History taking and physical examination of the knee
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Knee pain is one of the most common orthopaedic complaints. Performing a thorough physical examination of the knee is important for diagnosis and treatment. The exam involves inspection of gait, alignment, and deformities; palpation of bony landmarks and soft tissues for tenderness; and assessment of range of motion through active and passive movement. Specific tests evaluate the patellofemoral joint, test for intra-articular fluid, and stress the ligaments to identify injuries like ACL and PCL tears or meniscal damage. A complete physical exam aids in localizing the source of knee pathology.
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2. Examining the patient in standing, sitting, and supine positions to look for deformities, swelling, range of motion, tenderness, and special tests for effusion, stability, and meniscal/ligament injuries.
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Ankle sprain
-Affect any age group.
-Most of them inversion injury (incomplete tear of lateral ligaments.
-Complete rupture mean:
1-Fail to heal.
2-Instability of ankle.
-Signs and symptoms:
1-Pain.
2-Instability to weight bear in some cases.
3-Swelling.
4-Ecchymosis & bruising.
5-Palpation of ligaments especially ATFL is tender.
-Ottowa ankle rule: Institutions to determine on which patients ankle radiographs should be ordered.
1-No weight bearing X4 staps at time of injury.
2-Bony tendernes around medial and lateral malleolus.
3-Positive squeeze test.
4-stress test.
-Squeeze test: fibula and tibia pushed together by exminer at about the shin creating pain at ankle.
-Stress test: grasp the heel and forcibly put gently invert the foot, feeling for opening up thenlateral side of the ankle between tibia and talus.
Treatment:
-PRICE
-Pain control.
-Rest.
-Ice.
-Compression.
-Elevation.
--Fractures may require surgical fixation.
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History taking and physical examination of the knee
- 1. ORTHOPAEDIC PHYSICAL EXAMINATION OF THE KNEE Fajrullah Latama
- 2. ANATOMY
- 3. ANATOMY
- 5. INTRODUCTION • Knee pain is one of the most common complaints seen by both family physicians and orthopaedic surgeons • It is critical to be able to perform a thorough history and physical examination to aid in the diagnosis and direct the proper treatment oh knee pathology
- 6. HISTORY TAKING • Age • Pain (Onset, Location, Occurance) • Stiffness • Locking • Deformity • Instabiliy • Limp • Loss of Function • Trauma • Activity • Systemic
- 7. PHYSICAL EXAMINATION Inspection •Deformity •Alignment •Gait •Standing limb alignment •Mass •Swelling •Wound Palpation •Tenderness (determine location) •Skin temprature •Crepitation ROM •Active and Passive ROM
- 9. PALPATION • Start by running your hand down the length of the limb, feeling fo changes in skin temperature and compare with the normal side • Soft tissues and bony outlines are then palpated systematically, feeling for abnormal outlines and localize tenderness. The point of maximum tenderness will suggest at least the anatomical site of pathology if not the precise diagnosis • Synovial thickening is evaluated by positioning the knee in extension, then the examiner grasp the edges of patella in a pincer made of the thumb and middle finger, tries to lift the patella forwards. Normally, the bone can be grasped firmly, but if the patella is thickened, the fingers simplu slip off the edges of tha patella
- 11. • The size, shape and position of patella ar noted • Moving the patella up and down while pressing slightly againts the femur (friction test) • Patellar apprehension pressing the patella laterally with the thumb while flexing the knee slowly, may induce anxiety and sharp resistance to further movement. Diagnostic of recurrent patellar subluxation PATELLOFEMORAL JOINT
- 12. TESTING FOR INTRA- ARTICULAR FLUID • Cross Flutuation Left hand compress the superopatellar pouch while the right hand straddles the front joint below the patella • Patellar tap test Superopatellar pouch is compressed with left hand, with other hand the patella is then tapped sharply backward to the femoral condyle. In a positive test the patella can be felt striking the femur and bouncing off again • The bulge test Squeezing any fluid out of superopatellar pouch, then the medial compartement is emptied by pressing inner aspect of the joint, the hand then lifted away and the lateral side is sharply compressed • The juxtapatellar hollow test The knee is flexed, and a hollow appears lateral to the patellar ligament and disappears with further flexion
- 13. RANGE OF MOTION OF THE KNEE
- 15. SPECIAL TEST
- 16. ACL TESTS
- 17. PCL TESTS
- 19. VARUS AND VALGUS STRESS TEST Supine on table, relaxed leg on table flexed 30 degree, with one hand fixing thigh another hand placed above the ankle and apply valgus stress. Compare the mobility with the uninjured side For varus stress test, direction of the pressure is reversed
- 21. THANK YOU