Orthopaedics  |  Osteo Knee Pathway - Examination




Orthopaedics

Osteo Knee Pathway - Examination

  • Look at the patient - note if patient pyrexial or unwell. Measure weight and BMI.
  • Look at the patient's gait - note any limp.
  • Look at the joint - note joint swelling and deformity (valgus/varus).
  • Look at the muscles - note muscle wasting or contracture and compare sides.
  • Examine for an effusion using patellar tap and the massage (bulge) test.
  • Feel for site(s) of tenderness including the patellofemoral joint, medial and lateral joint including MCL and LCL.
  • Examine the popliteal fossa - note sites of tenderness, Baker's cyst, or vascular abnormality.


  • Assess range of movement (active and passive and compare both knees):

    • Knee flexion normally 3 to 140 degrees (115 degrees required for most activities of daily living).
    • Feel for crepitus with a hand on the knee cap.
    • Note fixed flexion deformity.
    • Note clicks or grinding on movement.


  • Examine the knee ligaments for laxity:

    • MCL and LCL - look for adduction and abduction movement with knee flexed to 30 degrees.
    • ACL - Anterior Drawer test (pull tibia forward when sitting on the patient's foot with patient prone with knee flexed to 90 degrees), Lachman's test (pull/push tibia forward and push/pull thigh backward with knee flexed to 15 to 20 degrees), and Pivot Shift test (best done by Orthopaedic surgeon).
    • PCL - Posterior Drawer test (as for Anterior Drawer test but push tibia backwards), Posterior Sag test (observe knees with patient prone and knees flexed to 90 degrees. Look for posterior sag).


  • Other tests:

    Vascular examination of lower limb.

    • Patellar apprehension test (apply pressure to medial patella when patient prone with knee extended - then, flex the knee to 30 degrees and note lateral patella movement and any patient apprehension).
    • Knee joint aspiration if there is an effusion.
    • Examine the patient's hips, ankles and lumbar spine. Note evidence of OA elsewhere and any referred pain.


  • Neurological examination of lower limb.

Knee assessment (history and examination) - patient.co.uk



Last updated : Tuesday, October 03, 2017
Next review date : Wednesday, October 03,2018


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