Knee joint PE
ACL objective
(+) Lachman (+) Anterior drawer Effusion
Meniscal tear objective
(+) McMurray (+) Thessaly (+) Apley Joint line TTP, loss of smooth ROM, inability to fully extend knee (locking)
MCL objective
(+) Valgus stress test Medial joint line TTP, eccymosis Often occurs w/ medial meniscus tear
PCL objective
(+) posterior drawer Effusion, sag sign, decreased ROM, inability to weight bear, antalgic gait
LCL tear objective
Abnormal gait, (+) lateral knee joint line TTP, (+) varus stress test *does not occur in isolation - look for other injuries like medial meniscual tear, ACL or PCL injuries
Iliotibial pertinent history
Activity level (runner)
ACL pertinent history
Activity level (sports)
ACL subjective
Audible pop followed by pain and swelling, feeling as if the knee is going to "give out"
Septic arthritis
Bacterial infection of joint usually d/t hematogenous seeding/less commonly a local extension from skin/bone infection MC: knee joint
Iliotibial band syndrome
Common overuse syndrome
Septic arthritis objective
Fever, joint pain, erythema, joint effusion, decreased ROM *Medical emergency
Septic arthritis subjective
Ill appearing child w/ acute UL joint pain, erythema, swelling, refusal to weight bear, limited ROM, fever
PE
Inspect Palpate (midline, medial, lateral) ROM (active & passive) -Flexion and extension
Iliotibial band subjective
Knee pain (sharp/burning) during heel strike
Iliotibial objective
Lateral knee pain w/ hip/knee ROM, weak hip abductors, genu varum, focal tenderness at distal ITB over LFE
LCL tear subjective
Lateral knee pain, instability, welling
PCL pertinent history
MVA, sports
MCL subjective
Medial knee pain, instability, swelling, bruising
ACL tear
Non-energy, non-contact tear d/t rapid deceleration, direction change or pivoting/twisting of LE w/ foot planted
Septic arthritis pertinent history
Sexual hx (d/t gonorrhea), IVDU, surgery
MCL pertinent history
Sports
LCL tear pertinent history
Sports (football)
MCL tear
Tear d/t valgus stress (push lateral knee medially), usually direct blow
Meniscal tear
Twisting motion during strenuous activity or uneven ground vs degenerative in older patient
PCL subjective
Vague knee pain, swelling, limb
Meniscal tear subjective
acute knee pain, esp. w/ squatting, instability, effuison, locking/catching
LCL tear
blow to medial or anteriomedial knee while its fully extended
Genu valrum
bow legged
Genu valgum
knock knees
Antalgic gait
limping
Lachman test
patient is supine, hip and knee are flexed, stabilize the distal femur with one hand and pull the proximal tibia anterior with the other (+) test is excessive anterior displacement of tibia Indicates ACL tear (alternative for anterior drawer test)
McMurray test (medial)
patient is supine, hold patient's foot in one hand, apply valgus stress at joint line and externally rotate the lower leg while gradually flexing and extending the knee (+) test is an audible click, palpable catch or pain Indicates medial meniscal tear
McMurray's test (lateral)
patient is supine, hold patient's foot in one hand, apply varus stress at joint line and externally rotate the lower leg while gradually flexing and extending the knee (+) test is an audible click, palpable catch or pain Indicates lateral meniscal tear
Valgus stress test
patient is supine, place one hand on lateral joint and other on medial ankle, apply valgus force to knee (+) test is pain or excessive medial joint widening Indicates MCL tear
Varus stress test
patient is supine, place one hand on medial joint and other on lateral ankle, apply varus force to knee (+) test is pain or excessive lateral joint widening Indicates LCL tear
Posterior drawer sign
position the patient and your hands the same as anterior drawer test, apply posterior force to tibia (+) test is excessive posterior displacement of tibia Indicates PCL tear
Meniscal tear pertinent history
sports
PCL
tear d/t hyperextension or blow to anterior aspect of proximal tibia
Ballottement sign
w/ knee extended, compress the suprapatellar pouch against the femur Indicates major effusion
Balloon sign
w/ knee extended, place thumb and index finger on the sides of the patella, compress the suprapatellar recess against the femur with the other hand Indicates major effusion
Bulge sign
w/ knee extened, apply pressure on suprapatellar recess, stroke downward on medial side, tap bulge formed on lateral side of knee Indicates minor effusion
Anterior drawer sign
w/ patient supine, hips and knees flexed, place thumbs on proximal tibia and fingers on insertions of hamstrings, apply anterior force to tibia (+) test is excessive anterior displacement of tibia Indicates ACL tear
