Upload
dylan-doherty
View
265
Download
3
Tags:
Embed Size (px)
Citation preview
History and examination of the knee
Mark BlythConsultant Orthopaedic SurgeonGlasgow Royal Infirmary
PAINPatellofemoralPoorly localisedAnteriorAntero-medialAntero-lateralPosteriorBilateralWorse stairs, hills, sitting, start up, squatting
Medial/lateral joint lineWell localisedSingle finger
Referred painFrom hip
From spine
SWELLING
EffusionSuprapatellar swellingBoth hands
Not effusionInfrapatellar swellingSingle finger
FragmentaryHard lumpLocalised to joint line
Extra-articularLocationBursae, meniscal cysts etc
GIVING WAYUnstable ligamentKnee gives outPivoting sensationSignif after effect – swelling and disabilityNo patternDifficulties with uneven ground
PFJ/ pain quads inhibitionPreceding ant knee painFrequentNo after effectsAss PFJ activitiesHyperextension sensationAss patellar click
Patellar instabilityHistory of patellar dislocationPatellar clunkSwelling possible
LOCKINGTrue meniscal lockingBlock to extensionMed/lat localised painUnlock several minutes+/- swellingAss squattingRotation to relieve
Pseudolocking PFJOccurs at 300
TransientFrequentNo swelling
Loose bodyNot activity specificNot transientKnee immobile several minutes
Poss palpable fragment
HISTORY OF INJURYCruciate injuryHeard/felt popImmed swellingContact/ non-contact sportStopped playing
Complex ligament injuryHigh energy mechanismContact sportSwelling disproportionate to pain
Meniscal injuryHistory of squattingTwisting injuryDelayed swelling
PFJ injuryDirect blow patellaImmed swelling
Ant/post drawerLachmansMCL/LCL laxityPLC laxityPivot shift
Joint line tendernessPostmed and lat tendernesss
LOOK FEEL MOVE TEST
STAND
SIT
SUPINEEXTN
SUPINE 20-900
HIP EXAMINATION
NEUROVASCULAR EXAMINATION
WalkAnt/postAlignmentScars/sinusesWastingSwelling/effusion
Patellar tracking on extensionLag on extension
Flexion contractureScars/sinusesWastingSwelling/effusion
Crepitus on extension
Quads mechanism tenderness
Confirm passive ROM
SquattingKneeling
Pain on resisted extension
Foot lift testPatellar stress testPatellar restraint test
Ligament evaluation
ACL
Difficult in the acute phase/ anxious patient+/- EUA
Lachman (Jonsson 1982, Torg 1976)Beware PCL false positivePivot shift may be negative
PCL
Posterior drawer test at 900
Grade 1 0-5mm (tibial condyles anterior)Grade 2 5-10mm (condyles in line)Grade 3 10+mm (tibial condyles posterior)
Grade 3 suspect collateral injury
Valgus stress at 300
Grade 1 0-5mmGrade 2 5-10mmGrade 3 10+mmGrade 3+ Valgus in extn
MCL/posteromedial corner
Grade 3+ suspect posteromedialcorner and cruciate injury
Varus stress at 300
Grade 1 0-2mmGrade 2 5-10mmGrade 3 10+mm
Dial testat 300 only Posterolateral cornerat 300+900 PCL+posterolateral cornerReverse pivot shift testHughstons hyperextension ext rotation test
LCL/posterolateral corner
Grade 2+3 suspectposterolateral injury
Clinical examination
Inverted J sign
Perch point 300
Clinical examination
Q angle > 20 degrees significant
Thank you