Exam Summary


1. Introduction

  • Introduce yourself and the exam
  • Ask them to expose their knee
  • Ask if the patient has any pain
  • Stand the patient
  • Hand hygiene

2. Observations

  • Temperature
  • Heart Rate
  • Blood Pressure
  • Respiratory Rate

3. General Inspection

Look for:
  • Bowing (Genu varum) - may be due to Osteoarthritis
  • Knock-kneed (Genu valgum) - may be due to Rheumatoid arthritis
  • Muscle wasting (especially quadriceps)
  • Other Deformities (eg Fixed flexion, Osgood-Schlatter's Disease)
  • Scars and/or Swelling
  • Walking Aids
  • Shoes - orthotics, sole wear pattern
Rickets.jpg
Children with rickets showing genu valgum (left) and genu varum (right)
Osgood Schlatter.jpg
Osgood-Schlatter Disease

4. Gait

Assess:
  • Fluidity of movement
  • The way the foot strikes the floor
  • Symmetry
  • Look specifically for:
    • Antalgic gait - A gait where the patient limits weight bearing on the affected side due to pain
    • Reduced knee swing

5. Inspection while Lying Supine

Lie the patient down and look for:
  • Scars
  • Rashes
  • Inflammation
  • Swelling
  • Redness

6. Anterior Knee Palpation

Assess for:
  • Quadriceps muscle wasting
  • Temperature
  • Effusion
    • Patella Tap
    • Bulge Test
  • Palpate around patella and tendon

7. Lateral and Posterior Knee Palpation

  • Feel behind knee – Baker’s cysts
  • Flex knee to 30°
    • Feel joint line
    • Feel medial femoral condyle
    • Detect tenderness or swelling
  • Move the patella laterally to assess stability

8. Movements of the knee

  • Ask patient to bend knee as much as they can by sliding their foot towards their body. Normal range is 135º.
  • Raise the leg and push it back to see if any further range is possible. Stop if the patient experiences significant pain.
  • Assess Extension - normal range is 5º.

9. Cruciate ligaments

a. Drawer Test

  • Sit on foot with knee flexed at 90º.
  • Place hands around tibial tuberosity
  • Pull towards (Anterior Drawer Test) and then push against (Posterior Drawer Test). Look for excessive movement (>5-10º)
    suggesting ligament damage or tear.

b. Lachman's Test

  • Flex knee at 20-30º.
  • Put one hand just above patella on the femur to stabilise it.
  • Put the other hand under proximal tibia and fibula close to the joint line.
  • Push the tibia from behind.
  • Easy displacement of the tibia indicates an Anterior Cruciate Ligament injury.

10. Collateral ligaments

  • Bend knee slightly
  • Fix heel against your hip
  • Push on knee from the medial and lateral sides

11. Menisci

McMurray's Test

Medial

  • Flex knee
  • Feel over the medial joint line
  • Apply valgus force
  • Externally rotate knee
  • Track the knee through extension

Lateral

  • Flex knee
  • Feel over the lateral joint
  • Apply varus force
  • Internally rotate knee
  • Track knee through extension

Apley's Grind Test

  • Lie the patient prone
  • Repeat McMurray's test

12. Functional Assessment

  • Ask the patient to cross their arms and stand up from a sitting position.
13. Other Examinations
Request:

14. Conclude

Thank the patient and offer assistance

See Also

References

Talley and O'Connor Clinical Examination - 7th edition pp320-23

Baker's Cyst image: From http://mohammadamir.blogspot.com.au/2011/05/bakers-cyst.html
Osgood Schlatter Disease image: "MaleWithOsgoodSchlatter" by D3aj86 - Own work. Licensed under CC BY 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:MaleWithOsgoodSchlatter.jpg#/media/File:MaleWithOsgoodSchlatter.jpg
Rickets image: "Photograph; three children with rickets Wellcome L0014375" by http://wellcomeimages.org/indexplus/obf_images/41/45/54127c3cb9dbd83c3e5ca87e90e6.jpgGallery: http://wellcomeimages.org/indexplus/image/L0014375.html. Licensed under CC BY 4.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Photograph;_three_children_with_rickets_Wellcome_L0014375.jpg#/media/File:Photograph;_three_children_with_rickets_Wellcome_L0014375.jpg