Examination of the knee - Ask Doctor Clarke

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Approach to joint examination. • Inspection (soft tissue swelling, scars, deformity). • Palpation. • Movement (active and passive). • Measurement (if indicated).
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Examination of the knee This document is based on the handout from the “Surgery for Finals” course. The notes provided here summarise key aspects, focusing on areas that are popular in clinical examinations. They will complement more detailed descriptions and are not intended to be comprehensive.

Approach to joint examination • Inspection (soft tissue swelling, scars, deformity) • Palpation • Movement (active and passive) • Measurement (if indicated) Examination of the knee • Introduce yourself and ask permission • Ask about tenderness • “Let me know if I cause you any discomfort” Inspection • ?knobbly knees of OA • ?deformity (varus / valgus) ?scars • ? fixed flexion- gap between knee and bed • soft tissues- ?synovial thickening • ?effusion with loss of hollow around patella • ?prepatellar bursa ?infrapatella bursa • quadriceps ?wasting of vastus medialis Palpation • Use back of hand to assess temperature • Slide hand under extended knee to check for Baker’s cyst in popliteal fossa • Check for effusion • Check stability of patella • Palpate joint margins with knee flexed and patient’s foot stabilised Effusion • Fluid displacement: massage or bulge test (massage fluid from antero-medial knee to suprapatellar pouch and back) • Patellar tap: ballotment (with left hand compressing suprapatellar pouch)

 Dr R Clarke

www.askdoctorclarke.com

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The Medical Protection Society

Supporting your education, protecting your future

D is p la c e m e n t te st fo r a n effu s io n

E xa m in e r’s le ft h a n d co m p re sse s su p ra p a te lla r p o u c h R ig h t h a n d m a ss a g e s flu id from m e d ia l to la te ra l c o m p a rtm e n t a n d b a ck a g a in “B u lg e te s t” a s b u lg e se e n w h e n flu id m o ve s a fte r m a ss ag e

Joint line assessment • The joint line is adjacent to the lower pole of the patella- lower than you imagine • Medial tenderness commonly caused by strain of medial collateral ligament • Lateral tenderness more commonly due to torn mensicus • Both can be due to loose body within joint or to arthritis Movement • Extension 0° - hyperextension abnormal • Flexion to 135° - check for crepitus • Valgus stress for medial collateral ligament • Varus stress for lateral ligament • Cruciates: flex knee + stabilise foot; check hamstrings relaxed; grasp tibia with both thumbs on tuberosity; Lachman or draw test The McMurray Test • For a torn cartilage • Poor reliability and poor validity • Check for pain, palpable click, audible clunk or locking • The idea is to try to trap the torn cartilage between tibia and fibula Extras • Stand the patient up and ask to observe gait • ?varus or valgus deformity ?Paget’s • Measure any swelling or quads circumference, comparing one side with other

 Dr R Clarke

www.askdoctorclarke.com

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The Medical Protection Society

Supporting your education, protecting your future

D ra w test for cruciate ligam ents B oth thum bs on tibial tu berosity

F oot stabilise d on co uc h

M cM urray test for a torn m eniscus Leg is flexed and then extended - with foot externally rotated - with foot internally rotated Exam iner’s thum b and fingers grip the joint lines- feeling for a click

The McMurray Test • Your left hand holds knee with fingers over joint line • Your right hand holds foot • Knee is flexed and then extended • First with foot internally rotated • Next with foot externally rotated

 Dr R Clarke

www.askdoctorclarke.com

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