Knee Examination

Introduction

1. Wash hands

Wash your hands using the Ayliffe technique

2. Introduce yourself

Introduce yourself and give your name and grade

3. Check patient details

Clarify patient's identity by confirming their name and asking for their DOB

4. Describe examination

Explain what examination you are performing and what this involves

5. Gain verbal consent

6. Expose appropriately

Fully expose the patient’s knee.

Look

1. General end of bed inspection

• Mobility aids such as wheeled walkers, zimmer frames or walking sticks
• Evidence of injury/trauma

2. Inspect Gait

• Symmetry and smoothness
• Gait cycle - stance and swing phase
• Abnormal gait - Ataxic (cerebellar disease), Antalgic (trauma/OA), waddling
  (proximal muscle weakness), shuffling ( Parkinson’s disease)

3. Knee inspection anterior and posterior (standing)

• Check alignment - valgus deformity (knock-knee) or varus deformity (bow-leg)
• Symmetry
• Muscle wasting
• Popliteal swelling - Baker’s cyst, aneurysm or abscess.

4. Ask the patient to lie on the bed and further inspect the knees

Feel

Start with the patient lying down in the bed with the knees exposed

1. Assess temperature

• Check for the temperature around the knee joints using the back of your hand

2. Check for effusion

• Usually done by performing a patella tap
• This involves running one hand down the patient’s thigh towards the knee
• Which results in an effusion being forced behind the patella
• With three fingers of the other hand push the patella down gently
• Positive test is when the patella bounces back and cause a tap

3. Knee joint palpation

• Flex the knee to 90°
• Palpate for tenderness and evidence of swelling along the joint line
• Starting at the femoral condyles moving down towards the inferior pole of the patella
• Then continue down the inferior patella tendon to the tibial tuberosities
• Work you way to the back of the knee feeling for any swellings (Baker’s cyst)

Move

1. Assess active movement

• Ask the patient to bend their knees one at a time (Flexion 140°)
• Ask them to then straighten their knees again (Extension)

2. Assess passive movement

• Place one hand on the knee and repeat the same movements
• Important to make sure the patient is relaxed
• Take note of any crepitus, locking or reduction in the movements

3. Look for evidence of hyperextension

• Place the palm of your hand on the patient’s heel and lift leg
• Look for any hyperextension >10° (hypermobility or collagen disorder)

Special Tests

1. Anterior draw test (Anterior cruciate ligament) and Posterior draw test (Posterior cruciate   ligament)

• Flex the patient’s knee to 90°
• Check for evidence of posterior sag or step-back of tibia from the side of the knee
• Wrap both hands around upper tibia
• Place thumbs on tibial tuberosity and index fingers in the popliteal fossa
• Stabilise lower tibia with forearm
• Gently pull forward
• Gently push backwards

2. Medial and lateral collateral ligament

• Hold the knee flexed at 15°
• Hold ankle with one hand and the knee with the other
• Apply pressure to the lower tibia on the medial and then the lateral aspect of the knee

End of examination

1. Thank patient

Let the patient know you have finished examining them and thank them for their time. Be courteous and offer them help to get redressed.

2. State other exams for completion

Turn to the examiner and state what else you would do to complete the exam.

3. State what tests you would perform

Explain to the examiner what tests and investigations you would perform based on your findings and the patient’s history