxity/rupture

Question 7

How do you complete a knee exam?

Answer 7

• Examine the ankle and hip
• Perform a neurovascular examination of the lower limbs