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Knee Exam
Aka: Knee Exam, Knee Examination, Knee Joint Finding, Knee Maneuver
- See Also
- Knee Injury Acute History
- Knee Pain
- Exam: General (compare with less affected knee)
- Observation
- Ecchymosis
- Knee Effusion with obscured landmarks
- See Knee Effusion Causes
- See Ballottable Patella Sign
- See Knee Bulge Sign
- Previous surgical scars
- Knee resting position
- Quadriceps muscle atrophy
- Evaluate Vastus Medialis Obliquus specifically
- Atrophy often on side of Ligamentous Injury
- Tenderness to Palpation
- Patella
- Tibial tubercle
- Patellar tendon
- Quadriceps tendon
- Joint line
- Pes Anserine Bursa
- Iliotibial Band
- Normal Knee Range of Motion
- Flexion: 135 degrees
- Extension: 0 to -10 degrees (above horizontal plane)
- Exam: Patellofemoral
- Quadriceps Femoris Muscle Angle (Q Angle)
- Patella tracking with quadriceps contraction
- Evaluate for smoothness of motion and crepitation
- Patellar Apprehension Test
- Evaluates for Patella Subluxation
- Exam: Anterior Cruciate Ligament (ACL) Stability Tests
- Lachman Test (most sensitive)
- Knee Anterior Drawer Test
- Pivot Shift Test (MacIntosh Test)
- Exam: Posterior Cruciate Ligament (PCL) Tests
- Knee Posterior Drawer Test
- PCL Sulcus Test
- PCL Sag Test
- Exam: Collateral ligament evaluation
- Knee Valgus Stress Test (Medial collateral ligament)
- Knee Varus Stress Test (Lateral collateral ligament)
- Exam: Meniscus Evaluation
- McMurray's Test
- Apley's Compression Test and Apley's Distraction Test
- Knee Bounce Test
- Thessaly Test
- Inability to fully extend knee may suggest "bucket-handle" meniscal tear
- Joint line tenderness is 76% sensitive for meniscal tear, but not specific
- Exam: Neurovascular
- Leg Motor Exam
- Distal sensation
- Deep Tendon Reflexes (Patella, achilles)
- Distal pulses (dorsalis pedis, posterior tibial)
- Exam: Standing evaluation
- Balanced weight on each leg
- Deformity
- Genu Varum

- Genu Valgum

- Gait analysis
- Patella baja or Patella alta deformity
- Hip, Knee, and ankle alignment
- Imaging
- See Knee XRay Indications in Acute Injury (e.g. Ottawa Knee Rule)
- Knee Ultrasound Indications
- Dynamic tendon evaluation (e.g. Patellar tendon, quadriceps tendon)
- Collateral ligament evaluation
- Baker Cyst
- Neurovascular evaluation
- Knee Effusion evaluation (esp. to direct needle aspiration)
- Knee MRI Indications
- Occult Fracture not visualized on XRay (CT may also be used)
- Malignancy
- Vascular Injury
- Osteomyelitis
- Potential surgery (ACL or PCL Tear, vertical meniscal tear)
- Mechanical symptoms refractory to trial of physical therapy
- Diagnostics: Knee Arthrocentesis
- See Monoarthritis or Polyarthritis
- Indications
- Large, painful Knee Effusion of unclear etiology
- Simple clear transudative fluid
- Knee sprain
- Chronic meniscal tear
- Hemarthrosis (Bloody effusion)
- Anterior Cruciate Ligament Tear
- Osteochondral Fracture (Tibial Plateau Fracture)
- Acute meniscal tear
- Pustular Drainage
- Septic Joint
- References
- Bach (1997) Physician Sportsmed, 25(5): 39-50
- Budoff (1997, April) Consultant, 919-30
- Budoff (1997, Feb) Consultant, 295-304
- Hoppenfeld (1976) Physical Exam, Prentice-Hall
- Bunt (2018) Am Fam Physician 98(9): 576-85 [PubMed]
- Calmbach (2003) Am Fam Physician 68(5):907-12 [PubMed]
- Rothenberg (1993) Postgrad Med, 93(3): 75-86 [PubMed]
- Smith (1995) Am Fam Physician 51(3):615-21 [PubMed]
- Solomon (2001) JAMA 286:1610-20 [PubMed]