Knee Examination_a65398d5-ee41-4da1-8e8c-d937b3d51dde.pptx

Knee

1. Knee Examination 1

2. Introduction & Initial Assessment Initial Assessment & Exposure Greeting and introduction. Adequate Exposure: From groin to toe. Observe Gait: Look for Antalgic gait, Lateral thrust, Stiff knee, Quadriceps avoidance gait. Assess posture. 2

3. Inspection (Patient Standing) From the Front: Alignment: Varus (Bow-legged) vs. Valgus (Knock-knee) Patellar position & rotation Foot rotation Scars, swelling, quadriceps wasting From the Side: Ask patient to push knee back. Assess for Flexion deformity or Recurvatum (hyperextension). Look for swellings. 3

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6. From the Back: Scars Popliteal swellings (e.g., Baker's cyst) Extensor Mechanism Alignment (Q-Angle): Line 1: ASIS to center of patella. Line 2: Center of patella to tibial tubercle. Measured in both standing and sitting positions. Males (10-14 degrees) Females ( 15-17 degrees) 6

7. Supine Examination - Look & Feel With Patient Lying Down - Look & Feel Look: Compare symmetry with normal side. Swelling, scars, sinus, bruising. Feel: Quadriceps bulk and tone. Temperature (compare sides). Tenderness: Palpate suprapatellar pouch, parapatellar area, patellar tendon, tibial tuberosity, femoral/tibial condyles, collateral ligament insertions. "Always look at the patient's face." 7

8.  Assessing Synovium & Effusion I Synovial Thickening & Mild Effusion Synovial Thickening Test: Knee in extension. Pincer grasp of patella edges with thumb & middle finger. Attempt to lift patella; fingers slip off if synovium is thickened. 8

9. Tests for Joint Effusion: Mild Effusion (Wipe/Bulge Test): Empty suprapatellar pouch. Press medial to patellar tendon. Observe for lateral bulge/ripple of fluid. 9

10. Assessing Effusion & Patella Moderate to Severe Effusion & Patellar Tests Moderate Effusion (Cross Fluctuation): Above-downwards and mediolateral fluctuation. Moderate-Severe Effusion (Patellar Tap Test): Compress suprapatellar pouch. Sharp tap on patella. Elicitable tap indicates significant effusion. Other Tests: Feel for defects in the quadriceps mechanism. Patellar Apprehension Test: Press patella laterally while flexing knee. Positive if patient apprehensive/senses instability. Distal Pulsation: Check Dorsalis Pedis & Posterior Tibial arteries. 10

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12. Assessing Movement - Extension & Flexion Range of Motion (ROM) Extension: Active: Straight Leg Raise (SLR) - tests extensor mechanism integrity. Passive: Lift both legs by ankles. Flexion: Active & Passive: Heel to buttock. Normal: 0° to 150°. Compare 'heel-to-buttock' distance bilaterally. 12

13. Assessing Movement - Rotation & Measurement Rotation & Measurements Internal/External Rotation: Hip & knee flexed to 90°. Rotate the foot. Normal: ≤ 10 degrees. Measure: Thigh and calf circumference for muscle wasting. Leg length discrepancy. 13

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15. Ligament Stability - Collateral Ligaments Collateral Ligament Testing Valgus (Abduction) & Varus (Adduction) Stress Test: Patient's foot under examiner's arm. Hold knee with hands on either side. Apply stress at 0° (full extension) and 30° flexion. Finding: Laxity at 30°: Collateral Ligament injury. Laxity at 0°: Severe injury (likely involving cruciate ligaments or capsule) 15

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17. Ligament Stability - Cruciate Ligaments I Cruciate Ligament Testing - Posterior Sag & Drawer Posterior Sag Sign: Knees flexed to 90°. View from side; posterior drop of tibia indicates PCL injury. Drawer Test: Knee flexed 90°, foot anchored. Grasp tibia and pull anteriorly/push posteriorly. Anterior Drawer: Excessive anterior movement → ACL injury. Posterior Drawer: Excessive posterior movement → PCL injury. 17

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19. The Lachman Test Gold Standard for ACL injury. Technique: Knee flexed 20-30 degrees. One hand stabilizes femur, other pulls tibia anteriorly. Grading: Grade 1+: 0-5 mm displacement Grade 2+: 5-10 mm displacement Grade 3+: >10 mm displacement 19

20. Meniscal Tests Tests for Meniscal Injuries McMurray's Test: Fully flex knee. Medial Meniscus: External rotation + Valgus stress + extend knee. Lateral Meniscus: Internal rotation + Varus stress + extend knee. A click + pain is a positive sign. Thessaly Test: Stand on affected leg, knee flexed 20°. Twist body & trunk 3 times. Joint line pain indicates meniscal injury. 20

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22. Thank You 22