Knee Assessment & Diagnosis of Pain

Knee Assessment

What Is Knee Joint & Knee Assessment?

  • Biggest joint in our body
  • Hinge type of synovial joint
  • Movements(Flexion, Extension, Rotation medial and lateral)
  • Most weight bearing joint
  • Resting position = 25 degree
  • Capsular pattern : Flexion,Extension
  • Close packed position : Full Extension,lateral rotation of Tibia
human-knee-joint-anatomy
human-knee-joint-anatomy

Knee Assessment :

Components of assessment :

  • History
  • Observation
  • Examination of the Movement
  • Special Tests
  • Reflexes and cutaneous distribution
  • Joint play movements
  • Palpation
  • Diagnostic imaging

History :

Questions to be asked :

Q#1:

  • Where did he Felt Pain ?

Q#2:

  • How did the accident occur?

Q#3:

  • What Is the patient able or unable to do functionally?

Q#4

  • Has the knee injured before?

Observation for Knee Assessment :

  • Aim : Gait patterns & functional activity
  • Initially Examiner should Note:

whether the patient puts weight on the affected limb or stands with only a slight amount of Weight on the affected side.

Than note :

1.Anterior view standing :

  • Genu varum (bow legs) & Genu valgum (knock knees)
  • Is there any swelling around the knee joint ..

Intracapsular = entire joint

Extracapsular = localized

e.g pre-patellar bursitis

2- Lateral View, Standing :

  • Comparison of both sides for higher or lower patella ( patella alta or patella infera)

3- Posterior view standing :

  • Look for abnormal swellings e.g Popliteal (Baker’s) Cyst.

4- Anterior and Lateral View, Sitting :

  • sitting on chair or stool with knee flexed 90 degree

Knee Examination of the Movement :

Active  Movements :

Passive Movements :

Functional Assessment :

 Reflexes and cutaneous supply :

  • Reflexes : Patellar Tendon (L3)
  • Dermatomes (L3)
  • Myotomes : Flexion (L5) & Extension (L3)

Special Tests :

Special Tests on knee are only performed if the examiner suspects certain pathologies & wants to do a confirming test.
Tests for swelling should always be performed.

Special Test
Special Test

Testing for Ligaments :

Tests for instability

  • Anterior Drawer Test & Lachman Test are  performed  to check ACL ( Anterior Cruciate Ligament )
  • Posterior Drawer Test & Sag Sign are performed to check PCL ( Posterior Cruciate Ligament )
  • Varus stress test is performed to check the LCL ( Lateral Collateral Ligament )
  • Valgus stress test is performed to check the MCL ( Medial Collateral ligament )
  • Appley’s Test & Mucmurrey Test both can be performed for Meniscle instability
  • Ober Test is performed for IT Band ( Iliotibial Band ) tightness.

 Joint Play Movements for Knee Examination :

  • Patient is in supine position.
  • Movement on the affected side is compared with that of the normal side.

Movements are :

  • Backward & Forward gliding/movement of Tibia on Femur
  • Medial & Lateral translation of the Tibia on the Femur
  • Medial & Lateral displacement of the Patella
  • Depression of the Patella
  • Anteroposterior movement of the Fibula on the Tibia.

Palpation :

  • Supine lying & knee slightly flexed
  • Meniscal cysts = 45 degree
  • Joint line = 90 degree

Anterior Palpation with knee extened :

  • Patella,Patellar Tendon,Quadriceps Muscles,Medial Collateral Ligament,Pes Anserinus(apponeurosis of tendons of gracilis,semi-tendinosus & Sartorius),TFL & IT band.

With knee flexed :

  • Adductor muscles,meniscal cyst,TFJ line at 90 degree,tibial plateau ,femoral condyles.

With foot resting on the normal Leg :

  • Lateral collateral ligament

Posterior Palpation with knee slightly flexed :

  • Posterior, Posterolateral & Posteromedial aspects of knee
  • Hamstring Muscles
  • Gastrocnemius muscles

Diagnostic Imaging:

Plain Film Radiography

  • For Knee evaluation
    Anteroposterior and lateral views are most commonly obtained.
  • Other diagnostic imaging tools are
    Computed tomography (CT SCAN) &
    MRI (Magnetic Rasonance Imaging)

Xeroradiography:

Xeroradiography may be used to delineate the edge of bone.

Xeroradiography :
Xeroradiography :

A good Physiotherapist should Know The Knee Anatomy & Assessment.

Download Knee Joint Assessment PDF From Here 

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