Physical Examination of the Knee should include careful inspection of the knee, palpation for point tenderness, assessment of joint effusion, range-of-motion testing, evaluation of ligaments for injury or laxity, and assessment of the meniscus. We’ll evaluate the ligaments on the inside and the outside of the knee. So we’ll basically have the knee, drop it over the side of the table, flex it about 30 to 40 degrees and stress it outside and stress it inside. This tests the medial collateral ligament and the lateral collateral ligament.
Introduction
- Follows the IP-PASS examination methodology
- Inspection
- Palpation
- Passive Range of Motion
- Active Range of Motion
- Strength & Neurovascular
- Special Tests
Inspection
- Skin
- Color: erythema, ecchymosis, white, black
- Trophic changes (altered hair growth, sweat production)
- Scars
- Swelling
- Joint effusion
- Muscle tone: atrophy, hypertrophy
- Deformity: asymmetry, rotation, amputation
- Areas of emphasis for knee exam
- Are there any deformities present?
- Is there a joint effusion?
- What is the resting position of the knee (i.e. is it held in partial flexion or extension)
Palpation
- Palpate for
- Effusion
- Clicking
- Snapping
- Crepitus
- Tenderness
- Temperature
- Masses
- Areas of Emphasis
- Medial/ lateral femoral condyle
- Medial/ lateral joint line
- Medial/ lateral tibial plateau
- 4 poles of the patella
- Tibial tubercle
- Pes anserine
- Hamstrings posteriorly
- Fibular head
Range of Motion
- Knee
- Flexion: 120-130
- Extension: 0
Strength and Neurovascular
- Knee Extension : Quadriceps Femoris (Rectus Femoris, Vastus Lateralis, Vastus Medialis, Vastus Intermedius)
- Knee Flexion: Hamstrings (Biceps Femoris, Semitendinosus, Semimembranosus), Gracilis, Sartorius, Gastrocnemius, Popliteus
Neurovascular
- Sensory Nerves
- L1: Iliac crest, groin
- L2, L3: Anterior and inner thigh
- L4: Lateral thigh, anterior knee, medial leg
- L5: Lateral leg, dorsal foot
- S1: Posterior Leg
- S2: Plantar foot
- S3, S4: Perianal
- Dermatome
- Needs to be updated
- Reflexes
- Commonly Used
- Patellar (L3, L4)
- Achilles (S1, S2)
- Uncommonly Used
- Medial Hamstring (L5, S1)
- Lateral Hamstring (S1, S2)
- Posterior Tibial (L4, L5)
- Cremasteric (L1, L2)
- Anal wink/ bulbocavernous (S2)
- Myotomes:
- L2: Hip Adduction, Hip Flexion
- L3: Knee Extension, Hip Adduction, Hip Flexion
- L4: Knee Extension, Dorsiflexion
- L5: Hip Abduction, Hip Extension, Toe Dorsiflexion, Foot Inversion, Dorsiflexion
- S1 Foot Version, Plantarflexion
- S2: Toe Plantar Flexion
- S3: Bowel, bladder function
- S4: Bowel, bladder function
- Vascular:
- Femoral Artery
- Popliteal Artery
- Dorsalis Pedis Artery
- Posterior Tibial Artery
Special Tests
- Knee Effusion
- Ballottement Test
- Iliotibial Band Syndrome
- Obers Test
- Nobles Test
- Renne Test
- Extensor Mechanism Injury
- Active Straight Leg Raise
- Patellar Tendonitis
- Bassets Sign
- Popliteus Tendinopathy
- Garrick Test
- ACL Injury
- Anterior Drawer Test
- Lachmans Test
- Pivot Shift Test
- Lever Test
- PCL Injury
- Posterior Drawer Test
- Quadriceps Active Test
- Posterior Sag Sign
- MCL Injury
- Valgus Stress Test
- LCL Injury
- Varus Stress Test
- Meniscal Pathology
- McMurrays Test
- Apley Grind Test
- Thessaly Test
- Bounce Home Test
- Posterolateral Corner Injury
- Dial Test
- Posterolateral Drawer Test
- Posterolateral External Rotation Test
- Reverse Pivot Shift Test
- Varus Stress Test (Knee)
- Patellofemoral Pain Syndrome, Chondromalacia Patella, Patellar Instability
- Patellar Compression Test
- Patellar Grind Test
- Patellar Apprehension Test
- Passive Patellar Glide
- Patella Alta Test
- Patellar Tilt Test
- Squat Test
- Vastus Medialis Coordination Test
- Waldrens Test
- Step Down Test
- Lateral Step Down Test
- Plica Syndrome
- Hughstons Plica Test
- Stutter Test
- Plica Active Extension Test
- Plica Flexion Test
- [[Medial Patellar Plica Test]
- Infrapatellar Fat Pad Impingement
- Hoffas Test
- Patellar Instability
- Patellar J Sign
- Patellar Glide Test
- Bakers Cyst
- Foucher Sign
- Homan Sign
- Saphenous Nerve Entrapment
- Tinels Test
