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

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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)

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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

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Range of Motion

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

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Strength and Neurovascular

• Knee Extension : Quadriceps Femoris (Rectus Femoris, Vastus Lateralis, Vastus Medialis, Vastus Intermedius)
• Knee Flexion: Hamstrings (Biceps Femoris, Semitendinosus, Semimembranosus), Gracilis, Sartorius, Gastrocnemius, Popliteus

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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

• Vascular:
  • Femoral Artery
  • Popliteal Artery
  • Dorsalis Pedis Artery
  • Posterior Tibial Artery

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Special Tests

• Knee Effusion
  • Ballottement Test
• Iliotibial Band Syndrome
  • Obers Test
  • Nobles Test
  • Renne Test
• Extensor Mechanism Injury
  • Active Straight Leg Raise
• Patellar Tendonitis
  • Bassets Sign
• Popliteus Tendinopathy
  • Garrick Test
• ACL Injury
  • Anterior Drawer Test
  • Lachmans Test
  • Pivot Shift Test
  • Lever Test
• PCL Injury
  • Posterior Drawer Test
  • Quadriceps Active Test
  • Posterior Sag Sign
• MCL Injury
  • Valgus Stress Test
• LCL Injury
  • Varus Stress Test
• Meniscal Pathology
  • McMurrays Test
  • Apley Grind Test
  • Thessaly Test
  • Bounce Home Test
• Posterolateral Corner Injury
  • Dial Test
  • Posterolateral Drawer Test
  • Posterolateral External Rotation Test
  • Reverse Pivot Shift Test
  • Varus Stress Test (Knee)
• Patellofemoral Pain Syndrome, Chondromalacia Patella, Patellar Instability
  • Patellar Compression Test
  • Patellar Grind Test
  • Patellar Apprehension Test
  • Passive Patellar Glide
  • Patella Alta Test
  • Patellar Tilt Test
  • Squat Test
  • Vastus Medialis Coordination Test
  • Waldrens Test
  • Step Down Test
  • Lateral Step Down Test
• Plica Syndrome
  • Hughstons Plica Test
  • Stutter Test
  • Plica Active Extension Test
  • Plica Flexion Test
  • Medial Patellar Plica Test
• Infrapatellar Fat Pad Impingement
  • Hoffas Test
• Patellar Instability
  • Patellar J Sign
  • Patellar Glide Test
• Bakers Cyst
  • Foucher Sign
  • Homan Sign
• Saphenous Nerve Entrapment
  • Tinels Test
• Parameniscal Cyst
  • Pisani Maneuver

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See Also

Internal

• Clinical Exam (Main)
• Knee Pain (Main)
• Knee Anatomy (Main)

External

• Sports Medicine Review Knee Pain: https://www.sportsmedreview.com/by-joint/knee/

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