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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 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)  
*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?  
*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)  
*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?  
*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. 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;  


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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>
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>


== Clinical reasoning - what does the history tell you?  ==
== 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).  
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 integrity of the ligaments.  
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. &nbsp;Use your physical examination to identify dysfunction and special tests to prove or disprove your hypothesis.  
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>  
 
<br>  
 
== Assessment and Management of common knee injuries<ref>Wilson, L and Blaney, A. Physiotherapy management of common knee conditions in the primary care setting. Online at [https://www.iscp.ie/component/docman/doc_view/739-knee-complaints.html https://www.iscp.ie/component/docman/doc_view/739-knee-complaints.html] [Accessed 26 jan 2015]</ref>  ==
 
[[Image:Assessment and managment of knee injuries.png]]


== Objective  ==
== Objective  ==
The objective examination gives you quantifiable measures to rule out what structures are involved and to reassess after treatment to determine improvement/deterioration.  
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  ===
=== General Observation  ===
*Posture  
*Posture  
*Movement Patterns
*Movement Patterns
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{| cellspacing="1" cellpadding="1" width="100%"
{| cellspacing="1" cellpadding="1" width="100%"
|-
|-
| {{#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|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|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|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|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|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>
|}
|}


=== Functional Tests<br>  ===
=== Functional Tests   ===
 
*Small knee bend  
*Small knee bend  
*Sit to stand  
*Sit to stand  
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=== Inspection &amp; Palpation  ===
=== Inspection &amp; Palpation  ===


*Inspection - effusion, poor alignment, muscle wasting
'''Inspection'''
*Palpation - MCL, LCL, joint line, patella, retinaculae, patellar tendon, hamstrings tendons, popliteus.
 
*Effusion
*Poor Alignment
*Muscle Wasting<br>
 
'''Palpation'''&nbsp;


{{#ev:youtube|ONA_y0znCoU|300}}<ref> BJSM Videos. Knee Exam (9 of 27): Inspection &amp;amp;amp; palpation: supine. Available from: http://www.youtube.com/watch?v=ONA_y0znCoU [last accessed 25/01/14]|}</ref>
*MCL
*LCL
*Joint Line
*Patella
*Retinaculae
*Patellar Tendon
*Hamstrings Tendons
*Popliteus.


=== Neurologic Assessment <br> ===
<br>  


If neurological defecits or referral from lumbar spine are suspected you should perform a neurological assessment:  
{{#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>


#Reflexes -&nbsp;Patella ligament (L3/L4) AND&nbsp;Achilles tendon (S1/S2)
=== Neurologic Assessment    ===
#Dermatomes - L1 to S4
If neurological deficits or referral from lumbar spine are suspected you should perform a neurological assessment:
#Myotomes


*L2 - hip flexion
'''Reflexes'''
*L3 - knee extension
*Patella Ligament (L3/L4)
*L4 - dorsiflexion
*Achilles Tendon (S1/S2)
*L5 - big toe extension OR 4 lesser toes extension
*L5/S1 - knee flexion
*S1 - plantaflexion OR foot eversion
*S2 - toe flexion


{{#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>
'''Dermatomes'''
*L1 to S4


Other neurological testing includes: Babinski and Clonus
'''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
 
{{#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>
 
Other neurological testing includes: Babinski and Clonus  


=== Movement Testing  ===
=== Movement Testing  ===
*AROM, PROM, and Overpressure  
*AROM, PROM, and Overpressure  
*Muscle Strength and length<br>  
*Muscle Strength and length<br>  
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| {{#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|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|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  ===
 
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]]  
Special tests are used to prove or disprove your working hypothesis and identify the dysfunctional structures. &nbsp;[[:Category:Knee Examination|See full list of knee special tests]]  


<br>  
<br>  
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'''ACL'''  
'''ACL'''  


*[[Lachman Test|Lachmans Test]]  
*[[Lachman Test|Lachman's Test]]  
*[[Anterior drawer test of the knee|Anterior drawer]]  
*[[Anterior Drawer Test of the Knee|Anterior drawer]]  
*[[Pivot Shift|Pivot-Shift]]  
*[[Pivot Shift|Pivot-Shift]]  
*[[Slocum's Test]]
*[[Slocum's Test]]
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*[[Wilson's Test|Wilson’s Test]]
*[[Wilson's Test|Wilson’s Test]]
<br>
<br>


{| 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;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;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:Knee_Examination]] [[Category:Assessment]] [[Category:Articles]] [[Category:Musculoskeletal/orthopaedics|orthopaedics]] [[Category:Videos]] [[Category:Knee]]
[[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, Kim Jackson, Rachael Lowe, Laura Ritchie, Ben Kasehagen, 127.0.0.1, Tarina van der Stockt, Kai A. Sigel, Vidya Acharya, Rucha Gadgil, Wanda van Niekerk, Samuel Winter, Jess Bell, Evan Thomas and Michelle Lee

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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