MSK CAS

Question 1

When performing an intermediate knee exam what position does the patient lie in?

Answer 1

On the couch with their knee, quadriceps and calf muscles visible

Question 2

What should you inspect for in an intermediate knee exam?

Answer 2

Scars
Muscle wastage
Knee deformities

Question 3

What can scars indicate in a knee exam?

Answer 3

Previous injury and trauma

Question 4

What can muscle wastage indicate in a knee exam?

Answer 4

Disease eg arthritis

Question 5

When should a neuro exam be done in relation to a knee exam?

Answer 5

If muscle wastage is suspected to be due to LMN

Question 6

What are the 2 knee deformities?

Answer 6

Varus and valgus

Question 7

What is varus?

Answer 7

Bow legged

Question 8

What is valgus?

Answer 8

Knock knees

Question 9

What do we palpate for in a knee exam?

Answer 9

Temperature
Patella
Medial and lateral joint lines
Effusion

Question 10

Where do you palpate for temperature in a knee exam?

Answer 10

Above patella, above and below the joint and always compare left to right

Question 11

Why may temp be raised in a knee exam?

Answer 11

Due to inflammatory disease like osteoarthritis and septic arthritis

Question 12

When must you look at the patient’s face and why?

Answer 12

During palpation to look for signs of pain, can indicate meniscal damage

Question 13

Where might meniscal damage at the knee occur ?

Answer 13

Tibial tuberosity
Head of fibula
Popliteal fossa

Question 14

What is a sign of Baker’s cyst?

Answer 14

Swelling at the popliteal fossa

Question 15

What is effusion?

Answer 15

Excess synovial fluid?

Question 16

What are the 2 methods to feel for effusion at the knee? When is each used?

Answer 16

Tap method- use for large effusions

Sweep method- use for small effusions

Question 17

Describe the tap method for assessing effusions at the knee

Answer 17

Make sure patient’s knee is extended
Slide your non-dominant hand down the thigh to empty suprapatellar pouch
Press firmly over patella with dominant hand and you’ll feel a tap as the patella hits the femur

Question 18

Describe the sweep method for assessing effusions at the knee

Answer 18

Make sure patient’s knee is extended
With the back of your non-dominant hand sweep upward on the medial side of the knee to empty the medial compartment
Keeping your non-dominant hand in place, sweep downward on the lateral side of the knee to empty the lateral compartment with the back of your dominant hand
If there is a small effusion you will see a ripple or bulge of fluid appears on the medial side of the knee from the lateral compartment

Question 19

What muscles handle flexion of the knee?

Answer 19

Biceps femoris Semitendinosus
Semimembranosus
and (gracilis)

Question 20

What muscles handle extension of the knee?

Answer 20

Quadriceps muscles Quadriceps tendon
Patella
Patellar tendon
Tibial tuberosity

Question 21

What will damage to the knee extensors cause?

Answer 21

Inability to straight leg raise

Question 22

What are the 2 ways movement at the knee is assessed?

Answer 22

Active and passive

Question 23

How is active movement at the knee assessed?

Answer 23

Ask the patient to flex and extend each knee as much as possible in turn
Whilst the patient is doing this, look for pain on movement and note the Range of Motion (ROM) of each joint.

Question 24

What can reduced ROM during active movement at the knee indicate?

Answer 24

Arthritis

Question 25

How is passive movement at the knee assessed?

Answer 25

Ask the patient to relax their legs Flex and extend each patient's legs to the maximum extent Test the extensor compartment by lifting the patient's foot with the patient's leg relaxed Look for hyperextension by comparing the angle between the thigh and lower leg.

Question 26

What angle of hyperextension is normal?

Answer 26

Up to 10 degrees of hyperextension is normal provided it is the same on the other side.

Question 27

How should ROM differ in passive movement compared to active?

Answer 27

ROM should be more than compared to active movement

Question 28

What are the 2 special tests in a knee exam?

Answer 28

Anterior draw for ACL and posterior sag for PCL | Medial and collateral ligaments

Question 29

How is the anterior draw for ACL and posterior sag for PCL done?

Answer 29

Flex the patient's knee to 90 degrees and maintain this position Check that the hamstring muscles are relaxed and look for posterior sag (posterior subluxation of the tibia on the femur). With your hands behind the upper tibia and both thumbs over the tibial tuberosity, pull the tibia anteriorly

Question 30

What does posterior sag cause?

Answer 30

This causes a false-positive anterior drawer sign that should not be interpreted as ACL laxity

Question 31

How is anterior draw positive?

Answer 31

Significant movement (compared with the opposite knee) indicates that the ACL is lax. Movement of > 1.5 cm suggests ACL rupture

Question 32

How is the test for the medial knee ligaments done?

Answer 32

Ask the patient to flex their legs to 30 degrees Place one hand on lateral aspect of the lower thigh Place your other hand on the medial aspect upper calf with the fingers over the medial joint line Provide a valgus stress with your hand over the thigh whilst feeling for the joint opening in the medial joint line

Question 33

How is the test for the collateral knee ligament done?

Answer 33

Ask the patient to flex their legs to 30 degrees Place one hand on medial aspect of the lower thigh Place your other hand on the lateral aspect upper calf with the fingers over the lateral joint line Provide a varus stress with your hand over the thigh whilst feeling for the joint opening in the lateral joint line

Question 34

What is the order for an intermediate knee exam?

Answer 34

1. Positioning and Exposure 2. Look: Looking for scars, knee deformity, muscle wasting 3. Feel: temperature 4. Around the patellar 5. Medial and lateral joint lines 6. The tibial tuberosity and head of the fibula 7. Popliteal fossa 8. Move: Active: Flexion and Extension 9. Passive: Flexion and Extension 10. Passive: Hyperextension 11. Special Tests 12. Anterior Draw and Posterior Sag 13. Medial and Lateral Collateral ligaments