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Clinical Examination of Knee Injuries

Examination Map HISTORY

Past Medical History

History of the Present Condition

Mechanism of Injury

FUNCTIONAL ASSESSMENT

Gait Assessment

INSPECTION

Girth Measurements

Inspection of the Anterior Structures

Patella

Patellar tendon

Quadriceps muscle group

Tibiofemoral alignment

Tibial tuberosity

Inspection of the Medial Structures

General medial aspect

Vastus medialis

Inspection of the Lateral Structures

General lateral structure

Fibular head

Posterior sag of tibia

Hyperextension

Inspection of the Posterior Structures

Hamstring muscle group

Popliteal fossa

  • Baker's cyst

Palpation

Palpation of the Anterior Structures

Patella

Patellar tendon

Tibial tuberosity

Quadriceps tendon

Quadriceps muscle group

  • Vastus medialis

  • Rectus femoris

  • Vastus lateralis

Sartorius

Palpation of the Medial Structures

Medial meniscus and joint line

Medial collateral ligament

Medial femoral condyle and epicondyle

Medial tibial plateau

Pes anserine tendon and bursa

Semitendinosus

Gracilis

Palpation of the Lateral Structures

Joint line

Fibular head

Lateral collateral ligament

Popliteus

Biceps femoris

Iliotibial band

Palpation of the Posterior Structures

Popliteal fossa

Hamstring muscle group

  • Biceps femoris

  • Semimembranosus

  • Semitendinosus

Determination of Intracapsular versus Extracapsular Swelling

JOINT AND MUSCLE FUNCTION ASSESSMENT

Goniometry

Flexion

Extension

Active Range of Motion

Flexion

Extension

Manual Muscle Tests

Knee extension

Knee flexion

Isolating the sartorius

Passive Range of Motion

Flexion

Extension

JOINT STABILITY TESTS

Stress Testing

Anterior instability

  • Anterior drawer test

  • Lachman test

  • Prone Lachman test

Posterior instability

  • Posterior drawer test

  • Godfrey's test

Medial instability

  • Valgus stress test: 0° flexion

  • Valgus stress test: 25° flexion

Lateral instability

  • Valgus stress test: 0° flexion

  • Valgus stress test: 25° flexion

Joint Play Assessment

Proximal tibiofibular syndesmosis

NEUROLOGICAL ASSESSMENT

Lower Quarter Screen

Common Peroneal Nerve

VASCULAR ASSESSMENT

Distal Capillary Refill

Distal Pulse

Posterior tibial artery

Dorsal pedal artery

REGION-SPECIFIC PATHOLOGIES

Uniplanar Knee Sprains

Medial collateral ligament

  • Valgus stress test

Lateral collateral ligament

  • Varus stress test

Anterior cruciate ligament

  • Anterior drawer test

  • Lachman test

  • Prone Lachman test

  • Quadriceps active test

Rotational Knee Instabilities

Anterolateral rotational instability

  • Pivot shift test

  • Jerk test

  • Slocum drawer test

  • Crossover test

  • Slocum ALRI test

  • Flexion-rotation drawer test

Anteromedial rotational instability

  • Slocum drawer test

  • Crossover test

  • Lachman test

  • Valgus stress test

Posterolateral rotational instability

  • External rotation (dial) test

  • External rotation recurvatum test

  • Posterolateral drawer test

  • Reverse-pivot shift test

  • Dynamic posterior shift test

Meniscal Tears

McMurray test

Apley compression/distraction test

Thessaly test

Osteochondral Lesions

Wilson's test

Iliotibial Band Friction Syndrome

Noble compression test

Ober test

Popliteus Tendinopathy

Tibiofemoral Joint Dislocations

Table 7-1Differential Diagnosis Based on the Location of Pain

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