Knee exam

Observation (supine)

• Ecchymosis (bruise)? Surgical scars?
• Erythema or overlying rash/celulitis
• Knee resting position
• Knee effusion with obscured landmarks
• Quadriceps muscle atrophy

Observation (standing)

• Balanced weight on each leg
• Genu varum or genu valgum deformity
• Gait analysis
• Hip, knee and ankle alignment
• Presence of Baker cysts (inspect popliteal fossa with patient standing)

Palpation

• Temperature
• Joint line tenderness
• Bony structures
• Bursae and tendons

Range of motion

• Normal flexion = 130 degrees
  • look for pain and crepitus
  • do active vs passive ROM
• Normal extension = 10 degrees above horizontal

Knee effusion tests

• patellar ballotment
• knee milking
• swipe test/bulge sign

Anterior Cruciate Ligament (ACL) Stability Tests

• Lachman's Test (most sensitive)
• Anterior drawer sign

Posterior Cruciate Ligament (PCL) Tests

• Posterior drawer test
• PCL sag test

Collateral ligament evalutation

• Knee valgus stress test (Medial collateral ligament)
• Knee varus stress test (Lateral colalteral ligament)

Meniscus Evaluation

• McMurrays Test (external rotation and extension from full knee flexion for medial meniscal tear, internal rotation and extension for lateral mensicusus)
• Apley's compression test (grind home test)

Other OSCE modules