Knee joint Examination, Diagnosis

Chief complains in knee joint examination

H/o presenting illness:

In knee joint examination elaborate on his chief complaints.

ADL:

ability to walk , run , sit cross leg, use bicycle etc.     

Examination of Knee joint:

Negative H/O:

 Pain in toe (gout), night cries (TB),/ trauma, /fever,/ bleeding diathesis./ ho of exposure( gonorrhea, reiter’s ), diarrhea(reactive, IBS,) 

Local Examination:

Gait: look for antalgic, knock knee, cross leg.
Pearls –what determines deformity‐ In paralytic conditions‐the overpowering muscles determines  the deformity,  
In non paralytic conditions‐Innate tendency of postural fixity  in possible position of walking that  determines the deformity. 

Inspection:

Anteriorly: 

ASIS –  is it at same level, Is there a varus valgus angulation at knee (Comment on varus / valgus – Outward or Inward deviation of knee  joint.

Laterally: 

look for Prominence of head of fibula, normal contours – any scars / sinuses, cyst of lat meniscus. 

Palpation:                

 Temperature:   local rise in temperature.                       

 Tenderness:     superficial and deep ,(superficial tenderness seen in cellulitis deep tenderness is seen in osteomyelitis, tumor, impingements, bursitis)

Mild effusion:      should be looked in standing position –because  the effusion settles in knee , milk suprapatellar pouch and do patellar tap. 

Moderate effusion: Cross fluctuation test and Patellar tap. 

Severe effusion: Patellar tap – not possible because massive tense effusion, ( also in FFD of knee joint and dislocation  of patella we cannot elicit patellar tap) 

Movements:

Look for active and passive, is it associated with pain, locking , Crepitus, and contracture, FFD.   

Biceps:
Movements Degree Muscles Nerve Flexion  0-120 Biceps, ST,SM L45S123 Extension 0 quadriceps L234. 

Quadriceps:
Look for quadriceps lag-(normally no lag , in quadriceps weakness , and patellectomies there is a lag of about 15 to 30 degrees) 

Measurements:

Circumferential –thigh and calf circumference.

Deformity Assessment:
  •  Q angle  120 – 150, look for Varus angle, Valgus angle 
  •  Intermalleolar distance <5cm –  important in genu valgus deformity. 
  •  Inter condylar distance ;-  1 cm or  1 finger should pass between the   condyles.  (for genu varus deformity) 
  •  Tibia torsion and  femoral anti version( checked by rotational profile of staheli i.e.  thigh foot angle/medial and lateral hip rotation in   extension/transmalleolar axis )             
  •  Valgus / varus disappears on flexion? (if varus or valgus disappears on   flexion the deformity is  in the femur and if it persists its in tibia.) 

Diagnosis for knee joint examination:

Anatomical:

What is involved bone, joint  or internal structures in the knee  joint  

Pathological:

It can be synovitis, arthritis, or menisci or ligament instabilities . 

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