II. 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

III. 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

IV. Exam: Anterior Cruciate Ligament (ACL) Stability Tests

V. Exam: Posterior Cruciate Ligament (PCL) Tests

VI. Exam: Collateral ligament evaluation

  1. Knee Valgus Stress Test (Medial collateral ligament)
  2. Knee Varus Stress Test (Lateral collateral ligament)

VII. Exam: Meniscus Evaluation

  1. McMurray's Test
  2. Apley's Compression Test and Apley's Distraction Test
  3. Knee 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

VIII. Exam: Standing evaluation

  1. Balanced weight on each leg
  2. Deformity
    1. Genu Varum
      1. orthoKneeGenuVarum.jpg
    2. Genu Valgum
      1. orthoKneeGenuValgum.jpg
  3. Gait analysis
  4. Patella baja or Patella alta deformity
  5. Hip, Knee, and ankle alignment

X. 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

XI. 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

Images: Related links to external sites (from Google)

Ontology: Knee joint finding (C0576085)

Concepts Finding (T033)
SnomedCT 299321000
English Knee joint observation, Knee joint finding (finding), Knee joint finding
Spanish hallazgo en la articulaciĆ³n de la rodilla (hallazgo), hallazgo en la articulaciĆ³n de la rodilla

Ontology: Knee maneuver (C1293843)

Concepts Diagnostic Procedure (T060)
SnomedCT 116321006
English Knee maneuver (procedure), Knee maneuver, Knee manoeuvre
Spanish maniobra de la rodilla (procedimiento), maniobra de la rodilla