Text of Clinical examination of the knee H.Mousavi Tadi,MD Department of orthopaedic Esfahan medical school...
Clinical examination of the knee H.Mousavi Tadi,MD Department of orthopaedic Esfahan medical school Feb,2013
Fundamental tool to diagnosis and treatment, and should never be replaced by the findings retrieved by the imaging studies. The introduction of highly effective imaging tools like and MRI has stolen the central role of clinical evaluation, so that there's a common feeling, between patients but also between surgeons, that the diagnosis of a thorn meniscus or a ruptured ACL has to be ruled out only on the basis of an imaging study. But the efficacy of a correct clinical examination needs not to be forgotten. clinical evaluation of the knee
HISTORY Chief complain Present illness Past history Family history
General Approach History look Feel movement Muscular and neurovascular exams Special test
History mechanism of injury Duration of complaint Location, nature of symptoms Exacerbating or relieving maneuvers
Key Questions in the History Mechanism of Injury? Acute or Chronic? Location and level of pain? Able to walk? Mechanical Symptoms? (Locking, popping, catching?) Associated instability? Swelling? Exacerbating or relieving maneuvers? Previous injuries or surgeries?
activity level (IKDC score) I - Strenuous activity (contact sports involving pivoting and cutting) II - Moderate activity (pivot sports without contact; manual work) III - Light activity (jogging, running) IV - Sedentary activity
SIGNS AND SYMPTOMS 1.Pain 2. Laxity 3.Locking: a: True locking b : False locking 4.Effusion
Diagnosis of a meniscal tear Joint line tenderness: Most important physical finding is localized tenderness along the medial or lateral joint line or over the periphery of the meniscus. This most often is located osteromedially or posterolaterally, Diagnostic accuracy rate 89%
sensitivities and specificities McMurray, 70% and 71% Apley, 60% and 70% joint line tenderness, 63% and 77%
Abduction (Valgus) Stress Test
Adduction (Varus) Stress Test
Varus and Valgus Stress Tests Varus stress test Valgus stress test
Anterior Drawer test
Posterior drawer test
Posterior Tibia Sag
Quadriceps Active Test
Slocum Anterior Rotary Drawer Test positive anterior drawer test result in neutral tibial rotation that is accentuated when the test is repeated in 30 degrees of external tibial rotation and reduced when it is performed with the tibia in 15 degrees of internal rotation indicates anteromedial rotary instability. The opposite indicates anterolateral rotary instability.
Center of rotation
lateral pivot shift test of Macintosh
Jerk Test of Hughston and Losee
Flexion-rotation drawer test
Flexion-Rotation Drawer Test (Noyes)
External Rotation- Recurvatum Test
Reverse Pivot Shift Sign
Tibial External Rotation (Dial Test) Increased external rotation at 30 degrees that decreases at 90 degrees indicates isolated injury to posterolateral corner. increased external rotation at both 30 and 90 degrees indicates injury to both PCL and posterolateral corner.