The hallmark signs when examining for joint surface damage are signs associated with higher friction, felt on moving one joint surface on its opposing surface under compression. Fine crepitus Crepitus on joint movement can be heard but it usually needs to be felt. Active movement loads the joint and the examiner places a hand over…
The following ligaments or ligament complexes can be examined individually or in combination and the pattern of instability determined: Collateral ligaments Anterior Cruciate ligament Posterior Cruciate ligament Postero lateral corner Postero-medial corner i) Collateral ligament examination Understanding the anatomical structure and attachments of the collateral ligaments is important for accurate examination. The MCL is a…
This is best performed with the knee flexed at 90 degrees. Both hands may be needed to palpate the specific trigger points around the knee while supporting the leg with the other hand. It is useful to ask the patient to indicate where the pain is felt, as meniscal problems tend to be point specific…
Inspection of the patello-femoral joint is initially best performed with the patient sitting with the leg flexed over the edge of the couch, noting the following features or signs. Position of the patellae: The patella normally faces forward and slightly up. Facing higher indicates patella alta, and lower indicates patella baja. Position of the tibial…
Examination supine involves a combination of look, feel and move. In order to look properly we need to feel the knee aiming to detect and confirm specific appearances and problems. General inspection: This takes into account evaluating alignment, position of the knee, skin problems, scars, muscle wasting, bruising for site of trauma, and the manner…
Examination starts with a general examination of the knee followed by specific examination to confirm a specific diagnosis that has been indicated by the history. The history and examination should lead to a management plan that may involve further targeted investigations. General examination includes assessing the patient standing, walking and lying supine, and includes active,…
After taking the history then there should be a fairly good idea of the diagnosis or, if not likely diagnoses, then the main category of problem. Essentially the patient will be in one of four main categories: Anterior knee pain Traumatic injury to knee ligaments, meniscus or other structures Degenerative osteoarthritis Inflammatory joint problem
Pain In principle the site, nature, character and severity of pain are determined by specific questions.General Questions:Location (vague widespread suggesting patella-femoral source or localised to medial or lateral joint line)Nature (sharp, burning, dull ache etc)Exacerbating features (activity related or at rest)Pain radiation Progress over time (getting worse or better)Specific Scenarios: Pain on medial aspect of…
The three key features when addressing a patient with a knee problem are: The main symptom: pain, swelling, locking or giving way Age of the patient Mechanism of onset of problem Most patients with knee problems will present with one or more of four core symptoms or signs: pain, swelling, locking and giving way. Each…
There are many different individual tests and signs described in the knee and for most of these the sensitivity and specificity has not been adequately reported. Surgeons therefore tend to have a set of primary signs or findings that confirm a particular diagnosis backed up by a set of secondary or confirmatory signs. For example…
