EXAMINATION OF THE KNEE

AND ASPIRATION TECHNIQUE

C SNYCKERS

INTRODUCTION

• The largest joint in the body • subject to a great variety of traumatic and

degenerative conditions• Outwardly simple but is actually quite

complex• Not just a hinge joint.

INTRODUCTION

• The tibia femoral joint is inherently unstable• Relies heavily on ligaments for stability• Patella is the largest sesamoid bone in the

body – acts as a fulcrum increasing mechanical advantage of quads.

INSPECTIONSurface anatomy

• Anterior: – Patella

• Fracture• Bipartite

– Infra-patellar tendon and Hoffa’s fat pad• Rupture• Tendonitis

– Tibial tubercle• Osgood – Schlatter• avulsions

INSPECTIONSurface anatomy

– Femoral condyles– Pre-patellar bursa• Bursitis

– Extensor mechanism• Rectus femoris• Vastus intermedius• Vastus medialis (VMO)• Vastus lateralis

INSPECTION:Surface anatomy

• Medial:– Pes anserinus• “Say Grace before Tea”

– MCL

• Lateral:– ITB (Gerdy’s Tuburcle)– LCL

INSPECTION:Surface anatomy

• Posterior:– Popliteal fossa• Baker’s Cyst• Popliteal aneurism

INSPECTION:Limb alignment

• INSPECTION:– Genu Valgum• Intra-maleolar distance

– Genu Varum• Intra-condylar distance

– Windswept deformity

INSPECTION:Patella alignment

• Squinting patellae– Increased femoral ante-version– Increased external tibial torsion

• Q angle– Anterior ASIS to center of patella– Center of patella to tibial tubercle– 14° in men, 17° in women

• Patella Alta• Patella baja

INSPECTION:GAIT

• Varus thrust• Valgus thrust• Recur vatum thrust• Antalgic gait• Stiff knee gait• Flexed knee gait

INSPECTION:Range of movement

• Extension: Normal range– Active : 0° – Passive: - 10° (prone hanging test)

• Flexion: Normal range– Active: 0° - 130°– Passive: 0° - 150°

PALPATION:

• Be systematic• Start and end at same spot• Helpful system is to start anteriorly

PALPATION:

• Patella• Infra-patella tendon• Tibial tubercle• Pes anserinus• MCL• Medial joint space and meniscus• Medial femoral condyle • VMO

PALPATION:

• Rectus femoris• Vastus intermedius• Vastus lateralis• Lateral femoral condyle• LCL• Lateral joint space and meniscus• ITB and Gerdy’s tubercle

PALPATION:

• REMEMBER TO CHECK POSTERIOR!!!• Popliteal fossa• Popliteal pulse

MANIPULATION:

• Muscle testing – Oxford grading (out of 5)• 5 – normal power• 4 – weak power• 3 – against gravity• 2 – with gravity• 1 - Flicker

MANIPULATION:

• Use:– “Flex or extend”– “Hold it there”– “Keep it there”

• Test:– Quads– Hamstrings

• Check for atrophy– Measuring tape (compare)

SPECIAL TESTS:

• PATELLA TAP:– Effusion

• FLUID THRILL:– Effusion

• PATELLA GRIND– OA

SPECIAL TESTS:

• VALGUS STRESS TEST:– MCL (30° flexion)– MCL, ACL and capsule (extension)

• VARUS STRESS TEST:– LCL (30° flexion)– LCL, ACL and capsule (extension)

• GRADE LAXITY:– Gr I– Gr II– Gr III

SPECIAL TESTS:

• LACHMAN TEST:– ACL– PCL

• GODFREY’S TEST: (drop off sign)– PCL

SPECIAL TESTS:

• DRAWER TEST:– POSTERIOR: PCL– ANTERIOR: ACL

SPECIAL TESTS:

• VARUS RECUVARTUM TEST:– Posterior lateral corner

• SQUAT TEST:– Meniscus

• APLEY’S GRINDING AND DISTRACTION TEST:– Menisci

SPECIAL TESTS:

• MC MURRAY’S TEST:– Medial meniscus– Lateral meniscus

KNEE ASPIRATION:

• Sterile technique NB!!!!!• Two fingers above and two fingers medial or

lateral to superior pole of the patella• Aim needle towards the tip of the patella

below patella