Physical Exam

Knee

• Approach:
  • Gait
  • Inspection
  • Palpation
  • ROM
  • Power Assessment
  • Special Tests
• Gait
  • Smoothnest of movement, stance phase, heal stance, mid stance, toe off.'
  • Antaglic Gait: pt limps, and stance phase is shortened on that side.
  • Swing Phase: if pelvis drops on swinging size, indicates hip abductor weakness on opposite side.
    • Bilateral hip abductor weakness: waddling gait.
• Inspection:
  • Standing
    • Front: Flexion deformity (genu procavatum).
    • Side: Muscle wasting/swelling, ensure knee fully extended 180 deg. Genu recurvatum (hyperextension)
    • Back: Swelling, baker's cyst, genu varum, genum valgum.
  • Supine
    • Swelling (parapatellar, suptrapatellar bulging), redness, muscle atrophy
    • Symmetry
• Palpation
  • Temperature (slightly cooler)
  • Patella (borders, quad tendon, quad muscle, patellar ligament, tibial tubercle) - tenderness? 
  • Popliteal fossa, pulse, (baker's cyst)
  • Flex to 90°
    • Feel joint line tenderness 
    • Ligaments (femoral/tibial condiles. condyles)
    • Patellar crepitus (flex/extend knee)
  • Bursae
    • prepatellar (over patella
    • Superficial infrapatellar bursa
    • Deep infrapatellar bursa
    • Anserine Bursa (common knee pain)
  • Effusion tests.
    • Medial + lateral parapatellar suci seen (if not, then effusion)
    • Fluid Milk Test: (Small effusions)
      • Sweep up medial side of knee, push fluids into the lateral+suprapatellar pouch
        • Then immediately sweep down lateral aspect, pushes fluid back, and can see buldge in medial side.
        • Useful for small effusions (large infusions cannot see).
    • Fluid Ballotment Test
      • Place fingers on boths ides of patella, and other hand on suprapatellar pouch.
      • Push fluid from suprapatellar puch to knee, and feel the fluid buldge on parapatellar bursae on both sides.
    • Patellar Tap (Large Effusions)
      • Hand on suprapatellar pouch, push fluid down. tap down on patella and feel tap.
  • ROM
    • Flexion: Bring keel to bottom.
    • Extension: 180° (flex-contracture)
    • External/internal rotation tibia on femur (~20°).
    • Patellar movement.  (pain laterally --> prior dislocation)
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