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KNEE JOINT
EXAMINATION
DR. UTKARSH SHAHI
ASSISTANT PROFESSOR
DEPARTMENT OF ORTHOPAEDICS
REVIEW OF KNEE ANATOMY
 The knee is called a pivot joint, as along with Flexion and
extension as principle movement aroun...
STRUCTURES AROUND KNEE
Can be divided into
A. Osseous structures.
B. Extra articular structures.
a. Extra articular tendi...
OSSEOUS STRUCTURES
Consist of three components
A. Distal Femoral Condyles.
B. Proximal Tibial Plateaus.
C. The Patella.
EXTRAARTICULAR STRUCTURES
 The important extra articular structures supporting and
influencing the function of this joint...
EXTRA-ARTICULAR
TENDINOUS STRUCTURES
 Principally these include:
Quadriceps mechanism
Gastrocnemius
Medial Hamstring g...
EXTRA-ARTICULAR LIGAMENTOUS
STRUCTURES
Primarily these include:
The joint capsule.
Medial collateral ligament.
Lateral...
INTRA ARTICULAR STRUCTURES
Medial meniscus
Lateral meniscus
Anterior cruciate ligament
Posterior cruciate ligament
KNEE CONDITIONS
Injury and mechanical derangement.
Congenital and developmental abnormalities.
Infection and inflammation....
HISTORY TAKING
PATIENT DETAILS CHIEF COMPLAINTS
HISTORY OF PRESENT ILLNESS PAST HISTORY
FAMILY HISTORY PERSONAL HISTORY
TR...
COMPLAINTS
PAIN LIMP
LOCKING SWELLING
DEFORMITY WEAKNESS
INSTABILITY PARASTHESIA
LOSS OF FUNCTION STIFFNESS
PAIN
Site Time and mode of onset
Severity or Intensity Character or Nature
Progression Referred pain
Aggravating factors R...
PAIN
 The extent of reference is governed by a number of factors.
 The depth of the structure beneath the skin.
 The po...
LIMP
Time of Onset
•Congenital
•Developmental
•Acquired
Duration
•Acute
•Chronic
Progression
•Progressive
•Static
•Regress...
SWELLING
Site Shape Size
First notice
Associated Symptoms
•Pain
•Pressure
•Neurological
•Vascular
•Articular
Progression
A...
DEFORMITY
Site
Associated Symptoms
• Neurological
• Vascular
• Articular
Amount of
disability
Time of Onset
• Congenital
•...
WEAKNESS
Site
Generalised
Localised
Type
Pure Motor
Sensorimotor
Muscular
Mixed
Duration
Acute
Chronic
Onset
Sudden
Gradua...
INSTABILITY
Time of Onset
•Congenital
•Developmental
•Acquired
Frequency
•Single episode
•Recurrent Aggravating factors
As...
PARASTHESIA
Aetiology
Mode of
onset
Duration
Site and
Pattern
Progression
Aggravating
and Relieving
Factors
LOSS OF FUNCTION
Mode of onset
• Sudden
• Gradual
Duration
• Congenital
• Chronic
• Acute
Involved region
and function(s)
...
STIFFNESS
Generalised Localised
Locking Ankylosis
DIFFERENTIAL DIAGNOSIS
1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ...
DIFFERENTIALS IN KNEE
 Trauma
 Patella Fracture
 Knee Dislocation
 Tibial Plateau Fracture
 Arthritis
 Osteoarthriti...
DIFFERENTIALS IN KNEE
 Sports Conditions
 Ligament Injury
 ACL Tear
 PCL Injury
 MCL Injuries
 LCL Injuries
 Poster...
Physical
Examination
General
Examination
Systemic
Examination
Regional
Examination
GENERAL EXAMINATION
Vitals
•Pulse
•Blood Pressure
•Respiratory Rate
•Temperature
Consciousness Orientation Comfort level P...
Systemic
Examination
Respiratory
System
Cardiovascular
System
Gastrointestinal
System
Central Nervous
System
REGIONAL EXAMINATION
• InspectionLOOK
• PalpationFEEL
• Strength TestingMOVE
• Shortening or Lengthening
• Range of Motion...
PHYSICAL EXAM - GENERAL
 Develop a standard routine
 Alleviate the patient's fears
 Adequate exposure - bilateral
 Com...
EXAMINATION OF THE KNEE
Observe the gait and posture.
Observe the patient in standing and lying on couch
Observe the pa...
INSPECTION
Any obvious deformity
Any compensatory mechanism
Gross shortening
Muscle wasting
Any swelling
Any scar
•Active ...
Temperature Tenderness Swelling
DeformityPALPATIONAnterior Knee
Palpation
Medial Knee
Palpation
Posterior Knee
Palpation
L...
PALPATION
ANTERIOR POSTERIOR
PALPATION
LATERAL MEDIAL
RANGE OF MOTION (ROM)
 Evaluate active ROM
 If movement limited by pain, weakness, or tightness, assist
passively
 Eval...
RANGE OF MOTION (ROM)
RANGE OF MOTION: 0 – 155 DEGREE
KNEE FLEXION
SCIATIC NERVE
KNEE EXTENTION
FEMORAL NERVE
SPECIAL TESTS
•Patellar grinding
•Patellar TrackingPATELLA
•Anterior drawer test
•Lachman testACL
•Posterior Drawer Test
•...
ANTERIOR DRAWER TEST
LACHMAN TEST
POSTERIOR DRAWER TEST
POSTERIOR SAG SIGN
STRESS TESTS
STRESS TESTS
VALGUS STRESS TEST
VARUS STRESS TEST
McMURRAY TEST
APLEY’S COMPRESSION TEST
PROVISIONAL DIAGNOSIS
1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _...
INVESTIGATIONS
DIAGNOSTIC
IMAGING
LABORATORY
TESTS
OTHER
SPECIALIZED
TESTS
DIAGNOSTIC
IMAGING
PLAIN
RADIOGRAPHS
CONTRAST
RADIOGRAPHS
SPECIALIZED
IMAGING
MODALITIES
ULTRASONOGRAPHY
LABORATORY
TESTS
HAEMATOLOGY
SEROLOGY
IMMUNOLOGY
ENZYME
ANALYSIS
SYNOVIAL
FLUID ANALYSIS
OTHER
SPECIALIZED
TESTS
BONE BIPOSY
BONE MINERAL
DENSITOMETRY
DIAGNOSTIC
ARTHROSCOPY
DEFINITIVE DIAGNOSIS
1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ...
THE END
THANK YOU
PS SESSION : EXAMINATION OF KNEE JOINT
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PS SESSION : EXAMINATION OF KNEE JOINT

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This is about the PS Session for Knee examination for GMCA Block 4.4

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PS SESSION : EXAMINATION OF KNEE JOINT

  1. 1. KNEE JOINT EXAMINATION DR. UTKARSH SHAHI ASSISTANT PROFESSOR DEPARTMENT OF ORTHOPAEDICS
  2. 2. REVIEW OF KNEE ANATOMY  The knee is called a pivot joint, as along with Flexion and extension as principle movement around this joint, it also has some rotary component.  The knee is one of the most frequently injured joints, because of  It’s anatomical structure.  Exposure to external forces.  Functional demands placed on it.
  3. 3. STRUCTURES AROUND KNEE Can be divided into A. Osseous structures. B. Extra articular structures. a. Extra articular tendinous structures b. Extra articular ligamentous structures. C. Intra articular structures.
  4. 4. OSSEOUS STRUCTURES Consist of three components A. Distal Femoral Condyles. B. Proximal Tibial Plateaus. C. The Patella.
  5. 5. EXTRAARTICULAR STRUCTURES  The important extra articular structures supporting and influencing the function of this joint are The synovium. Joint capsule. Collateral ligaments. Musculotendinous units that span the joint. ( also known as “extra articular tendinous structures of knee joint”
  6. 6. EXTRA-ARTICULAR TENDINOUS STRUCTURES  Principally these include: Quadriceps mechanism Gastrocnemius Medial Hamstring group Lateral Hamstring group Popliteus Iliotibial Band
  7. 7. EXTRA-ARTICULAR LIGAMENTOUS STRUCTURES Primarily these include: The joint capsule. Medial collateral ligament. Lateral collateral ligament.
  8. 8. INTRA ARTICULAR STRUCTURES Medial meniscus Lateral meniscus Anterior cruciate ligament Posterior cruciate ligament
  9. 9. KNEE CONDITIONS Injury and mechanical derangement. Congenital and developmental abnormalities. Infection and inflammation. Arthritis and rheumatic disorders. Metabolic and endocrine disorders. Tumours and lesions that mimic them. Neurological disorders and muscle weakness.
  10. 10. HISTORY TAKING PATIENT DETAILS CHIEF COMPLAINTS HISTORY OF PRESENT ILLNESS PAST HISTORY FAMILY HISTORY PERSONAL HISTORY TREATMENT HISTORY NEGATIVE HISTORY
  11. 11. COMPLAINTS PAIN LIMP LOCKING SWELLING DEFORMITY WEAKNESS INSTABILITY PARASTHESIA LOSS OF FUNCTION STIFFNESS
  12. 12. PAIN Site Time and mode of onset Severity or Intensity Character or Nature Progression Referred pain Aggravating factors Relieving factors Any diurnal variation Any seasonal variation
  13. 13. PAIN  The extent of reference is governed by a number of factors.  The depth of the structure beneath the skin.  The position of the structure within the dermatome.  The severity of the lesion
  14. 14. LIMP Time of Onset •Congenital •Developmental •Acquired Duration •Acute •Chronic Progression •Progressive •Static •Regressive Aggravating factors Associated symptoms •Pain •Disability •Neurovascular Associated Illness
  15. 15. SWELLING Site Shape Size First notice Associated Symptoms •Pain •Pressure •Neurological •Vascular •Articular Progression Any other swelling Reducibility Any discharge •If present •Duration •Regular or intermittent •Character of discharge
  16. 16. DEFORMITY Site Associated Symptoms • Neurological • Vascular • Articular Amount of disability Time of Onset • Congenital • Developmental • Acquired Correctability • Completely correctable • Partially correctable • Incorrectable
  17. 17. WEAKNESS Site Generalised Localised Type Pure Motor Sensorimotor Muscular Mixed Duration Acute Chronic Onset Sudden Gradual Progression Progressive Static Regressive
  18. 18. INSTABILITY Time of Onset •Congenital •Developmental •Acquired Frequency •Single episode •Recurrent Aggravating factors Associated symptoms •Pain •Disability •Neurovascular Reducibility •Reducible •Irreducible Associated Illness
  19. 19. PARASTHESIA Aetiology Mode of onset Duration Site and Pattern Progression Aggravating and Relieving Factors
  20. 20. LOSS OF FUNCTION Mode of onset • Sudden • Gradual Duration • Congenital • Chronic • Acute Involved region and function(s) Progression Associated features
  21. 21. STIFFNESS Generalised Localised Locking Ankylosis
  22. 22. DIFFERENTIAL DIAGNOSIS 1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  23. 23. DIFFERENTIALS IN KNEE  Trauma  Patella Fracture  Knee Dislocation  Tibial Plateau Fracture  Arthritis  Osteoarthritis  Rheumatoid Arthritis  Traumatic arthritis  Tumour  Infections  Knee Lesions  Articular Cartilage Defects of Knee  Osteonecrosis of the Knee  Spontaneous Osteonecrosis of the Knee (SONK)  Plicae  Paediatric Conditions  Osteochondritis Dissecans  Osgood Schlatter's Disease (Tibial Tubercle Apophysitis)  Sinding-Larson-Johansson Syndrome
  24. 24. DIFFERENTIALS IN KNEE  Sports Conditions  Ligament Injury  ACL Tear  PCL Injury  MCL Injuries  LCL Injuries  Posterolateral Corner Injury  Proximal Tibiofibular dislocation  Meniscal Injuries  Medial Meniscal Tear  Lateral Meniscal Tear  Sports Conditions  Knee Overuse injuries  Patellar Tendinitis  Quadriceps tendonitis  Semimembranosus Tendinitis  Pre-patellar Bursitis (Housemaid's knee)  Iliotibial Band Friction Syndrome  Knee Extensor Mechanism  Patellofemoral joint  Patellar Instability  Lateral Patellar Compression Syndrome  Idiopathic Chondromalacia Patellae  Quadriceps Tendon Rupture  Patella Tendon Rupture
  25. 25. Physical Examination General Examination Systemic Examination Regional Examination
  26. 26. GENERAL EXAMINATION Vitals •Pulse •Blood Pressure •Respiratory Rate •Temperature Consciousness Orientation Comfort level Position of Patient Height and Weight General Appearance Pallor Icterus Clubbing Cyanosis Pupillary Reaction Lymphadenopathy Dexterity Anything specific
  27. 27. Systemic Examination Respiratory System Cardiovascular System Gastrointestinal System Central Nervous System
  28. 28. REGIONAL EXAMINATION • InspectionLOOK • PalpationFEEL • Strength TestingMOVE • Shortening or Lengthening • Range of Motion • Regional measurements MEASURE • Depends upon specific region in considerationSPECIAL TESTS
  29. 29. PHYSICAL EXAM - GENERAL  Develop a standard routine  Alleviate the patient's fears  Adequate exposure - bilateral  Compare both sides
  30. 30. EXAMINATION OF THE KNEE Observe the gait and posture. Observe the patient in standing and lying on couch Observe the patient from front, side and back. Look for any evidence of shortening.
  31. 31. INSPECTION Any obvious deformity Any compensatory mechanism Gross shortening Muscle wasting Any swelling Any scar •Active sinus •Healed sinus •Scars of old surgery
  32. 32. Temperature Tenderness Swelling DeformityPALPATIONAnterior Knee Palpation Medial Knee Palpation Posterior Knee Palpation Lateral Knee Palpation
  33. 33. PALPATION ANTERIOR POSTERIOR
  34. 34. PALPATION LATERAL MEDIAL
  35. 35. RANGE OF MOTION (ROM)  Evaluate active ROM  If movement limited by pain, weakness, or tightness, assist passively  Evaluate bilaterally for comparison
  36. 36. RANGE OF MOTION (ROM) RANGE OF MOTION: 0 – 155 DEGREE
  37. 37. KNEE FLEXION SCIATIC NERVE
  38. 38. KNEE EXTENTION FEMORAL NERVE
  39. 39. SPECIAL TESTS •Patellar grinding •Patellar TrackingPATELLA •Anterior drawer test •Lachman testACL •Posterior Drawer Test •Posterior Sag SignPCL •Valgus Stress TestMCL •Varus Stress TestLCL •Apley’s Grinding •McMurray’s TestMeniscus
  40. 40. ANTERIOR DRAWER TEST
  41. 41. LACHMAN TEST
  42. 42. POSTERIOR DRAWER TEST
  43. 43. POSTERIOR SAG SIGN
  44. 44. STRESS TESTS
  45. 45. STRESS TESTS
  46. 46. VALGUS STRESS TEST
  47. 47. VARUS STRESS TEST
  48. 48. McMURRAY TEST
  49. 49. APLEY’S COMPRESSION TEST
  50. 50. PROVISIONAL DIAGNOSIS 1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  51. 51. INVESTIGATIONS DIAGNOSTIC IMAGING LABORATORY TESTS OTHER SPECIALIZED TESTS
  52. 52. DIAGNOSTIC IMAGING PLAIN RADIOGRAPHS CONTRAST RADIOGRAPHS SPECIALIZED IMAGING MODALITIES ULTRASONOGRAPHY
  53. 53. LABORATORY TESTS HAEMATOLOGY SEROLOGY IMMUNOLOGY ENZYME ANALYSIS SYNOVIAL FLUID ANALYSIS
  54. 54. OTHER SPECIALIZED TESTS BONE BIPOSY BONE MINERAL DENSITOMETRY DIAGNOSTIC ARTHROSCOPY
  55. 55. DEFINITIVE DIAGNOSIS 1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  56. 56. THE END THANK YOU

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