Knee examination

61 Knee examination





Questions



image What are the signs of active inflammation in the knee?

image What tests indicate anterior ligamentous stability?

image What tests indicate a meniscal tear?

Knee problems can give rise to altered gait, active inflammation and swelling.


Active inflammation is indicated by heat, rubor (redness or erythema), swelling caused by effusions and pain. Knee swelling can be caused by general effusions: rheumatoid arthritis, osteoarthritis, septic arthritis (hot and swollen; uncommon). Posterior swelling could be a Baker’s cyst, bursitis or popliteal aneurysm. Anterior swelling can be bursitis (common) or Osgood–Schlatter’s disease.




Introduction


Knee pain may be referred to the hip or lower back (or referred from the hip). An OSCE station might cover knee pain (commonly osteoarthritis or rheumatoid arthritis), knee swellings, ligamental instability or meniscal tear.



Look


With the patient standing assess gait (a step comprises heel strike, stance, toe-off and swing), look for posterior scars and palpate in the popliteal fossa for a Baker’s cyst.


With the patient lying down look for:


image scars: longitudinal midline scar indicates total knee replacement; arthroscopy portals

image effusions and redness: normal joint contours may be lost

image wasting: of the quadriceps can be quantified by measuring the circumference of both thighs with a tape measure, 10 cm from the top of the patella

image genu valgum (knock-kneed) and genu varum (bow legged)

image deformity of the foot (e.g. club foot).
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Knee examination

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