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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.

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EXAMINATION OF THE KNEE

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  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

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