Knee Examination

<videoflash>fNUGyNYVhqE</videoflash>

Look

Inspect from the end of the bed for:

• Lack of symmetry
• Varus or valgus deformity.
• Fixed flexion of the knee

Look closer for:

• Rashes
• Scars
• Swelling
• Muscle wasting

Get the patient to stand, where varus and valgus, and popliteal swellings may be more noticeable. Ask the patient to walk.

Feel

• Temperature should be assessed, all around and compare the knees with each other.
• Palpate the borders of the patella for tenderness, then behind the knee for popliteal cysts or swellings
• Assess for knee effusion with a patella tap
• Assess for smaller effusions by run a hand along the side side, over and down the lateral side. If present, the medial side will refill, causing a bulge.
• With the knee flexed to 90 degrees, the joint line can be palpated.

Move

• Knee flexion – can you take your foot as far up towards your bum as possible. Extension - Then back flat out.
• Repeat it passively.
• Anterior drawer test. which tests the anterior cruciate ligament. Put knee in ninety degrees of flexion, stabilise foot, lay patient flat and grasp posterior tibia over the upper calf muscle, and pull forwards steadily. If one tibia pulls forward more than normal, the test is positive.
• Collateral ligament assessment – flex the knee to 15 degrees, and stressing each side of the knee.

With the patient standing:

• Medial and lateral ligament assessment