Knee Exam

Aka: Knee Exam, Knee Examination, Knee Joint Finding, Knee Maneuver

1. See Also
   1. Knee Injury Acute History
   2. Knee Pain
2. Exam: General (compare with less affected knee)
   1. Observation
      1. Ecchymosis
      2. Knee Effusion with obscured landmarks
         1. See Knee Effusion Causes
         2. See Ballottable Patella Sign
         3. See Knee Bulge Sign
      3. Previous surgical scars
      4. Knee resting position
      5. Quadriceps muscle atrophy
         1. Evaluate Vastus Medialis Obliquus specifically
         2. Atrophy often on side of ligamentous injury
   2. Tenderness to Palpation
      1. Patella
      2. Tibial tubercle
      3. Patellar tendon
      4. Quadriceps tendon
      5. Joint line
   3. Normal Range of Motion
      1. Flexion: 135 degrees
      2. Extension: 0 to 10 degrees above horizontal plane
3. Exam: Patellofemoral
   1. Quadriceps Femoris Muscle Angle (Q Angle)
   2. Patella tracking with quadriceps contraction
      1. Evaluate for smoothness of motion and crepitation
   3. Patellar Apprehension Test
      1. Evaluates for Patella Subluxation
4. Exam: Anterior Cruciate Ligament (ACL) Stability Tests
   1. Lachman Test (most sensitive)
   2. Knee Anterior Drawer Test
   3. Pivot Shift Test (MacIntosh Test)
5. Exam: Posterior Cruciate Ligament (PCL) Tests
   1. Knee Posterior Drawer Test
   2. PCL Sulcus Test
   3. PCL Sag Test
6. Exam: Collateral ligament evaluation
   1. Knee Valgus Stress Test (Medial collateral ligament)
   2. Knee Varus Stress Test (Lateral collateral ligament)
7. Exam: Meniscus Evaluation
   1. McMurray's Test
   2. Apley's Compression Test and Apley's Distraction Test
   3. Bounce Test
   4. Thessaly Test
   5. Inability to fully extend knee may suggest "bucket-handle" meniscal tear
   6. Joint line tenderness is 76% sensitive for meniscal tear, but not specific
8. Exam: Standing evaluation
   1. Balanced weight on each leg
   2. Genu Varum or Genu Valgum deformity
   3. Gait analysis
   4. Patella baja or Patella alta deformity
   5. Hip, Knee, and ankle alignment
9. Imaging
   1. See Knee XRay Indications in Acute Injury (e.g. Ottawa Knee Rule)
10. Diagnostics: Knee Arthrocentesis
    1. Indications
       1. Large, painful Knee Effusion of unclear etiology
    2. Simple clear transudative fluid
       1. Knee sprain
       2. Chronic meniscal tear
    3. Hemarthrosis (Bloody effusion)
       1. Anterior Cruciate Ligament Tear
       2. Osteochondral Fracture (Tibial plateau Fracture)
       3. Acute meniscal tear
11. References
    1. Bach (1997) Physician Sportsmed, 25(5): 39-50
    2. Budoff (1997, April) Consultant, 919-30
    3. Budoff (1997, Feb) Consultant, 295-304
    4. Hoppenfeld (1976) Physical Exam, Prentice-Hall
    5. Calmbach (2003) Am Fam Physician 68(5):907-12
    6. Rothenberg (1993) Postgrad Med, 93(3): 75-86
    7. Smith (1995) Am Fam Physician 51(3):615-21
    8. Solomon (2001) JAMA 286:1610-20