Post on 18-Dec-2015
Clinical examination of the knee
H.Mousavi Tadi,MDDepartment of orthopaedicEsfahan medical schoolFeb,2013
Fundamental tool to diagnosis and treatment, and should never be replaced by the findings retrieved by the imaging studies .
The introduction of highly effective imaging tools like and MRI has stolen the central role of clinical evaluation, so that there's a common feeling, between patients but also between surgeons, that the diagnosis of a thorn meniscus or a ruptured ACL has to be ruled out only on the basis of an imaging study.
But the efficacy of a correct clinical examination needs not to be forgotten.
clinical evaluation of the knee
History mechanism of injury Duration of complaint Location, nature of symptoms Exacerbating or relieving
maneuvers
Key Questions in the History
Mechanism of Injury? Acute or Chronic? Location and level of pain? Able to walk? Mechanical Symptoms? (Locking, popping, catching?) Associated instability? Swelling? Exacerbating or relieving maneuvers? Previous injuries or surgeries?
activity level (IKDC score)
I - Strenuous activity(contact sports involving pivoting and cutting)
II - Moderate activity(pivot sports without contact; manual work)
III - Light activity(jogging, running)
IV - Sedentary activity
Clinical Examination
1) patello-femoral joint/extensor mechanism
2) articular (meniscal and chondral) lesions
3) knee instability
Diagnosis of a meniscal tear Joint line tenderness: Most important physical finding is localized
tenderness along the medial or lateral joint line or over the periphery of the meniscus. This most often is located osteromedially or posterolaterally,
Diagnostic accuracy rate 89%
Meniscal Rotation Tests Thessaly test
Diagnostic accuracy rate:
94%medial meniscus
96% lateral meniscus.
sensitivities and specificities
McMurray, 70% and 71% Apley, 60% and 70% joint line tenderness, 63% and
77%
Slocum Anterior Rotary Drawer Test
positive anterior drawer test result in neutral tibial rotation that is accentuated when the test is repeated in 30 degrees of external tibial rotation and reduced when it is performed with the tibia in 15 degrees of internal rotation indicates anteromedial rotary instability. The opposite indicates anterolateral rotary instability.
Tibial External Rotation (Dial Test)
Increased external rotation at 30 degrees that decreases at 90 degrees indicates isolated injury to posterolateral corner.
increased external rotation
at both 30 and 90 degrees indicates injury to both PCL and posterolateral corner.