Knee Examination

Prepare patient

  • Introduction
  • Position with knees & thighs exposed

General Principles of Joint Exam

  • Check if any pain, then look, feel, move, measure & compare with other side, & assess function.

Look

  • General inspection
    • Room
    • Patient
      • Obvious other joint disease
  • Knees
    • Quadriceps wasting
    • Skin – Scars, swelling
    • Deformities – incl fixed flexion (look for gap under knees when lying down), valgus (e.g. RA) or varus (e.g. OA)

Feel

  • Quadriceps bulk
  • Warmth, swelling over knee
  • Patellar tap for large effusion (compress suprapatellar bursa with other hand)
  • Bulge sign for small effusion (compress suprapatellar bursa with one hand and run other hand up lat & medial sides of knee looking for fluid wave on opposite side)
  • Joint line tenderness
  • Popliteal pulse
  • Popliteal Baker cyst

Move

  • Passive movements: Place a hand over the knee & note any crepitus & ROM.
    • Flexion (135 deg)
    • Extension (5 deg)
  • Active flexion/extension of knee – look for subluxation of patella Ligament laxity:
    • Med/lat collateral ligaments (≤5 deg). Stress at 30 deg.
    • ACL (≤5-10 deg):
      • Lachman: (95% sens, knee flexed ~30 deg, distal femur fixed & proximal tibia pulled anteriorly – intact ACL should stop with “firm endpoint”),
      • Pivot shift (75%).
      • Anterior draw (60%)
    • PCL (≤5-10 deg):
      • Posterior draw,
      • Godfrey’s sign (affected tibia sags when supine if legs passively lifted into 90 deg flexion at hip & knee.)
    • Meniscal:
      • Bragard’s (point tenderness along jt line),
      • McMurray’s test
  • Patellar apprehension test if recurrent patella dislocation suspected:
    • Push patella laterally whilst flexing knee. Stop if patient’s face shows apprehension (impending dislocation) Reposition patient prone
  • Can perform Apley’s grind test (not sens/spec) in this position for meniscal tear (fix thigh, flex knee and rotate leg by pressing down & turning foot – clicking of pain make test positive)

Function

  • Ability to stand from sitting position with arms folded.
  • Gait

Wash hands

Summary

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