The document outlines a comprehensive examination process for knee joint issues, detailing chief complaints, local examinations, and various assessments for deformities and movement capabilities. It discusses palpation techniques, measurements, and specific tests to diagnose conditions like meniscal injuries, arthritis, and ligament instabilities. The document emphasizes the importance of thorough neurovascular examination and relevant investigations, including laboratory tests and radiological imaging.

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EXAMINATION OF KNEE JOINT
Chief complaints: – Any Swellings, Deformity, Pain disability / locking/ giving away.
H/o presenting illness:- elaborate on his chief complaints and add 2 sub headings
ADL: - ability to walk , run , sit cross leg, use bicycle etc.
Negative H/O: – multiple joint pain (Rheumatoid), constitutional symptoms (TB / Septic).
Pain in gr toe (gout), night cries (TB),/ trauma, /fever,/ bleeding diathesis./ ho of exposure(
gonorrhea, reiters),diarrhea(reactive, IBS,)
Local Examination:-
Gait;- look for antalgic, knock knee, crossleg,
Attitude; – Supine or standing ;-
Look for level of ASIS, level of patella Hip/knee/ankle position(eg;- pt in supine position hip
is in extension,knee is in 45deg of flexion, ankle in equinus of 5 deg , toe in neutral position).
Deformity;- Look for FFD, Varus and Valgus deformity, Angular deformity.
Pearls –what determines deformity‐ In paralytic conditions‐the overpowering muscles determines
the deformity,
In non paralytic conditions‐Innate tendency of postural fixity in possible position of walking that
determines the deformity.
INSPECTION:-
Antrly ;-
ASIS – is it at samelevel,
Is there a varus valgus angulation at knee(Comment on varus / valgus – Outward or Inward
deviation of knee joint.check in sitting and standing position,)
Is there wasting of quadriceps muscle .
Swelling ;-size, shape, extent, surface margins.(use the word swelling in tumor , eg,
exostoses cases only)
Look for fullness in knee it supra patella fossa, para patellar fossa (eg in effusion and
synuvitis its full).
look for Visible scars or sinuses.
Laterally :-look for Prominence of head of fibula, normal contours – any scars / sinuses, cyst
of lat meniscus.
Posteriorly:– contour of thigh, supra popliteal slope, popliteal fossa.

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PALPATION:-
Temperature - local rise in temp,
Tenderness- superficial and deep ,(supfl tenderness seen in cellulitis, deep
tenderness is seen in osteomyelitis, tumor, impingement s, bursitis)
1. Structures surrounding the knee- MCL / LCL/bursa/synovial thickening.
2. Bony components - femur – Patella(feel for articular and nonarticular surfaces)
- Tibia
3. Joint line – look for tenderness medially( msc tear) or laterally( lsc tear ) or
underneath patella (osteochondritis)
4. Fluctuation and patellar tap– in cases of effusion
Mild effusion– should be looked in standing position –because the effusion settles in knee ,
milk suprapatellar pouch and do patellar tap
Moderate effusion – Cross fluctuation test and Patellar tap.
Severe effusion – Patellar tap – not possible bcos massive tense effusion, ( also in FFD of
knee joint and dislocation of patella we cannot elicit patellar tap)
MOVEMENTS :- look for active and passive, is it associated with pain, locking , Crepitus,
and contracture, FFD.
Movements Degree Muscles Nerve
Flexion 0-120 Biceps, ST,SM L45S123
Extension 0 quadriceps L234
Look for quadriceps lag-(normally no lag , in quadriceps weakness , and patellectomies
there is a lag of about 15 to 30 degress)
MEASUREMENTS:-
1. Linear – Apparent Length, True length, Segmental measurements
2. Circumferential –thigh and calf circumference
DEFORMITY ASSESMENT :-
1. Q angle ;– 120
– 150
, look for Varus angle, Valgus angle
2. Intermalleolar distance <5cm – important in genu valgus deformity.
3. Inter condylar distance ;- 1 cm or 1 finger should pass between the condlyles.(for
genu varus deformity)
4. Tibia torsion and femoral anti version( checked by rotational profile of staheli ie
thigh foot angle/medial and lateral hip rotation in extension/transmalleolar axis )
5. Valgus / varus disappears on flexion? (if varus or valgus disappears on flexion the
deformity is in the femur and if it persists its in tibia.) .
Spl. Tests: - kindly read in standard text books about all these tests , by heart and
apply these tests wherever necessary.

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1. Varus & valgus stress tests
2. Lachman’s test– done with 150
knee flexion – Sensitive than drawers test, done in
acute injuries of knee joint with pain .
3. Drawers test- done in neutral and 15deg IR and ER
Anterior drawers– 6 – 8 mm translation than opp knee (for AM bundle )
Posterior drawers – Neutral , 15deg IR / ER,(for PL bundle)
4. Mc. Murrays test – for meniscal injuries --- for MSC tear ,pls do –AB+ER at the knee
and then-FLEX TO EXTN-look for pain through the movement, (pain when fully
flexed –post horn involved, mid flexion –middle horn, terminal extension pain- antr
horn is involved) similarly AD+IR at the knee and then FLEXION TO EXTN –look
for pain implies lsc tear,
Also Look for terminal flexion implies posterior horn tear, terminal extension is
painful in anterior horn tear in either meniscus, ok
5. Childress test- deep squat and walk –implies meniscus tear
6. Apley’s – grinding / distraction test
7. Wilsons – FL+ IR
8. Fair banks / Apprehension test:- Manually push the patella laterally- Pt. winces with
pain.
9. Pivotal shift
10. Slocum test : For ACL and PM Complex injuries.
11. Elys test (rectus femoris contracture prove – flex knee – Hip and drop it it hangs mid
air)
12. Patellar tracking (inverted J sign).
Exam of others joints and thorough Neurovascular (motor, sensory, reflexes, and
distal pulses and lymph node examination .
DIAGNOSIS :‐ ANATOMICAL –what is involved bone,joint or internal structures in the knee
joint
PATHOLOGICAL‐ it can be synovitis, arthritis, or menisci or ligament instabilities .
INVESTIGATIONS;-
1)LABORATORY ; Hb , wbc , Tc, Dc, Esr, CRP, RA Factor,
2)RADIOLOGICAL ;- plain x ray of knee joint in AP &LAT views
3)SPECIAL INVESTIGATIONS;-1 MRI, (in meniscal/ ligamentous injuries and instability)

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SELF NOTES