A standardized approach basic approach to the knee. Objectives develop a standardized, evidencebased history and physical examination of patients with knee injuries. Patients with knee pain often present for initial evaluation to their primary care physician. Pdf physical examination of the spine and extremities.
Many physical examination pe maneuvers exist to assess knee function, none of which are specific to knee osteoarthritis koa. Thorough examination of all of the knee structures, including the ligaments and menisci, should be included in every knee evaluation. With its unique combination of classic netter artwork, exam photos and videos, and rigorous. Answer if possible, wear shorts to your appointment, so your doctor can easily examine your knee.
Pdf the clinical evaluation of the knee is a fundamental tool to correctly address diagnosis and treatment, and should never be replaced by the. Anatomy introduction knee joint is the largest synovial joint in the body. During the past 4 weeks, or since the date of your injury, how often have you had pain. Knee complaints are common and the knee exam is the most important way to address these complaints by finding the cause of knee pain and figuring out what treatment is needed. Sep 01, 2003 accurate diagnosis requires a knowledge of knee anatomy, common pain patterns in knee injuries, and features of frequently encountered causes of knee pain, as well as specific physical examination. Look also for muscle atrophy of the quadriceps, hamstrings and gastrocnemius. An effective and efficient evaluation of the patient with kneerelated complaints depends upon an understanding of the knees anatomy and function, and the proper performance of an appropriately focused physical examination. How to perform a full knee assessment in 10 minutes. 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. Incoordination do any of the above factors additionally limit joint function. Furthermore, a general understanding of the mechanisms of common injuries refer to the article on mechanisms of injuries in this issue will facilitate the clinicians interpretation of examination results. On examination, he has a knee effusion and tenderness laterally. This allows for comparison and relaxes the patient as you are not performing maneuvers that cause discomfort from the outset.
Knee pain and other kneerelated complaints are a common reason for visits to primary care clinics and emergency departments. A detailed physical and radiographic examination with a thorough understanding of knee anatomy is crucial to assess all damaged structures. Knee exercises range of motion exercise 3 knee bending exercises 3 knee straightening exercises 5 strengthening exercises 6 aerobic exercise 10 additional resources 10 pain and swelling in your knee can often lead to loss of strength and motion. Physical examination of the knee musculoskeletal key. This installment will help the learner take information. This portion of the visit builds on the history gathered earlier. Discusses what will be done during a physical exam. Inspection standing, feet straight forward facing toward examiner swelling deformity flatfoot pes planus and hindfoot valgus high arch pes cavus and hindfoot varus peekaboo heel varus too many toes valgus hallux valgusvarus. Knee examination musculoskeletal osce skills medistudents. With the patient lying supine on the table, the examiner uses one hand to hold the patients heel or ankle and the other hand to grasp the proximal portion of the lower leg figure 3.
Strenuous activities like heavy physical work, skiing or tennis moderate activities like moderate physical work, running or jogging light activities like walking, housework or yard work unable to perform any of the above activities due to knee pain 2. However, these diagnostic tools have low sensitivity and specificity. Describes how to interview the patient and take the health history. There are no biomarkers for oa that can be used in clinical practice at this time.
Knowing what is normal is key to being able to identify and assess what is not. Osteoarthritis is currently diagnosed by physical examination and, where necessary, with xray, mri scan and arthroscopy. Youll be expected to pick up the relevant clinical signs using your examination skills. This knee conditioning program should be continued for 4 to 6 weeks, unless otherwise specified by your doctor or physical therapist. An overarching element of the physical examination of the knee is observation. Examination of the knee joint introduction introduce yourself wash hands briefly explain to the patient what the examination involves ask the patient remove their bottom clothing, exposing the knee inspection whilst patient standing patient gait assess for asymmetry deformity muscle bulk.
Accurate diagnosis requires a knowledge of knee anatomy, common pain patterns in knee injuries, and features of frequently encountered causes of knee pain, as well as specific physical examination. Examination of the patient with knee osteoarthritis. Many physical examination pe maneuvers exist to assess knee function, none of which are specific. The knee examination, along with all other joint examinations, is commonly tested on in osces. Covers what your doctor might ask if you have knee pain. Examination of the patient with knee osteoarthritis medbridge. This knee examination osce guide provides a clear step by step approach to examining the knee, with an included video demonstration. Palpation and examination for degenerative joint disease. This video aims to give you an idea of whats required in the osce and you can then. What is the highest level of activity that you can perform without significant knee pain. The process begins with observing the patient beginning with their. History, physical examination, radiographs, and laboratory tests wa lter l. Checklist for physical examination of the knee muscuoskeletalblock chris mcgrew md, andrew ashbaughdo this handout is for use as a rough guide and study aid. Briefly explain to the patient what the examination involves.
Determining diagnostic accuracy of lachman, pivot shift and anterior drawer tests versus gold standard diagnosis magnetic resonance imaging or arthroscopy for anterior cruciate ligament acl insufficiency cases. If the itband is tight, the patient will have difficulty adducting the leg beyond the midline and may experience pain at the lateral knee. Knee norm exam pain flexion extension 5 internal rotation 10 external rotation 10 orthneuro tests test left right patfemoral grind effusion apprehension tinels anterior drawer ant drawer wrot posterior drawer post drawer wrot helfets mcintoshs lachmans hyperflexion mcmurrays steinmans apleys circumference knee left right inches. Reminds students of common, normal, and abnormal physical.
Netters orthopaedic clinical examination pdf download. This course series will help the learner make accurate judgments on the patient with knee oa, like tolerance for examination and treatment, while identifying key impairments to strength, range of motion, flexibility, gait, and balance that can be addressed with manual therapy and exercise. The physical examination should include careful inspection of the knee, palpation for point tenderness, assessment of joint. Performing the exercises two to three days a week will maintain. Discuss a systematic method for the physical evaluation of the knee. With its unique combination of classic netter artwork, exam photos and videos, and. Physical examination findings and their relationship with performancebased function in adults with knee osteoarthritis maura d. Physical examination of the knee z11 most physical exam tests should most physical exam tests should be referenced back to the original description z22 sensitivity sensitivity z33 specificity specificity z4 4 likelihood ratioslikelihood ratios z5 5 ppvppv z6 6 npvnpv functional testing algorithm knee 2016 zsport specific testing. Diagnostic accuracy of physical examination for anterior. The examination must be comprehensive and also focus on specific assessments that are appropriate for the childs or adolescents age, developmental phase, and needs. Evaluation of every patient should begin with a complete history of. Careful examination of the knee can provide valuable information and help the physician determine when imaging studies may or may not be helpful.
The history and physical examination still remain the first step for making an accurate diagnosis of anterior knee pain and patellar instability above any technique of diagnostic image. Your instructor may perform certain maneuvers differently than depicted here. Seated knee extension to strengthen your thigh muscles quadriceps the exercise. Examination of the knee joint introduction introduce yourself wash hands briefly explain to the patient what the examination involves ask the patient remove their bottom clothing, exposing the knee inspection whilst patient standing patient gait assess for asymmetry. The patient lies with the unaffected side down and the unaffected hip and knee at a 90degree angle. How to perform a comprehensive examination of the knee citeseerx. A thorough knowledge of knee anatomy, biomechanics, and arthrokinematics is necessary for meaningful examination of the knee. Knee orthopedic tests university of western states. Very strenuous activities like jumping or pivoting as in basketball or soccer strenuous activities like heavy physical work, skiing or tennis moderate activities like moderate physical work, running or jogging.
The view from the side detects any recurvatum or lack of complete extension. Physical examination a complete physical examination is included as part of every bright futures visit. The pocket guide to physical examination and history taking, 7th edition is a concise, portable text that. Physical examination tests for hip dysfunction and injury. The lachman test is known as the test with highest validity on physical examination.
Physical examination findings and their relationship with. Knee pain is more common in active people such as athletes. Aug 27, 2016 chapter 3 clinical examination of the knee michael p. May 16, 2019 what happens in a physical exam for knee pain. An effective and efficient evaluation of the patient with knee related complaints depends upon an understanding of the knee s anatomy and function, and the proper performance of an appropriately focused physical examination. Physical examination of the cervical spine and temporomandibular joint. Immediate swelling and bruising usually indicates significant trauma and may require xray to rule out tibial plateau fractures, bone bruises or an mri to investigate the integrity of the ligaments. I think that their analysis also supports the alternative explanation that imaging studies, specifically. Covers tests that may be ordered, including the lachman test, the posterior drawer test, and the valgus and varus tests.
Searching medline, embase and pubmed identified studies on diagnostic. If you are interested in attending certified cpd courses in physical therapy at the iconic venue of. Dec 06, 2012 how to perform a full knee assessment in 10 minutes. Ask the patient remove their bottom clothing, exposing the knee. Knee pain and other knee related complaints are a common reason for visits to primary care clinics and emergency departments. The osteoarthritis research society international also recommends the use of six functional performance measures to assess function in adults with koa.
In their rational clinical examination article, dr solomon and colleagues1 concluded that the physical examination of the knee would obviate the need for many imaging studies. Basic approach knee examination cme at osu the ohio state. If so, express the additional limitation in degrees. In all cases, the clinical evaluation should be introduced by a careful interview of the patient, in order to address the subsequent exam to the. On physical examination, assessment of joint line tenderness at the lateral and medial joint lines was performed with the patients knee flexed 90 degrees. The examiner must rely on numerous physical exam maneuvers to evaluate these structures. Up to one third of musculoskeletal problems seen in primary care are related to knee pain which can be acute or chronic. Clinical examination of the knee musculoskeletal key. Regardless of whether the assessment involves an acute traumatic. Chief complains pain swelling stiffness mechanical disorders locking, giving way, click limp deformity 3.
Discussion a detailed description of the various different tests is given, with photographs for each test procedure. To standardize how physical examinations are performed and compared, they should follow the original description or agreedon standards. He has a 1a lachman and a normal posterior drawer test. Physical examination of knee injuries jama jama network. The ability to carry out a structured knee examination is something every medical student needs to master. Norman scott history despite improvements in advanced imaging techniques, clinical examination of the knee remains an essential step in evaluating the knee patient. Physical examination requires a basic knowledge of anatomy and physiology to be able to make sense out of what the cow is telling you. In addition, the significance of a physical examination finding must be understood to ensure that patients with knee complaints are accurately diagnosed and properly treated. Twentysix 25% patients sustained injuries while in the turkish army, and 78 patients 75% sustained injuries before they came to the army. Chapter 3 clinical examination of the knee michael p. Pdf physical examination of the patellofemoral joint. Dr dhananjaya sabat ms, dnb, mnams assistant professor department of orthopedics maulana azad medical college, new delhi, india 2.
Physical examination of knee ligament injuries request pdf. After your recovery, these exercises can be continued as a maintenance program for lifelong protection and health of your knees. Knee pain history taking and physical examination see online here knee pain is a common encounter in the general practitioners o. May 26, 2018 the knee examination, along with all other joint examinations, is commonly tested on in osces. The examination of all joints follows the general pattern of look, feel, move and occasionally some special tests. Examination of theof the knee foundation for orthopaedic. If the knee is injured, start by examining the unaffected side.
Bates pocket guide to physical examination and history taking. Nov 28, 2012 this video produced by students at oxford university medical school in conjunction with the faculty demonstrates how to perform an orthopaedic examination of the knee joint. Straighten knee as far as you can, then slowly bend knee as far as it will go. The history should include characteristics of the patients pain. An evidencebased approach 3rd edition pdf author joshua cleland pt dpt phd isbn 0323340636 file size 243.