PS SESSION : EXAMINATION OF KNEE JOINT
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The document provides an overview of knee joint examination including: 1) A review of knee anatomy and the structures around the knee such as osseous, extra-articular, and intra-articular structures. 2) Details on components of the history taking for knee examinations including chief complaints, past history, and physical examination focusing on inspection, palpation, range of motion, and special tests. 3) Discussions of common knee conditions, differential diagnoses, investigations including imaging and laboratory tests, and formulation of provisional and definitive diagnoses.
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PS SESSION : EXAMINATION OF KNEE JOINT
- 1. KNEE JOINT EXAMINATION DR. UTKARSH SHAHI ASSISTANT PROFESSOR DEPARTMENT OF ORTHOPAEDICS
- 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. 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. OSSEOUS STRUCTURES Consist of three components A. Distal Femoral Condyles. B. Proximal Tibial Plateaus. C. The Patella.
- 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. EXTRA-ARTICULAR TENDINOUS STRUCTURES Principally these include: Quadriceps mechanism Gastrocnemius Medial Hamstring group Lateral Hamstring group Popliteus Iliotibial Band
- 7. EXTRA-ARTICULAR LIGAMENTOUS STRUCTURES Primarily these include: The joint capsule. Medial collateral ligament. Lateral collateral ligament.
- 8. INTRA ARTICULAR STRUCTURES Medial meniscus Lateral meniscus Anterior cruciate ligament Posterior cruciate ligament
- 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. HISTORY TAKING PATIENT DETAILS CHIEF COMPLAINTS HISTORY OF PRESENT ILLNESS PAST HISTORY FAMILY HISTORY PERSONAL HISTORY TREATMENT HISTORY NEGATIVE HISTORY
- 11. COMPLAINTS PAIN LIMP LOCKING SWELLING DEFORMITY WEAKNESS INSTABILITY PARASTHESIA LOSS OF FUNCTION STIFFNESS
- 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. 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. LIMP Time of Onset •Congenital •Developmental •Acquired Duration •Acute •Chronic Progression •Progressive •Static •Regressive Aggravating factors Associated symptoms •Pain •Disability •Neurovascular Associated Illness
- 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. DEFORMITY Site Associated Symptoms • Neurological • Vascular • Articular Amount of disability Time of Onset • Congenital • Developmental • Acquired Correctability • Completely correctable • Partially correctable • Incorrectable
- 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. PARASTHESIA Aetiology Mode of onset Duration Site and Pattern Progression Aggravating and Relieving Factors
- 20. LOSS OF FUNCTION Mode of onset • Sudden • Gradual Duration • Congenital • Chronic • Acute Involved region and function(s) Progression Associated features
- 22. DIFFERENTIAL DIAGNOSIS 1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
- 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. 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
- 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
- 28. REGIONAL EXAMINATION • InspectionLOOK • PalpationFEEL • Strength TestingMOVE • Shortening or Lengthening • Range of Motion • Regional measurements MEASURE • Depends upon specific region in considerationSPECIAL TESTS
- 29. PHYSICAL EXAM - GENERAL Develop a standard routine Alleviate the patient's fears Adequate exposure - bilateral Compare both sides
- 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. INSPECTION Any obvious deformity Any compensatory mechanism Gross shortening Muscle wasting Any swelling Any scar •Active sinus •Healed sinus •Scars of old surgery
- 32. Temperature Tenderness Swelling DeformityPALPATIONAnterior Knee Palpation Medial Knee Palpation Posterior Knee Palpation Lateral Knee Palpation
- 35. RANGE OF MOTION (ROM) Evaluate active ROM If movement limited by pain, weakness, or tightness, assist passively Evaluate bilaterally for comparison
- 36. RANGE OF MOTION (ROM) RANGE OF MOTION: 0 – 155 DEGREE
- 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
- 41. LACHMAN TEST
- 44. STRESS TESTS
- 45. STRESS TESTS
- 48. McMURRAY TEST
- 50. PROVISIONAL DIAGNOSIS 1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
- 55. DEFINITIVE DIAGNOSIS 1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _