Physical Exam

    Table of contents
    1. 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
    • 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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