Knee Examination Dr Kholoud AlZain Acknowledgment Dr Abdulaziz

Knee Examination Dr. Kholoud Al-Zain Acknowledgment: Dr. Abdulaziz Alomar

General MSK Physical Examination Principles for Lower Examination • • Exposure Bilateral limb examination Anterior and posterior Gait LLD NV examination Joint above and joint below

Gait • Antalgic gait

Knee Examination • Look (Inspection) • Feel (Palpation) • Move • Special tests

Inspection (Look) • • • Deformity Scars Swelling Skin colour changes Muscle wasting

Muscle wasting

Deformity

Scars

Localize Swelling

Defuse swelling (Effusion)

Feel (palpation) • Temperature • Tenderness • Effusion

Tenderness • Soft tissue • Bony prominences • Joint line

Surface anatomy

Joint line palpation

Effusion Ballotment Milking

MOVE Active ROM Passive ROM

ROM • Flexion contracture • Extension lag

Special tests • Ligaments (stability): – ACL (Anterior Cruciate Ligament) – PCL (Posterior Cruciate Ligament) – MCL (Medial Collateral Ligament) – LCL (Lateral Collateral Ligament) • meniscus • Patellofemoral joint

ACL (anterior cruciate ligament) Anterior drawer test • Excessive forward movement of the tibia on the femur

ACL (anterior cruciate ligament) Lachman’s test • The most sensitive test for ACL rupture • Anterior Translation and end point (soft vs. hard)

ACL (anterior cruciate ligament) Pivot shift test: When positive, it is painful It needs experience to be able to elicit it

PCL (posterior cruciate ligament) Posterior drawer test • excessive backward movement of the tibia in relation to the femur.

PCL (posterior cruciate ligament) Sagging sign: • compare both knees in 90 degrees of flexion. • In the injured knee the proximal tibia is displaced backwards compared to the other side.

MCL Full extension 15 degree flexion

LCL Full extension 15 degree of flextion

Meniscus • Joint line tenderness: – Tenderness in the medial joint line (medial meniscus) – Tenderness in the lateral joint line (lateral meniscus) • Mc. Murrey’s test for medial and lateral meniscus