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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