MSK Knee

Question 1

INTRODUCTION

Answer 1

• Clean your hands
• Give full name & status, ask patient details
• Check wrist bands and charts
• Explain what you would like to examine and wait for verbal consent
• Ask if patient is experiencing any pain
• Ask patient to remove any necessary clothing

Question 2

LOOK

Standing first then lying on couch

Answer 2

• Symmetry and alignment
• Varus or valgus deformity
• Fixed flexion of the knee
• Rashes, wounds, scars or swelling
• Wasting of quadriceps muscles

Question 3

FEEL

Answer 3

• Feel for temperature difference, comparing mid-thigh and knee of both legs
• Feel for tenderness along border of patella, extensor mechanism, and medial and lateral joint lines
• Feel behind the knee for popliteal cysts (Bakers cyst)
• Feel for knee effusion by performing patellar tap
• If no patella tap present, then assess for small effusion using bulge test

Question 4

MOVE

Answer 4

• Active - flexion ask patient to fully flex knee towards buttock sand then full extension of knee
• Passive flexion and extension with one hand on knee to detect crepitus - assess and compare movement of both knees
• Assess for hyperextension by lifting legs by heels, looking for extension extension

COLLATERALS
* Flex knee to 20-30 degrees and apply lateral and medial stress to the knee, and repeat extended
* Excessive movement suggests damage to ligament or wear in medial or lateral compartment in older patients

CRUCIATE LIGAMENTS
* Posterior sag (draw) test - Observe the knees when hips are flexed to 45 degrees and knees flexed to 90 degrees
* Anterior draw test - position the hips at 45 degrees and knees at 90 degrees - attempt to draw the tibia forwards

Question 5

MOVE

Answer 5

• Active - flexion ask patient to fully flex knee towards buttock sand then full extension of knee
• Passive flexion and extension with one hand on knee to detect crepitus - assess and compare movement of both knees
• Assess for hyperextension by lifting legs by heels, looking for extension extension

COLLATERALS
* Flex knee to 20-30 degrees and apply lateral and medial stress to the knee, and repeat extended
* Excessive movement suggests damage to ligament or wear in medial or lateral compartment in older patients

CRUCIATE LIGAMENTS
* Posterior sag (draw) test - Observe the knees when hips are flexed to 45 degrees and knees flexed to 90 degrees
* Anterior draw test - position the hips at 45 degrees and knees at 90 degrees - attempt to draw the tibia forwards

Question 6

FUNCTION

Answer 6

• Ask the patient to walk, Observe for a limp, valgus/varus deformity or fixed flexion gait
• Examine hip and foot

Question 7

CLOSURE

Answer 7

• Thank the patient
• Help them redress if requires and make them comfortable
• Doff PPE and dispose of safely
• Perform hand hygiene