Knee Pain
Questions to ask:
Date of Injury
Mechanism of Injury
Able to walk or continue activity
immediately after injury
Able to walk or bear weight since injury
Effusion/Bruising
Mechanical symptoms
1st Injury?
To evaluate on PE:
Inspection/Palpation: obvious deformity,
joint line tenderness,effusion
ROM
Ligaments:Lachman
Menisci:McMurray
Patellofemoral assessment:VMO,Patellar
grind
Gait
Ligaments:
ACL: Lachman’s 30 degree flexion
PCL: Posterior sag sign, Posterior drawer test
MCL:Valgus stress 30 degree flexion
LCL:Varus stress 30 degree flexion
Menisci:
Joint line tenderness:
tender medially:medical meniscus, tender laterally: lateral meniscus
McMurrays: pain/pop on extension means +
Lateral meniscus- IR tibia + valgus
Medical meniscus-ER tibia + varus
Patellofemoral:
Effusion
Crepitus
VMO tone
Patellar grind
Xrays to order:
Bilateral AP weight bearing
Lateral
“Theater sign”-pain with
standing up
“circle sign”: pts point to knee
and draw a circle around patella
when asked where pain is
Merchants View
Knee Exam:
Always compare sides when examining!!
Lachmans: sensitivity 84% and specificity 93%
+:the tibia will feel unrestrained in forward movement
Suggests: ACL tear
Posterior Drawer Test: http://ajs.sagepub.com/content/26/3/471/F3.large.jpg
opposite of anterior drawer sign. Clinician pushes in.
+: if no discrete endpoint
suggests: PCL tear
Posterior Sag Sign:
+:difference in contour
suggests: PCL tear
McMurray Test: sensitivity 53-59% and specificity 59-97%
+: pain/pop as you extend the externally rotated leg while applying varus stress
suggests: Medial Meniscus teat
+: pain/pop as you extend the internally rotated leg while applying valgus stress
suggests: Lateral Meniscus tear
Varus and Valgus Stress:
+Valgus: if joint laxity/reproducible pain present
suggests: MCL(look for joint line tenderness)
+Varus: if joint laxity/reproducible pain present
suggests: LCL(look for joint line tenderness)
Patellar Grind Test:
Hold the patella in place with your
hand and ask the patient to contract
their quadriceps muscle
.
+: if you reproduce pain
suggests: patellofemoral pain syndrome
VMO tone:
+: if poor tone
suggests: patellofemoral pain syndrome
Effusion: Ballotable Patella, milking of knee inferior to superior