NP/CNM/PA
PROFESSIONAL PRACTICE GROUP
CITY & COUNTY OF SAN FRANCISCO
APRIL 21, 2011 CONFERENCE
Dan Bertheau, NP, MPH
Orthopaedic Trauma Institute
SFGH/UCSF
Knee Examination
DISCLOSURE
I have no relevant financial disclosures related to topics in this lecture
KNEE EXAM- TOPICS
• Anatomy
• Three Typical Conditions
• History
• Physical Exam Tests
• Diagnostics
• Red Flag/Emergent/Urgent
• Referrals
• Physical Exam
KNEE ANATOMY
www.aclsolutions.com
KNEE ANATOMY
www.aclsolutions.com
THREE TYPICAL CONDITIONS
• DJD
• Ligament Injury (ACL- most common)
• Meniscus Injury
HISTORY
• Mechanism of Injury
• Edema
• Duration
• Neurovascular
• Walking Tolerance
(# blocks)
• Range of Motion
(~0-140)
• Locking? (unable to
fully extend- r/o
Bucket Handle)
• Sensation
• Motor
• Previous Treatment
(success/failure)
• Assistive Devices
PAIN
• Anterior- Patella & Associated Soft Tissues
• Medial- Meniscus, OA
• Lateral- Iliotibial Band Friction, Meniscus, OA
• Posterior- Meniscus, Baker’s Cyst
KNEE DJD
LACHMAN- ACL
Snider, R.
ANTERIOR DRAWER- ACL
Snider, R.
MRI – NORMAL ACL – SAGITTAL VIEW
Helms, C. A.
MRI – ACL RUPTURE – SAGITTAL VIEW
VARUS STRESS- LCL
VALGUS STRESS- MCL
www.aafp.org
POSTERIOR SAG- PCL
Snider, R.
MCMURRAY TEST- MENISCUS
MRI – MENISCAL TEAR – SAGITTAL VIEW
MENISCUS TEAR
www.leadingmd.com
X-RAY IMAGING
***WEIGHT BEARING***
• AP
• Tibiofemoral Joint
• LAT
• Patellofemoral Joint
• Rosenberg (Bent Knee PA)
• Tibiofemoral Joint
• Sunrise (Merchant, Axial)
• Patellofemoral Joint
MRI IMAGING
• Order Plain X-Rays First
• R/O Soft Tissue Injury
• Do Not Order In Patient With Known DJD
LAB
• CBC with Differential
• ESR
• CRP
RED FLAG/EMERGENT/URGENT
• Knee Dislocation
• Septic Knee
• Acute Fractures
• Bucket Handle Tear of Meniscus
REFERRAL- LESS THAN IDEAL
“knee pain”
REFERRAL- IDEAL
“64 year old male with several years of
progressive right knee pain; less than 2 block
walking tolerance for last 6 months; failed
NSAIDs; started PT 3 months ago; Jan 2011
WB x-rays = arthritic changes; interested in
op & non-op options”
PATIENT HANDOUTS
• PCP “Bridge” to Physical Therapy
• Online (in the future)
REFERENCES
• Atlas of Human Anatomy, 2 nd Edition, Netter, Frank, 2003, Icon
Learning Systems
• Essentials of Musculoskeletal Care, Snider, Robert K., Ed.,2003,
American Academy of Orthopedic Surgeons
• Fundamentals of Skeletal Radiology, 2 nd Ed., Helms, Clyde A., 1995,
W. B. Saunders
• Orthopaedist’s Guide to Plain Film Imaging, Pavlov, H., Burke, M.,
Giesa, M., Seager, K.R., White, E.T.,1999, Thieme Medical Publishers
• Orthopedic Physical Assessment, 4 th Ed., Magee, David J., 2002,
Elsevier Sciences
• Physical Examination of the Spine & Extremities, Hoppenfeld,
Stanley, 1976, Appleton-Century-Crofts
Thank
You!