Knee Assessment

For the knee examination you would not need the pt to remove their top, however you may ask them to lift it to reveal their tummy when looking at posture. You should ask them to remove their socks and shoes, and don’t forget to clear the surrounding area to remove obstacles! Unless you’re working on agility anyhow.

Observation

·  How the pt stands

·  Are the iliac crests level?

·  Hip drop

·  Spread of weight

·  Muscle bulk – same on both legs?

·  Creases – same on both legs?

·  Skin Abrasions

·  Bruising

·  Swelling

·  Discolouring

·  Genu valgum, genu varum or normal?

·  How the pt walks

·  Apply with stairs and squats

Genu Valgum – knees are bent inwards causing a stretch on
the medial side and compression on the lateral side.

Genu Varum – knees are bent outwards causing a stretch on 

the lateral side and compression on the medial side.

AROM and OP

Flexion – in supine. Flex the hip and knee up to 90 degrees and then straighten the leg as far as possible. Get the pt to bend their leg bringing their heel down to their arse. How far do they go? 

Apply overpressure – what is the end feel?  Place one hand on knee to prevent pushing knee towards chest and push downwards with the other hand.

Limiting Factors – What’s stopping them from continuing?

Extension – in supine. Start from the end of flexion, and ask them pt to lift their toes to the ceiling keeping their knee where it is. Perhaps hold knee to support.

Apply overpressure – what is the end feel? Lie their leg flat on the plinth and push down on the knee whilst lifting the ankle. This can also be done sat up where the pt reaches as far back under the bed as possible and then extends, however this technique is unsuitable for those with poor balance.

Both of the above can be done in standing, providing support is provided. However in general it is easier to just use the plinth.

Passive ROM

Differentiate the difference in range and pain. Pain only on active movements indicates muscle issues, whereas pain on passive indicates joint involvement.

Accessory Movements

Place the pt on their back and bring the sore leg up to the angle where the pain is (so not always at 90 degrees).

AP – Wrap hands around the back and place base of thumbs on front around the joint line. Push in line with the femur.

PA – Wrap hands around the back and place fingers in between the gastroc. Place thumbs on the joint line and pull in line with the femur.

Static Resisted Testing

Place pt on back, with hip and knee flexed at right angles.  Push down for extension and pull up for flexion. Ensure the bed is low so you can use your body weight and keep a straight back.

MRC

Start at three and then progress up or down depending on the results.

You would test flexion in prone, where you would ask the pt to lift their foot up to their bum. A different position would be needed for flexion beyond 90 degrees as it becomes with gravity.

Extension could be tested from standing or sitting, where you would ask the pt to bring their foot from their bottom up towards the ceiling.

Grade 2 can be done in side lying, with a pillow between the knees and underneath the pts head.

Grade 4 can be established by applying resistance in the same positions as used in grade 3.

Muscle Length

Use of Thomas test and hamstring length test.

Palpation of Soft and Hard Structures of the Knee

·  Patella

·  Condyles

·  Rec Fem

·  Hamstrings

·  Sartorius

·  Tibial Tuberosity