Knee Exam

* as with all rheumatologic exams, note patient comfort and compare bilaterally

Inspection

S    Swelling – look for loss of normal hollow around patella
E    Erythema
A   Atrophy of quadriceps muscle (measure quadriceps size 15 cm above tibial tubercle)
D   Deformity (varus/valgus/recurvatum, symmetry, alignment)
S    Skin changes (scars, bruising)

Stance
Gait 

  • Abnormal movements used to compensate for pain in knee joint

Crouch compression test

  • Anterior pain → patellofemoral
  • Lateral or medical joint line pain → meniscal problem



 

Palpation – tenderness, effusion, swelling, temperature, crepitus, atrophy

  • Knee extended
    • Tenderness, effusion, nodules, or warmth
    • Patella (effusions are companied by warmth)
    • Patellar tendon
    • Tibial tuberosity
    • Medial fat pad – tender in fibromyalgia
  • Knee flexed (30°)
    • Femoral condyles
    • Tibiofemoral joint line (lateral aspect for meniscal cysts)
    • MCL, LCL
    • Tibial tubercle
    • Bursa: prepatellar, infrapatellar, suprapatellar, anserine (bursitis → pain)
    • Popliteal fossa (Baker’s cyst, politeal artery)

Effusions

  • Wipe/bulge test:
    • Stroke upwards on medial side of the knee to milk fluid to the lateral compartment, then stroke downwards on lateral side of the knee and observe for fluid returning to the medial compartment
    • Ballotment/Patellar tap (L hand on suprapatellar – feel with R)
    • Squeeze fluid out of the suprapatellar pouch and then while maintaining pressure (holding on to the tendon), push down quickly on the patella to produce a palpable click in the other hand

ROM

  • Active vs Passive
    • Flexion/Extension (genu recorvatum)
    • Internal/External rotation (10°)

Stability

  • Feel for a solid end point; if ligament torn, the end of ROM would be soft
    • MCL: valgus stress test
    • LCL: varus stress test
    • ACL: anterior drawer test, Lachman
    • PCL: posterior drawer test
  • Lachman’s externally rotate hip, bend knee 15o, pull up on tibia and push back on femur)

Meniscal

  • Crouch compression test (already complete)
  • McMurray’s test (patient supine, knee bent at 90°, feel for obvious click along joint line on medial/lateral sides)
    • Medial meniscus: externally rotate, place valgus force on knee, and extend
    • Lateral meniscus: internally rotate, place varus force on knee, and exten

Injecting knees

  • Cortisone injections may relieve OA symptoms
  • Easiest to inject laterally just under the upper portion of the patella (have patient sit with legs dangling over edge of bed, feel for patellar movement, inject just under upper portion of lateral patella)
  • Can also inject laterally into depression just below the bottom of the lateral edge of the patella

1 thought on “Knee Exam

  1. I am interested in getting the OSCE to apply it to my students at UDLAP

    Gracias desde Puebla, México

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