1 / 24

EXAMINATION OF THE KNEE

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.

tadhg
Download Presentation

EXAMINATION OF THE KNEE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. EXAMINATION OF THE KNEE AND ASPIRATION TECHNIQUE C SNYCKERS

  2. 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.

  3. 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.

  4. INSPECTIONSurface anatomy • Anterior: • Patella • Fracture • Bipartite • Infra-patellar tendon and Hoffa’s fat pad • Rupture • Tendonitis • Tibial tubercle • Osgood – Schlatter • avulsions

  5. INSPECTIONSurface anatomy • Femoral condyles • Pre-patellar bursa • Bursitis • Extensor mechanism • Rectus femoris • Vastus intermedius • Vastus medialis (VMO) • Vastus lateralis

  6. INSPECTION:Surface anatomy • Medial: • Pes anserinus • “Say Grace before Tea” • MCL • Lateral: • ITB (Gerdy’s Tuburcle) • LCL

  7. INSPECTION:Surface anatomy • Posterior: • Popliteal fossa • Baker’s Cyst • Popliteal aneurism

  8. INSPECTION:Limb alignment • INSPECTION: • Genu Valgum • Intra-maleolar distance • Genu Varum • Intra-condylar distance • Windswept deformity

  9. 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

  10. INSPECTION:GAIT • Varus thrust • Valgus thrust • Recur vatum thrust • Antalgic gait • Stiff knee gait • Flexed knee gait

  11. INSPECTION:Range of movement • Extension: Normal range • Active : 0° • Passive: - 10° (prone hanging test) • Flexion: Normal range • Active: 0° - 130° • Passive: 0° - 150°

  12. PALPATION: • Be systematic • Start and end at same spot • Helpful system is to start anteriorly

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

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

  15. PALPATION: • REMEMBER TO CHECK POSTERIOR!!! • Popliteal fossa • Popliteal pulse

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

  17. MANIPULATION: • Use: • “Flex or extend” • “Hold it there” • “Keep it there” • Test: • Quads • Hamstrings • Check for atrophy • Measuring tape (compare)

  18. SPECIAL TESTS: • PATELLA TAP: • Effusion • FLUID THRILL: • Effusion • PATELLA GRIND • OA

  19. 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

  20. SPECIAL TESTS: • LACHMAN TEST: • ACL • PCL • GODFREY’S TEST: (drop off sign) • PCL

  21. SPECIAL TESTS: • DRAWER TEST: • POSTERIOR: PCL • ANTERIOR: ACL

  22. SPECIAL TESTS: • VARUS RECUVARTUM TEST: • Posterior lateral corner • SQUAT TEST: • Meniscus • APLEY’S GRINDING AND DISTRACTION TEST: • Menisci

  23. SPECIAL TESTS: • MC MURRAY’S TEST: • Medial meniscus • Lateral meniscus

  24. 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

More Related