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Physical Exam Knee

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Introduction

  • Follows the IP-PASS examination methodology
    • Inspection
    • Palpation
    • Passive Range of Motion
    • Active Range of Motion
    • Strength & Neurovascular
    • Special Tests

Inspection

  • Skin
    • Color: erythema, ecchymosis, white, black
    • Trophic changes (altered hair growth, sweat production)
    • Scars
  • Swelling
  • Joint effusion
  • Muscle tone: atrophy, hypertrophy
  • Deformity: asymmetry, rotation, amputation
  • Areas of emphasis for knee exam
    • Are there any deformities present?
    • Is there a joint effusion?
    • What is the resting position of the knee (i.e. is it held in partial flexion or extension)

Palpation

  • Palpate for
    • Effusion
    • Clicking
    • Snapping
    • Crepitus
    • Tenderness
    • Temperature
    • Masses
  • Areas of Emphasis
    • Medial/ lateral femoral condyle
    • Medial/ lateral joint line
    • Medial/ lateral tibial plateau
    • 4 poles of the patella
    • Tibial tubercle
    • Pes anserine
    • Hamstrings posteriorly
    • Fibular head

Range of Motion

  • Knee
    • Flexion: 120-130
    • Extension: 0

Strength and Neurovascular


Neurovascular

  • Sensory Nerves
    • L1: Iliac crest, groin
    • L2, L3: Anterior and inner thigh
    • L4: Lateral thigh, anterior knee, medial leg
    • L5: Lateral leg, dorsal foot
    • S1: Posterior Leg
    • S2: Plantar foot
    • S3, S4: Perianal
  • Dermatome
    • Needs to be updated
  • Reflexes
    • Commonly Used
    • Patellar (L3, L4)
    • Achilles (S1, S2)
    • Uncommonly Used
    • Medial Hamstring (L5, S1)
    • Lateral Hamstring (S1, S2)
    • Posterior Tibial (L4, L5)
    • Cremasteric (L1, L2)
    • Anal wink/ bulbocavernous (S2)
  • Myotomes:
    • L2: Hip Adduction, Hip Flexion
    • L3: Knee Extension, Hip Adduction, Hip Flexion
    • L4: Knee Extension, Dorsiflexion
    • L5: Hip Abduction, Hip Extension, Toe Dorsiflexion, Foot Inversion, Dorsiflexion
    • S1 Foot Version, Plantarflexion
    • S2: Toe Plantar Flexion
    • S3: Bowel, bladder function
    • S4: Bowel, bladder function

Special Tests


See Also


Created by:
John Kiel on 27 March 2021 13:41:28
Authors:
Last edited:
10 April 2022 10:56:19
Categories: