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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  
</div>  
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== Subjective (Patient Intake)  ==
== Subjective ==


=== Patient Intake  ===
=== Patient Intake  ===
*History of present condition (HPC) (Was there trauma or was it insidious onset? Mechanism of Injury?)<br>
*History of present condition (HPC) (Was there trauma or was it insidious onset? Mechanism of Injury?)<br>


=== Special Questions (Region‐specific historical examination)<br>  ===
=== Special Questions (Region‐specific historical examination)   ===
 
*Any back or leg pain? (Is pain in a dermatomal region - pain in the knee can be referred from the back)  
*Any backhip or leg pain? (Is pain in a dermatomal region - pain in the knee can be referred from the back)  
*Is there hip or ankle pain? (Knee pain can be referred from the hip or biomechanically affected by the ankle)  
*Is there hip pain? (Knee pain can be referred from the hip)  
*Did the patient hear a pop/click at time of injury?  
*Did the patient hear a pop/click at time of injury?  
*Does the knee give way? (instability/rupture of ligaments)  
*Does the knee give way? (instability/rupture of ligaments)  
*Does the knee lock? (meniscus, true locking associated with bucket handle tears)
*Did the knee swell? How quickly? Where is the swelling? (Intra articular/ extra articular; immediate swelling usually indicates trauma within the knee such as ligament damage)  
*Did the knee swell? How quickly? Where is the swelling? (Intra articular/ extra articular; immediate swelling usually indicates trauma within the knee such as ligament damage)  
*Was there bruising? (Immediate bruising indicates significant trauma  
*Was there bruising? (Immediate bruising indicates significant trauma  
*Cough/sneeze cause pain?&lt;/span&gt;
*Cough/sneeze cause pain?  
*Does the patient experiencing locking (may indicate a bucket handle meniscal tear).
*Age – The following conditions are not exclusive to these age groups but a higher prevalence is noted in these populations (elderly – OA?, young – osgoods schlatters, middle aged- meniscal).  
*Age – The following conditions are not exclusive to these age groups but a higher prevalence is noted in these populations (elderly – OA?, young – osgoods schlatters, middle aged- meniscal).  
*Type of shoes ( wear patterns/age of shoes/proper design)
*Type of shoes ( wear patterns/age of shoes/proper design)


=== Additional Information  ===
=== Additional Information  ===
*Past Medical History (PMH) (Pre-existing medical conditions)  
*Past Medical History (PMH) (Pre-existing medical conditions)  
*Drug history (DH) (Any relevant medications?)  
*Drug history (DH) (Any relevant medications?)  
*Social History (SH) (Work/sports/hobbies affected?)
*Social History (SH) (Work/sports/hobbies affected?)


=== Investigations<br>  ===
=== Investigations   ===
 
*Radiological Considerations &nbsp;- any previous X-Rays or scans<br>  
*Radiological Considerations &nbsp;- any previous X-Rays or scans<br>  
*Other investigations - any recent blood tests
*Other investigations - any recent blood tests


=== Red Flags  ===
=== Red Flags  ===
 
These are the special questions which may indicate that something more sinister may be going on. If you suspect that the problem is not musculoskeletal and/or something sinister may be going on patients should be referred immediately back to their doctor with your concerns noted.&nbsp;  
These are the special questions which may indicate that something more sinister may be going on. Patients should be referred immediately back to the GP with your concerns noted. Ask a seniors advice on the severity of these symptoms and whether and A&amp;E referral is more appropriate. Mechanism of Injury is important here, what force was exerted through the leg? Was it enough for a tibia/femur fracture? Loss of pulses in the foot may indicate vascular compromise.&nbsp;  


*Bilateral pins and needles or numbness in the LL.  
*Bilateral pins and needles or numbness in the LL.  
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*Loss of pulses in the LL (Vascular compromise).  
*Loss of pulses in the LL (Vascular compromise).  
*Obvious deformity.
*Obvious deformity.
<br>
If nothing sinister but the symptoms are more severe than you might expect ask a seniors advice on whether and A&amp;E referral is more appropriate. Mechanism of Injury is important here, what force was exerted through the leg? Was it enough for a tibia/femur fracture? Loss of pulses in the foot may indicate vascular compromise.<br>


<br>
== Clinical Reasoning - What does the History tell you?  ==
Knowing the history gives clues as to the structures affected. Mechanism of injury is extremely important. If you can work out the force of the injury this gives you clues on likely stretched/ damaged structures (Valgus force may indicate an MCL sprain, varus force may indicate an LCL sprain, foot planted and twisted may indicate an ACL sprain/rupture).


== What does the history tell you?  ==
Make sure you rule out the back and hip unless there is a clear mechanism of injury as the knee can be a referred site of pain for both these areas. Immediate swelling and bruising usually indicates significant trauma and may require X-Ray to rule out tibial plateau fractures, bone bruises or an MRI to investigate the integrity of the ligaments.


Knowing the history gives clues as to the structures affected. Mechanism of injury is extremely important. If you can work out the force of the injury this gives you clues on likely stretched/ damaged structures (Valgus force may indicate an MCL sprain, varus force may indicate an LCL sprain, foot planted and twisted may indicate an ACL sprain/rupture).  
Go into your objective examination with a working hypothesis. Use your physical examination to identify dysfunction and special tests to prove or disprove your hypothesis.<br>


Make sure you rule out the back and hip unless there is a clear mechanism of injury as the knee can be a referred site of pain for both these areas. Immediate swelling and bruising usually indicates significant trauma and may require X-Ray to rule out tibial plateau fractures, bone bruises or an MRI to investigate integrity of the ligaments.  
== Objective  ==
The objective examination gives you quantifiable measures to rule out what structures are involved and to reassess after treatment to determine improvement/deterioration.  


Go into your objective examination with a working hypothesis. &nbsp;Use your physical examination to identify dysfunction and special tests to prove or disprove your hypothesis.
=== General Observation  ===
*Posture
*Movement Patterns


<br>  
{| cellspacing="1" cellpadding="1" width="100%"
|-
| {{#ev:youtube|MgdkcX7koAg|350}}&nbsp;<ref>BJSM Videos. Knee Exam (1 of 27): Introduction. Available from: http://www.youtube.com/watch?v=MpWVqi6C9RY [last accessed 25/01/14]</ref>
| {{#ev:youtube|MpWVqi6C9RY|350}}&nbsp;<ref>BJSM Videos. Knee Exam (2 of 27): Inspection: standing. Available from: http://www.youtube.com/watch?v=MpWVqi6C9RY [last accessed 25/01/14]</ref>
|-
| {{#ev:youtube|8FToHsom980|350}}&nbsp;<ref>BJSM Videos. Knee Exam (3 of 27): Walking. Available from: http://www.youtube.com/watch?v=8FToHsom980 [last accessed 25/01/14]</ref>
| {{#ev:youtube|PO7e-h8h2FU|350}}&nbsp;<ref>BJSM Videos. Knee Exam (4 of 27): Balance. Available from: http://www.youtube.com/watch?v=PO7e-h8h2FU [last accessed 25/01/14]|}</ref>
|}


== Mechnisms of Injury  ==
=== Functional Tests  ===
*Small knee bend
*Sit to stand
*Squat
*Jump
*Hop
*Run<br>


'''ACL strain/ tear'''
=== Inspection &amp; Palpation  ===


*H/o valgus or hyperextension force to knee if contact injury.
'''Inspection'''
*Sharp change in direction in non contact injury.
*H/o audible ‘pop’
*H/o a quick stop, landing with knee fully extended
*Severe effusion within 4-6 hours.<br>


'''ITB Syndrome'''
*Effusion
*Poor Alignment
*Muscle Wasting<br>


*H/o increased training (ie running distance; intensity/distance/frequency)
'''Palpation'''&nbsp;  
*C/o lateral knee pain<br>


'''MCL strain/ Tear'''
*MCL  
*LCL
*Joint Line
*Patella
*Retinaculae
*Patellar Tendon
*Hamstrings Tendons
*Popliteus.


*Valgus force to knee in contact/non contact injury.
<br>  
*C/o medial knee pain.<br>


'''LCL strain/Tear'''
{{#ev:youtube|ONA_y0znCoU|350}}<ref>BJSM Videos. Knee Exam (9 of 27): Inspection &amp; palpation: supine. Available from: http://www.youtube.com/watch?v=ONA_y0znCoU [last accessed 25/01/14]|}</ref>


*Varus force to knee in contact/non contact injury.
=== Neurologic Assessment    ===
*C/o lateral knee pain.
If neurological deficits or referral from lumbar spine are suspected you should perform a neurological assessment:


'''Chronic patella subluxation'''  
'''Reflexes'''  
*Patella Ligament (L3/L4)
*Achilles Tendon (S1/S2)


*C/o giving way/instability/pain.
'''Dermatomes'''
*C/o catching of the patella
*L1 to S4
*Localised pain on the medial aspect of patella.
*Restricted function/ sports due to apprehension of instability.<br>


'''Patella dislocation'''  
'''Myotomes'''  
*L2 &nbsp; &nbsp; &nbsp;Hip Flexion
*L3 &nbsp; &nbsp; &nbsp;Knee Extension
*L4 &nbsp; &nbsp; &nbsp;Dorsiflexion
*L5 &nbsp; &nbsp; &nbsp;Big Toe Extension OR 4 Lesser Toes Extension
*L5/S1 Knee Flexion
*S1 &nbsp; &nbsp; &nbsp;Plantarflexion OR Foot Eversion
*S2 &nbsp; &nbsp; &nbsp;Toe Flexion


*H/o rotation or valgus force to knee.  
{{#ev:youtube|xeW7dwcBZCI|300}}<ref>BJSM Videos. Knee Exam (5 of 27): Neurovascular evaluation: supine. Available from: http://www.youtube.com/watch?v=xeW7dwcBZCI [last accessed 25/01/14]|}</ref>  
*Patient may describe seeing dislocation that ‘popped back’ spontaneously or needed reduction by medical staff.  
*Increased prevalence in females.
*C/o medial patella shift of knee.<br>


'''Patella tendinopathy (Jumper’s knee)'''
Other neurological testing includes: Babinski and Clonus


*H/o kicking, running, climbing.
=== Movement Testing  ===
*Symptoms localised to the patella tendon.
*AROM, PROM, and Overpressure
*Muscle Strength and length<br>
*Clear hip and ankle with full AROM + overpressure
*If lumbar spine suspected add passive intevertebral mobilisations (PA spinous processes, PA transverse processes).


'''Osgood-Schlatters Syndrome'''
{| cellspacing="1" cellpadding="1" width="100%"
|-
| {{#ev:youtube|wFB9WxfPFWI|300}} <ref>BJSM Videos. Knee Exam (6 of 27): Hip examination: supine. Available from: http://www.youtube.com/watch?v=wFB9WxfPFWI [last accessed 25/01/14]</ref>
| {{#ev:youtube|z33P1xBpBt0|300}} <ref>BJSM Videos. Knee Exam (7 of 27): Range of Motion Part 1. Available from: http://www.youtube.com/watch?v=z33P1xBpBt0 [last accessed 25/01/14]</ref>
|-
| {{#ev:youtube|9c4ePN7hOdE|300}}<ref>BJSM Videos. Knee Exam (8 of 27): Range of Motion Part 2. Available from: http://www.youtube.com/watch?v=9c4ePN7hOdE[last accessed 25/01/14]|}</ref>
|}
 
=== Special Tests  ===
Special tests are used to prove or disprove your working hypothesis and identify the dysfunctional structures. &nbsp;[[:Category:Knee - Assessment and Examination|See full list of knee special tests]]


*Children/Puberty.
<br>
*Pain on tibial tuberosity.


== Objective  ==
'''ACL'''


The objective examination gives you quantifiable measures to rule out what structures are involved and to reassess after treatment to determine improvement/deterioration.
*[[Lachman Test|Lachman's Test]]
*[[Anterior Drawer Test of the Knee|Anterior drawer]]
*[[Pivot Shift|Pivot-Shift]]
*[[Slocum's Test]]


=== Observation  ===
'''PCL'''


*Posture
*Sag sign<br>
*Movement Patterns
*[[Posterior Drawer Test (Knee)|Posterior Drawer]]


{| cellspacing="1" cellpadding="1" width="100%"
'''MCL/LCL'''
|-
| {{#ev:youtube|MpWVqi6C9RY|300}} <ref>BJSM Videos. Knee Exam (2 of 27): Inspection: standing. Available from: http://www.youtube.com/watch?v=MpWVqi6C9RY [last accessed 25/01/14]</ref>
| {{#ev:youtube|8FToHsom980|300}} <ref>BJSM Videos. Knee Exam (3 of 27): Walking. Available from: http://www.youtube.com/watch?v=8FToHsom980 [last accessed 25/01/14]</ref>
|-
| {{#ev:youtube|PO7e-h8h2FU|300}}<ref> BJSM Videos. Knee Exam (4 of 27): Balance. Available from: http://www.youtube.com/watch?v=PO7e-h8h2FU [last accessed 25/01/14]|}</ref>
| {{#ev:youtube|xeW7dwcBZCI|300}}<ref> BJSM Videos. Knee Exam (5 of 27): Neurovascular evaluation: supine. Available from: http://www.youtube.com/watch?v=xeW7dwcBZCI [last accessed 25/01/14]|}</ref>
|}


=== Functional Tests<br>  ===
*Valgus stress test


*Small knee bend
'''LCL'''
*Sit to stand
*Squat
*Jump
*Hop
*Run<br>


=== Palpation  ===
*[[Lateral Collateral Ligament|Varus stress tests]]
*[[Dial Test|Dial Test]] (postero-lateral corner)


*MCL, LCL, joint line, patella, retinaculae, patellar tendon, hamstrings tendons, popliteus.
'''Meniscus'''


=== Neurologic Assessment <br>  ===
*[[McMurrays Test|McMurrays]]
*Bounce home
*[[Joint Line Tenderness of the Knee|Joint line tenderness]]
*[[Apley's Test|Apley’s Test]]
*[[Ege's Test]]
*[[Steinman Test]]
*[[Thessaly test]]


If neurological defecits or referral from lumbar spine are suspected you should perform a neurological assessemnt:
'''Patellofemoral'''


#Reflexes
*[[Moving Patellar Apprehension Test|Apprehension]]
#Dermatomes
*[[Patellar Grind Test|Grind Test (Clarkes sign)]]
#Myotomes


{| cellspacing="1" cellpadding="1" width="100%"
'''ITB'''
|-
| {{#ev:youtube|wFB9WxfPFWI|300}} <ref>BJSM Videos. Knee Exam (6 of 27): Hip examination: supine. Available from: http://www.youtube.com/watch?v=wFB9WxfPFWI [last accessed 25/01/14]</ref>
| {{#ev:youtube|z33P1xBpBt0|300}} <ref>BJSM Videos. Knee Exam (7 of 27): Range of Motion Part 1. Available from: http://www.youtube.com/watch?v=z33P1xBpBt0 [last accessed 25/01/14]</ref>
|-
| {{#ev:youtube|9c4ePN7hOdE|300}}<ref> BJSM Videos. Knee Exam (8 of 27): Range of Motion Part 2. Available from: http://www.youtube.com/watch?v=9c4ePN7hOdE[last accessed 25/01/14]|}</ref>
| {{#ev:youtube|ONA_y0znCoU|300}}<ref> BJSM Videos. Knee Exam (9 of 27): Inspection &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; palpation: supine. Available from: http://www.youtube.com/watch?v=ONA_y0znCoU [last accessed 25/01/14]|}</ref>
|}


=== Movement Testing  ===
*[[Noble's test|Noble’s compression]]
*[[Ober's Test|Ober’s Test]]


*AROM, PROM, and Overpressure
'''Osteochondritis Dissecans'''
*Muscle Strength<br>
*Clear hip and ankle with full AROM + overpressure
*If lumbar spine suspected add passive intevertebral mobilisations (PA spinous processes, PA transverse proceses).


=== Special Tests  ===
*[[Wilson's Test|Wilson’s Test]]


{| cellspacing="1" cellpadding="1" width="100%"
{| cellspacing="1" cellpadding="1" width="100%"
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| {{#ev:youtube|ViMiwp5w-yE|300}} <ref>BJSM Videos. Knee Exam (11 of 27): Effusion (subtle). Available from: http://www.youtube.com/watch?v=ViMiwp5w-yE [last accessed 25/01/14]</ref>
| {{#ev:youtube|ViMiwp5w-yE|300}} <ref>BJSM Videos. Knee Exam (11 of 27): Effusion (subtle). Available from: http://www.youtube.com/watch?v=ViMiwp5w-yE [last accessed 25/01/14]</ref>
|-
|-
| {{#ev:youtube|dH_jnTy1rNk|300}}<ref> BJSM Videos. Knee Exam (12 of 27): Lachman test. Available from: http://www.youtube.com/watch?v=dH_jnTy1rNk [last accessed 25/01/14]|}</ref>  
| {{#ev:youtube|dH_jnTy1rNk|300}}<ref>BJSM Videos. Knee Exam (12 of 27): Lachman test. Available from: http://www.youtube.com/watch?v=dH_jnTy1rNk [last accessed 25/01/14]|}</ref>  
| {{#ev:youtube|rP_1cZgMEq0|300}}<ref> BJSM Videos. Knee Exam (13 of 27): Posterior drawer. Available from: http://www.youtube.com/watch?v=rP_1cZgMEq0 [last accessed 25/01/14]|}</ref>
| {{#ev:youtube|rP_1cZgMEq0|300}}<ref>BJSM Videos. Knee Exam (13 of 27): Posterior drawer. Available from: http://www.youtube.com/watch?v=rP_1cZgMEq0 [last accessed 25/01/14]|}</ref>
|-
|-
| {{#ev:youtube|NMi2RsAohSw|300}} <ref>BJSM Videos. Knee Exam (14 of 27): MCL. Available from: http://www.youtube.com/watch?v=NMi2RsAohSw [last accessed 25/01/14]</ref>  
| {{#ev:youtube|NMi2RsAohSw|300}} <ref>BJSM Videos. Knee Exam (14 of 27): MCL. Available from: http://www.youtube.com/watch?v=NMi2RsAohSw [last accessed 25/01/14]</ref>  
| {{#ev:youtube|GDheZioSCs4|300}} <ref>BJSM Videos. Knee Exam (15 of 27): LCL. Available from: http://www.youtube.com/watch?v=GDheZioSCs4 [last accessed 25/01/14]</ref>
| {{#ev:youtube|GDheZioSCs4|300}} <ref>BJSM Videos. Knee Exam (15 of 27): LCL. Available from: http://www.youtube.com/watch?v=GDheZioSCs4 [last accessed 25/01/14]</ref>
|-
|-
| {{#ev:youtube|bnXaTdvZZ6o|300}}<ref> BJSM Videos. Knee Exam (16 of 27): Posterolateral corner. Available from: http://www.youtube.com/watch?v=bnXaTdvZZ6o [last accessed 25/01/14]|}</ref>  
| {{#ev:youtube|bnXaTdvZZ6o|300}}<ref>BJSM Videos. Knee Exam (16 of 27): Posterolateral corner. Available from: http://www.youtube.com/watch?v=bnXaTdvZZ6o [last accessed 25/01/14]|}</ref>  
| {{#ev:youtube|52reQsXQAZk|300}}<ref> BJSM Videos. Knee Exam (17 of 27): Meniscal assessment: palpation &amp;amp;amp;amp;amp;amp;amp;amp;amp; bounce home test. Available from: http://www.youtube.com/watch?v=52reQsXQAZk [last accessed 25/01/14]|}</ref>
| {{#ev:youtube|52reQsXQAZk|300}}<ref>BJSM Videos. Knee Exam (17 of 27): Meniscal assessment: palpation &amp; bounce home test. Available from: http://www.youtube.com/watch?v=52reQsXQAZk [last accessed 25/01/14]|}</ref>
|-
|-
| {{#ev:youtube|fkt1TOn1UfI|300}} <ref>BJSM Videos. Knee Exam (18 of 27): McMurray's test. Available from: http://www.youtube.com/watch?v=fkt1TOn1UfI [last accessed 25/01/14]</ref>  
| {{#ev:youtube|fkt1TOn1UfI|300}} <ref>BJSM Videos. Knee Exam (18 of 27): McMurray's test. Available from: http://www.youtube.com/watch?v=fkt1TOn1UfI [last accessed 25/01/14]</ref>  
| {{#ev:youtube|GDheZioSCs4|300}} <ref>BJSM Videos. Knee Exam (19 of 27): Apley's test. Available from: http://www.youtube.com/watch?v=GDheZioSCs4 [last accessed 25/01/14]</ref>
| {{#ev:youtube|w57I1cYXlCA|300}} <ref>BJSM Videos. Knee Exam (19 of 27): Apley's test. Available from: http://www.youtube.com/watch?v=GDheZioSCs4 [last accessed 25/01/14]</ref>
|-
|-
| {{#ev:youtube|BDJXSYlMK4k|300}}<ref> BJSM Videos. Knee Exam (20 of 27): Acute patellofemoral joint injuries. Available from: http://www.youtube.com/watch?v=BDJXSYlMK4k [last accessed 25/01/14]|}</ref>  
| {{#ev:youtube|BDJXSYlMK4k|300}}<ref>BJSM Videos. Knee Exam (20 of 27): Acute patellofemoral joint injuries. Available from: http://www.youtube.com/watch?v=BDJXSYlMK4k [last accessed 25/01/14]|}</ref>  
| {{#ev:youtube|FGs1WlmUdWg|300}}<ref> BJSM Videos. Knee Exam (21 of 27): Standing McMurray's test. Available from: http://www.youtube.com/watch?v=FGs1WlmUdWg [last accessed 25/01/14]|}</ref>
| {{#ev:youtube|FGs1WlmUdWg|300}}<ref>BJSM Videos. Knee Exam (21 of 27): Standing McMurray's test. Available from: http://www.youtube.com/watch?v=FGs1WlmUdWg [last accessed 25/01/14]|}</ref>
|-
|-
| {{#ev:youtube|ZWEGB0ToXZo|300}} <ref>BJSM Videos. Knee Exam (22 of 27): Pivot shift. Available from: http://www.youtube.com/watch?v=ZWEGB0ToXZo [last accessed 25/01/14]</ref>  
| {{#ev:youtube|ZWEGB0ToXZo|300}} <ref>BJSM Videos. Knee Exam (22 of 27): Pivot shift. Available from: http://www.youtube.com/watch?v=ZWEGB0ToXZo [last accessed 25/01/14]</ref>  
| {{#ev:youtube|hXU-TbyNZmg|300}} <ref>BJSM Videos. Knee Exam (23 of 27): ACL assessment Part 1. Available from: http://www.youtube.com/watch?v=hXU-TbyNZmg[last accessed 25/01/14]</ref>
| {{#ev:youtube|hXU-TbyNZmg|300}} <ref>BJSM Videos. Knee Exam (23 of 27): ACL assessment Part 1. Available from: http://www.youtube.com/watch?v=hXU-TbyNZmg[last accessed 25/01/14]</ref>
|-
|-
| {{#ev:youtube|3h7wZle9FcY|300}}<ref> BJSM Videos. Knee Exam (24 of 27): ACL assessment Part 2. Available from: http://www.youtube.com/watch?v=3h7wZle9FcY [last accessed 25/01/14]|}</ref>  
| {{#ev:youtube|3h7wZle9FcY|300}}<ref>BJSM Videos. Knee Exam (24 of 27): ACL assessment Part 2. Available from: http://www.youtube.com/watch?v=3h7wZle9FcY [last accessed 25/01/14]|}</ref>  
| {{#ev:youtube|MJgfajhsnCM|300}}<ref> BJSM Videos. Knee Exam (25 of 27): ACL assessment Part 3 ("Ladies' Lachman"). Available from: http://www.youtube.com/watch?v=MJgfajhsnCM [last accessed 25/01/14]|}</ref>
| {{#ev:youtube|MJgfajhsnCM|300}}<ref>BJSM Videos. Knee Exam (25 of 27): ACL assessment Part 3 ("Ladies' Lachman"). Available from: http://www.youtube.com/watch?v=MJgfajhsnCM [last accessed 25/01/14]|}</ref>
|-
|-
| {{#ev:youtube|44-Of-664DU|300}}<ref> BJSM Videos. Knee Exam (26 of 27): ACL case examination. Available from: http://www.youtube.com/watch?v=44-Of-664DU [last accessed 25/01/14]|}</ref>  
| {{#ev:youtube|44-Of-664DU|300}}<ref>BJSM Videos. Knee Exam (26 of 27): ACL case examination. Available from: http://www.youtube.com/watch?v=44-Of-664DU [last accessed 25/01/14]|}</ref>  
| {{#ev:youtube|ysj5rIAcaA0|300}}<ref> BJSM Videos. Knee Exam (27 of 27): Pearls &amp;amp;amp;amp;amp;amp;amp;amp;amp; Pitfalls. Available from: http://www.youtube.com/watch?v=ysj5rIAcaA0 [last accessed 25/01/14]|}</ref>
| {{#ev:youtube|ysj5rIAcaA0|300}}<ref>BJSM Videos. Knee Exam (27 of 27): Pearls &amp; Pitfalls. Available from: http://www.youtube.com/watch?v=ysj5rIAcaA0 [last accessed 25/01/14]|}</ref>
|}
|}
== Assessment and Management of common knee injuries<ref>Wilson, L and Blaney, A. Physiotherapy management of common knee conditions in the primary care setting. Irish Society of Chartered Physiotherapists. [Accessed 26 jan 2015]</ref>  ==
[[Image:Assessment and managment of knee injuries.png]]


== References  ==
== References  ==
<references />  
<references />  


[[Category:Assessment]] [[Category:Articles]] [[Category:Musculoskeletal/orthopaedics|orthopaedics]] [[Category:Videos]] [[Category:Knee]] [[Category:Knee_Examination]]
[[Category:Assessment]]  
[[Category:Knee - Assessment and Examination]]  
[[Category:Knee]]  
[[Category:Musculoskeletal/Orthopaedics]]
[[Category:Sports Medicine]]
[[Category:Athlete Assessment]]

Latest revision as of 11:13, 16 November 2023

Original Editor - Rachael Lowe

Top Contributors - Admin, Naomi O'Reilly, Rachael Lowe, Laura Ritchie, Kim Jackson, Ben Kasehagen, 127.0.0.1, Tarina van der Stockt, Vidya Acharya, Rucha Gadgil, Wanda van Niekerk, Samuel Winter, Jess Bell, Evan Thomas, Michelle Lee and Kai A. Sigel

Subjective[edit | edit source]

Patient Intake[edit | edit source]

  • History of present condition (HPC) (Was there trauma or was it insidious onset? Mechanism of Injury?)

Special Questions (Region‐specific historical examination)[edit | edit source]

  • Any back or leg pain? (Is pain in a dermatomal region - pain in the knee can be referred from the back)
  • Is there hip or ankle pain? (Knee pain can be referred from the hip or biomechanically affected by the ankle)
  • Did the patient hear a pop/click at time of injury?
  • Does the knee give way? (instability/rupture of ligaments)
  • Does the knee lock? (meniscus, true locking associated with bucket handle tears)
  • Did the knee swell? How quickly? Where is the swelling? (Intra articular/ extra articular; immediate swelling usually indicates trauma within the knee such as ligament damage)
  • Was there bruising? (Immediate bruising indicates significant trauma
  • Cough/sneeze cause pain?
  • Age – The following conditions are not exclusive to these age groups but a higher prevalence is noted in these populations (elderly – OA?, young – osgoods schlatters, middle aged- meniscal).
  • Type of shoes ( wear patterns/age of shoes/proper design)

Additional Information[edit | edit source]

  • Past Medical History (PMH) (Pre-existing medical conditions)
  • Drug history (DH) (Any relevant medications?)
  • Social History (SH) (Work/sports/hobbies affected?)

Investigations[edit | edit source]

  • Radiological Considerations  - any previous X-Rays or scans
  • Other investigations - any recent blood tests

Red Flags[edit | edit source]

These are the special questions which may indicate that something more sinister may be going on. If you suspect that the problem is not musculoskeletal and/or something sinister may be going on patients should be referred immediately back to their doctor with your concerns noted. 

  • Bilateral pins and needles or numbness in the LL.
  • Problems with bowel and bladder function where the patient is unable to feel themselves going to the toilet.
  • Incontinence.
  • Paraesthesia in the groin region.
  • Loss of pulses in the LL (Vascular compromise).
  • Obvious deformity.


If nothing sinister but the symptoms are more severe than you might expect ask a seniors advice on whether and A&E referral is more appropriate. Mechanism of Injury is important here, what force was exerted through the leg? Was it enough for a tibia/femur fracture? Loss of pulses in the foot may indicate vascular compromise.

Clinical Reasoning - What does the History tell you?[edit | edit source]

Knowing the history gives clues as to the structures affected. Mechanism of injury is extremely important. If you can work out the force of the injury this gives you clues on likely stretched/ damaged structures (Valgus force may indicate an MCL sprain, varus force may indicate an LCL sprain, foot planted and twisted may indicate an ACL sprain/rupture).

Make sure you rule out the back and hip unless there is a clear mechanism of injury as the knee can be a referred site of pain for both these areas. Immediate swelling and bruising usually indicates significant trauma and may require X-Ray to rule out tibial plateau fractures, bone bruises or an MRI to investigate the integrity of the ligaments.

Go into your objective examination with a working hypothesis. Use your physical examination to identify dysfunction and special tests to prove or disprove your hypothesis.

Objective[edit | edit source]

The objective examination gives you quantifiable measures to rule out what structures are involved and to reassess after treatment to determine improvement/deterioration.

General Observation[edit | edit source]

  • Posture
  • Movement Patterns
 [1]
 [2]
 [3]
 [4]

Functional Tests[edit | edit source]

  • Small knee bend
  • Sit to stand
  • Squat
  • Jump
  • Hop
  • Run

Inspection & Palpation[edit | edit source]

Inspection

  • Effusion
  • Poor Alignment
  • Muscle Wasting

Palpation 

  • MCL
  • LCL
  • Joint Line
  • Patella
  • Retinaculae
  • Patellar Tendon
  • Hamstrings Tendons
  • Popliteus.


[5]

Neurologic Assessment[edit | edit source]

If neurological deficits or referral from lumbar spine are suspected you should perform a neurological assessment:

Reflexes

  • Patella Ligament (L3/L4)
  • Achilles Tendon (S1/S2)

Dermatomes

  • L1 to S4

Myotomes

  • L2      Hip Flexion
  • L3      Knee Extension
  • L4      Dorsiflexion
  • L5      Big Toe Extension OR 4 Lesser Toes Extension
  • L5/S1 Knee Flexion
  • S1      Plantarflexion OR Foot Eversion
  • S2      Toe Flexion

[6]

Other neurological testing includes: Babinski and Clonus

Movement Testing[edit | edit source]

  • AROM, PROM, and Overpressure
  • Muscle Strength and length
  • Clear hip and ankle with full AROM + overpressure
  • If lumbar spine suspected add passive intevertebral mobilisations (PA spinous processes, PA transverse processes).
[7]
[8]
[9]

Special Tests[edit | edit source]

Special tests are used to prove or disprove your working hypothesis and identify the dysfunctional structures.  See full list of knee special tests


ACL

PCL

MCL/LCL

  • Valgus stress test

LCL

Meniscus

Patellofemoral

ITB

Osteochondritis Dissecans

[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]

Assessment and Management of common knee injuries[28][edit | edit source]

Assessment and managment of knee injuries.png

References[edit | edit source]

  1. ↑ BJSM Videos. Knee Exam (1 of 27): Introduction. Available from: http://www.youtube.com/watch?v=MpWVqi6C9RY [last accessed 25/01/14]
  2. ↑ BJSM Videos. Knee Exam (2 of 27): Inspection: standing. Available from: http://www.youtube.com/watch?v=MpWVqi6C9RY [last accessed 25/01/14]
  3. ↑ BJSM Videos. Knee Exam (3 of 27): Walking. Available from: http://www.youtube.com/watch?v=8FToHsom980 [last accessed 25/01/14]
  4. ↑ BJSM Videos. Knee Exam (4 of 27): Balance. Available from: http://www.youtube.com/watch?v=PO7e-h8h2FU [last accessed 25/01/14]|}
  5. ↑ BJSM Videos. Knee Exam (9 of 27): Inspection & palpation: supine. Available from: http://www.youtube.com/watch?v=ONA_y0znCoU [last accessed 25/01/14]|}
  6. ↑ BJSM Videos. Knee Exam (5 of 27): Neurovascular evaluation: supine. Available from: http://www.youtube.com/watch?v=xeW7dwcBZCI [last accessed 25/01/14]|}
  7. ↑ BJSM Videos. Knee Exam (6 of 27): Hip examination: supine. Available from: http://www.youtube.com/watch?v=wFB9WxfPFWI [last accessed 25/01/14]
  8. ↑ BJSM Videos. Knee Exam (7 of 27): Range of Motion Part 1. Available from: http://www.youtube.com/watch?v=z33P1xBpBt0 [last accessed 25/01/14]
  9. ↑ BJSM Videos. Knee Exam (8 of 27): Range of Motion Part 2. Available from: http://www.youtube.com/watch?v=9c4ePN7hOdE[last accessed 25/01/14]|}
  10. ↑ BJSM Videos. Knee Exam (10 of 27): Effusion. Available from: http://www.youtube.com/watch?v=5DxTb2_r8lk [last accessed 25/01/14]
  11. ↑ BJSM Videos. Knee Exam (11 of 27): Effusion (subtle). Available from: http://www.youtube.com/watch?v=ViMiwp5w-yE [last accessed 25/01/14]
  12. ↑ BJSM Videos. Knee Exam (12 of 27): Lachman test. Available from: http://www.youtube.com/watch?v=dH_jnTy1rNk [last accessed 25/01/14]|}
  13. ↑ BJSM Videos. Knee Exam (13 of 27): Posterior drawer. Available from: http://www.youtube.com/watch?v=rP_1cZgMEq0 [last accessed 25/01/14]|}
  14. ↑ BJSM Videos. Knee Exam (14 of 27): MCL. Available from: http://www.youtube.com/watch?v=NMi2RsAohSw [last accessed 25/01/14]
  15. ↑ BJSM Videos. Knee Exam (15 of 27): LCL. Available from: http://www.youtube.com/watch?v=GDheZioSCs4 [last accessed 25/01/14]
  16. ↑ BJSM Videos. Knee Exam (16 of 27): Posterolateral corner. Available from: http://www.youtube.com/watch?v=bnXaTdvZZ6o [last accessed 25/01/14]|}
  17. ↑ BJSM Videos. Knee Exam (17 of 27): Meniscal assessment: palpation & bounce home test. Available from: http://www.youtube.com/watch?v=52reQsXQAZk [last accessed 25/01/14]|}
  18. ↑ BJSM Videos. Knee Exam (18 of 27): McMurray's test. Available from: http://www.youtube.com/watch?v=fkt1TOn1UfI [last accessed 25/01/14]
  19. ↑ BJSM Videos. Knee Exam (19 of 27): Apley's test. Available from: http://www.youtube.com/watch?v=GDheZioSCs4 [last accessed 25/01/14]
  20. ↑ BJSM Videos. Knee Exam (20 of 27): Acute patellofemoral joint injuries. Available from: http://www.youtube.com/watch?v=BDJXSYlMK4k [last accessed 25/01/14]|}
  21. ↑ BJSM Videos. Knee Exam (21 of 27): Standing McMurray's test. Available from: http://www.youtube.com/watch?v=FGs1WlmUdWg [last accessed 25/01/14]|}
  22. ↑ BJSM Videos. Knee Exam (22 of 27): Pivot shift. Available from: http://www.youtube.com/watch?v=ZWEGB0ToXZo [last accessed 25/01/14]
  23. ↑ BJSM Videos. Knee Exam (23 of 27): ACL assessment Part 1. Available from: http://www.youtube.com/watch?v=hXU-TbyNZmg[last accessed 25/01/14]
  24. ↑ BJSM Videos. Knee Exam (24 of 27): ACL assessment Part 2. Available from: http://www.youtube.com/watch?v=3h7wZle9FcY [last accessed 25/01/14]|}
  25. ↑ BJSM Videos. Knee Exam (25 of 27): ACL assessment Part 3 ("Ladies' Lachman"). Available from: http://www.youtube.com/watch?v=MJgfajhsnCM [last accessed 25/01/14]|}
  26. ↑ BJSM Videos. Knee Exam (26 of 27): ACL case examination. Available from: http://www.youtube.com/watch?v=44-Of-664DU [last accessed 25/01/14]|}
  27. ↑ BJSM Videos. Knee Exam (27 of 27): Pearls & Pitfalls. Available from: http://www.youtube.com/watch?v=ysj5rIAcaA0 [last accessed 25/01/14]|}
  28. ↑ Wilson, L and Blaney, A. Physiotherapy management of common knee conditions in the primary care setting. Irish Society of Chartered Physiotherapists. [Accessed 26 jan 2015]
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