Table of contents
- 1. Knee
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
- Standing
- 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).
- Sweep up medial side of knee, push fluids into the lateral+suprapatellar pouch
- 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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