- Does pt have a normal swing phase?
- Limp? Do they spend as much time on one foot as the other.
- Knee alignment:
- Varus [bow leg].
- Valgus [knock-knee].
- Normal is knee concavity should be bigger on medial side.
- Normal is small suprapatellar pouch.
- Swelling DDx:
- Effusion [#1 cause].
- Synovial proliferation [RA, etc]
- Quads wasting: measure their diameter at fixed distance up from tibial tubercle.
- Abnormal fixed flexion when legs laid flat (flexion deformity).
- Over joint line [apply firm pressure] (meniscal tear).
- Over medial/lateral ligaments.
- Bony prominences.
- Popliteal fossa for Baker's cyst [knee capsule hernia].
- Do active, then passive movement. Note range, pain, and crepitus [grating sound]:
- Flexion [normal: 135°].
- Extension [normal: 5°].
- Stress the medial and collateral ligament for laxity:
- Pt's leg should be flexed at 20°, so nice and loose as Dr wobbles it.
ACL: Lachman test
ACL: Anterior drawer test
PCL: Posterior drawer test
PCL: Posterior sag sign
- Pt. flexes knee and hip to 90°.
- Dr. looks at knees side-on.
- Normal is a convex part on the front of the knee.
- If see a concave instead, then it's a posterior sag from bone falling downwards with
gravity. Dx is PCL tear.
Meniscus: McMurray's rotation test
- Pt flexes knee to 90°.
- Dr rotates knee externally [only about 6°], and as rotate, extend knee 10°.
- If hear a click/klunk, then possible Dx of meniscal tear.
- Then repeat again, rotating the other way.
Meniscus: Joint palpation
- Dr places hand on suprapatellar pouch and move it back and forth.
Bursa: Bulge sign
- If bulge positive, then Dx an effusion.
- Only for very small effusions.
- A patella tap is used for a moderate effusions [won't work if too much or too little].
Bursa: Fluid thrill
- Dr flicks finger on lateral of knee, feeling for thrill on medial side [or vice versa]
- If feel thrill, Dx an effusion.
- Good for small effusions.
- Dr compresses patella against thigh.
- If painful, suggestive Dx is:
- Young pt: chondromalacia patellae.
- Old pt: arthritis.
Patella: apprehension test
- Purpose: DDx whether knee pain is subluxated or dislocated.
- Dr starts to apply sideways pressure to patella, looking at pt's face for apprehension.
- If pt apprehensive that patella will dislocate?? when continue, then the knee pain is