Knee examination
Encyclopedia
The knee examination, in medicine
and physiotherapy, is performed as part of a physical examination
, or when a patient presents with knee
pain
or a history that suggests a pathology
of the knee joint.
The exam includes several parts:
The latter three steps are often remembered with the saying look, feel, move.
and the bed or examination table should be flat. The patient's hands should remain at his or her sides with the head resting on a pillow. The knees and hips should be in the anatomical position (knee extend
, hip neither flexed or extend).
Lighting – adjusted so that it is ideal.
Draping – both of the patient's knees should be exposed so that the quadriceps muscle
s can be assessed.
(swelling), rubor (redness), calor
(heat), dolor
(pain). Swelling and redness should be evident by inspection. Pain is gained by history and heat by palpation.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
and physiotherapy, is performed as part of a physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
, or when a patient presents with knee
Knee
The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...
pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
or a history that suggests a pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
of the knee joint.
The exam includes several parts:
- position/lighting/draping
- inspection
- palpation
- motion
The latter three steps are often remembered with the saying look, feel, move.
Position/lighting/draping
Position – for most of the exam the patient should be supineSupine
In grammar a supine is a form of verbal noun used in some languages.-In Latin:In Latin there are two supines, I and II . They are originally the accusative and dative or ablative forms of a verbal noun in the fourth declension, respectively. The first supine ends in -um. It has two uses. The first...
and the bed or examination table should be flat. The patient's hands should remain at his or her sides with the head resting on a pillow. The knees and hips should be in the anatomical position (knee extend
Extension (kinesiology)
In kinesiology, extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of...
, hip neither flexed or extend).
Lighting – adjusted so that it is ideal.
Draping – both of the patient's knees should be exposed so that the quadriceps muscle
Quadriceps muscle
The quadriceps femoris , also called simply the quadriceps, quadriceps extensor, quads, is a large muscle group that includes the four prevailing muscles on the front of the thigh...
s can be assessed.
Inspection done while the patient is standing
The knee should be examined for:- Baker's cystBaker's cystA Baker's cyst, also known as a popliteal cyst, is a benign swelling of the semimembranous or more rarely some other synovial bursa found behind the knee joint. It is named after the surgeon who first described it, William Morrant Baker...
- genu recurvatumGenu recurvatumGenu recurvatum is a deformity in the knee joint, so that the knee bends backwards. In this deformity, excessive extension occurs in the tibiofemoral joint. Genu recurvatum is also called knee hyperextension and back knee. This deformity is more common in women and people with familial ligamentous...
- Valgus deformityValgus deformityIn orthopedics, a valgus deformity is a term for outward angulation of the distal segment of a bone or joint. The opposite deformation, medial deviation of the distal bone, is called varus....
(knock-kneed) - Varus deformityVarus deformityIn orthopedics, a varus deformity is a term for the inward angulation of the distal segment of a bone or joint. The opposite of varus is called valgus.The terms varus and valgus always refer to the direction that the distal segment of the joint points....
(bowlegged) - GaitGaitGait is the pattern of movement of the limbs of animals, including humans, during locomotion over a solid substrate. Most animals use a variety of gaits, selecting gait based on speed, terrain, the need to maneuver, and energetic efficiency...
- antalgic gaitAntalgic gaitAntalgic gait is a form of gait abnormality where the stance phase of gait is abnormally shortened relative to the swing phase. It can be a good indication of pain with weight-bearing.-Conditions associated with an antalgic gait:* Coxalgia...
?
Inspection done while supine
The knee should be examined for:- Masses
- Scars
- Lesions
- Signs of trauma/previous surgery
- Swelling (edemaEdemaEdema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
- particular in the medial fossa (the depression medial to the patella) - erythemaErythemaErythema is redness of the skin, caused by hyperemia of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation...
(redness) - Muscle bulk and symmetry (in particular atrophy of the medial aspect of the quadriceps muscleQuadriceps muscleThe quadriceps femoris , also called simply the quadriceps, quadriceps extensor, quads, is a large muscle group that includes the four prevailing muscles on the front of the thigh...
- vastus medialis) - Displacement of the patella (knee cap)
Palpation
An inflamed knee exhibits tumorSwelling (medical)
In medical parlance, swelling is the transient enlargement or protuberance in the body and may include tumors. According to cause, it may be congenital, traumatic, inflammatory, neoplastic or miscellaneous....
(swelling), rubor (redness), calor
Heat
In physics and thermodynamics, heat is energy transferred from one body, region, or thermodynamic system to another due to thermal contact or thermal radiation when the systems are at different temperatures. It is often described as one of the fundamental processes of energy transfer between...
(heat), dolor
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
(pain). Swelling and redness should be evident by inspection. Pain is gained by history and heat by palpation.
- Temperature change - using the back of the hand one should feel the temperature of the knee below the patella, over the patella, and above the patella. Normally, the patella is cool relative to above and below the knee. A complete exam involves comparing the knees to one another.
- joint line tenderness - this is done by flexing the knee and palpating the joint line with the thumb.
- EffusionEffusionIn physics, effusion is the process in which individual molecules flow through a hole without collisions between molecules. This occurs if the diameter of the hole is considerably smaller than the mean free path of the molecules...
s, test for- Patellar tap - useful for large effusions
- BallottementBallottementBallottement is a medical sign which indicates increased fluid in the suprapatellar pouch over the patella at the knee joint. To test ballottement the examiner would apply downward pressure towards the foot with one hand, while pushing the patella backwards against the femur with one finger of the...
- defined as a palpatory technique for detecting or examining a floating object in the body - Bulge sign - useful for smaller effusions
Motion
The patient should be asked to move their knee. Full range of motion is 0-135 degrees. If the patient has full range of motion and can move their knee on their own it is not necessary to move the knee passively.- examination of crepitusCrepitusCrepitus is a medical term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints.-Causes:...
- clicking of the joint with motion
Ligament tests
- Anterior drawer sign - tests the anterior cruciate ligamentAnterior cruciate ligamentThe anterior cruciate ligament is a cruciate ligament which is one of the four major ligaments of the human knee. In the quadruped stifle , based on its anatomical position, it is referred to as the cranial cruciate ligament.The ACL originates from deep within the notch of the distal femur...
(ACL) - Posterior drawer sign - tests the posterior cruciate ligamentPosterior cruciate ligamentThe posterior cruciate ligament is one of the four major ligaments of the knee. It connects the posterior intercondylar area of the tibia to the medial condyle of the femur...
- Lachman test (ACL)
- Medial collateral ligamentMedial collateral ligamentThe medial collateral ligament of the knee is one of the four major ligaments of the knee. It is on the medial side of the knee joint in humans and other primates. It is also known as the tibial collateral ligament, or abbreviated as the MCL.- Structure :It is a broad, flat, membranous band,...
- Lateral collateral ligament
Meniscus tests
- McMurray testMcMurray testThe McMurray test, also known as the McMurray circumduction test is used to evaluate individuals for tears in the meniscus of the knee. It is a rotation test for demonstrating torn cartilage of the knee...
- medial meniscus is tested by external rotation + lateral force (mnemonic Mel)
- lateral meniscus is tested by internal rotation + medial force
- Apley grind testApley grind testThe Apley grind test or Apley test is used to evaluate individuals for problems in the meniscus of the knee.In order to perform the test, the patient lays prone on an examination table and flexes their knee to a ninety degree angle. The examiner then places his or her own knee across the posterior...
See also
- Knee painKnee painKnee pain is a common complaint for many people. There are several factors that can cause knee pain. Awareness and knowledge of knee pain causes lead to faster diagnosis and treatment. Knee pain can be related to knee joint or around the knee.-Knee joint:...
- Reflex hammerReflex hammerA reflex hammer is a medical instrument used by physicians to test deep tendon reflexes. Testing for reflexes is an important part of the neurological physical examination in order to detect abnormalities in the central or peripheral nervous system....
- Knee effusion
- Knee osteoarthritisKnee osteoarthritisKnee osteoarthritis is a degenerative disease of the knee joint. It is more common in people older than 40 years. Women have greater chance to be affected.-Signs and symptoms:Some of the signs and symptoms associated with knee osteoarthritis include:* Pain...