Transcript EXAMINATION OF THE KNEE

EXAMINATION OF THE KNEE
AND ASPIRATION TECHNIQUE
C SNYCKERS
INTRODUCTION
• The largest joint in the body
• subject to a great variety of traumatic and
degenerative conditions
• Outwardly simple but is actually quite
complex
• Not just a hinge joint.
INTRODUCTION
• The tibia femoral joint is inherently unstable
• Relies heavily on ligaments for stability
• Patella is the largest sesamoid bone in the
body – acts as a fulcrum increasing
mechanical advantage of quads.
INSPECTION
Surface anatomy
• Anterior:
– Patella
• Fracture
• Bipartite
– Infra-patellar tendon and Hoffa’s fat pad
• Rupture
• Tendonitis
– Tibial tubercle
• Osgood – Schlatter
• avulsions
INSPECTION
Surface anatomy
– Femoral condyles
– Pre-patellar bursa
• Bursitis
– Extensor mechanism
•
•
•
•
Rectus femoris
Vastus intermedius
Vastus medialis (VMO)
Vastus lateralis
INSPECTION:
Surface anatomy
• Medial:
– Pes anserinus
• “Say Grace before Tea”
– MCL
• Lateral:
– ITB (Gerdy’s Tuburcle)
– LCL
INSPECTION:
Surface anatomy
• Posterior:
– Popliteal fossa
• Baker’s Cyst
• Popliteal aneurism
INSPECTION:
Limb alignment
• INSPECTION:
– Genu Valgum
• Intra-maleolar distance
– Genu Varum
• Intra-condylar distance
– Windswept deformity
INSPECTION:
Patella alignment
• Squinting patellae
– Increased femoral ante-version
– Increased external tibial torsion
• Q angle
– Anterior ASIS to center of patella
– Center of patella to tibial tubercle
– 14° in men, 17° in women
• Patella Alta
• Patella baja
INSPECTION:
GAIT
•
•
•
•
•
•
Varus thrust
Valgus thrust
Recur vatum thrust
Antalgic gait
Stiff knee gait
Flexed knee gait
INSPECTION:
Range of movement
• Extension: Normal range
– Active : 0°
– Passive: - 10° (prone hanging test)
• Flexion: Normal range
– Active: 0° - 130°
– Passive: 0° - 150°
PALPATION:
• Be systematic
• Start and end at same spot
• Helpful system is to start anteriorly
PALPATION:
•
•
•
•
•
•
•
•
Patella
Infra-patella tendon
Tibial tubercle
Pes anserinus
MCL
Medial joint space and meniscus
Medial femoral condyle
VMO
PALPATION:
•
•
•
•
•
•
•
Rectus femoris
Vastus intermedius
Vastus lateralis
Lateral femoral condyle
LCL
Lateral joint space and meniscus
ITB and Gerdy’s tubercle
PALPATION:
• REMEMBER TO CHECK POSTERIOR!!!
• Popliteal fossa
• Popliteal pulse
MANIPULATION:
• Muscle testing
– Oxford grading (out of 5)
•
•
•
•
•
5 – normal power
4 – weak power
3 – against gravity
2 – with gravity
1 - Flicker
MANIPULATION:
• Use:
– “Flex or extend”
– “Hold it there”
– “Keep it there”
• Test:
– Quads
– Hamstrings
• Check for atrophy
– Measuring tape (compare)
SPECIAL TESTS:
• PATELLA TAP:
– Effusion
• FLUID THRILL:
– Effusion
• PATELLA GRIND
– OA
SPECIAL TESTS:
• VALGUS STRESS TEST:
– MCL (30° flexion)
– MCL, ACL and capsule (extension)
• VARUS STRESS TEST:
– LCL (30° flexion)
– LCL, ACL and capsule (extension)
• GRADE LAXITY:
– Gr I
– Gr II
– Gr III
SPECIAL TESTS:
• LACHMAN TEST:
– ACL
– PCL
• GODFREY’S TEST: (drop off sign)
– PCL
SPECIAL TESTS:
• DRAWER TEST:
– POSTERIOR: PCL
– ANTERIOR: ACL
SPECIAL TESTS:
• VARUS RECUVARTUM TEST:
– Posterior lateral corner
• SQUAT TEST:
– Meniscus
• APLEY’S GRINDING AND DISTRACTION TEST:
– Menisci
SPECIAL TESTS:
• MC MURRAY’S TEST:
– Medial meniscus
– Lateral meniscus
KNEE ASPIRATION:
• Sterile technique NB!!!!!
• Two fingers above and two fingers medial or
lateral to superior pole of the patella
• Aim needle towards the tip of the patella
below patella