05 Knee Examination Lecture handout - tablet view

80 Pages·2013·3.49 MB·English

Examination of the Knee
Ed Mulligan, PT, DPT, OCS, SCS, ATC
Clinical Orthopedic Rehabilitation Education
Examination of the Knee
subjective evaluation of the knee
help set the pre-exam probabilities of the diagnosis
HISTORY:
• Age and Gender
• Chief Complaint and Functional 
LLiimmiittaattiioonnss
• Patient's Rehabilitation Goal(s)
“… Stop squirming, Mr. Silcox. The sooner
we fill out these forms, the sooner we’ll
ffiindd outt exacttlly whhatt’’s wrong wiitthh you.””
subjective evaluation of the knee
Mechanism of Injury
gradduall vs. ttraumattiic onsett

known vs. insidious cause 

ooccccuuppaattiioonnaall aanndd//oorr aatthhlleettiicc AADLss

Frequency
–
Duration
–
IInttensiitty
–
Recent changes 
–
subjective evaluation of the knee
• Date of Injury
• Date of Surgery
length of immobilization 
–
ffoolllloowwiinngg ssuurrggeerryy
type of immobilization following 
–
surgery 
weight bearing status
–
“Looks to me as if every ligament
weight bearing progression 
– in your knee has been hideously
shredded beyond repair … Then
pprescripption or orders
aaggaaiinn,, iitt ccoouulldd bbee jjuusstt aa bbrruuiissee..”
subjective evaluation of the knee
• Previous Treatment
what, where, when, by whom?
–
orthotics, braces, sleeves, etc.?
–
medications or injections?
–
OTC  NSAIDs

– Acetaminophen (Tylenol), Ibuprofen (Advil, Motrin);
Naproxen (Aleve); Aspirin
Prescriptive NSAIDs (Cox‐2 Inhibitor)

– Celecoxib (Celebrex) or Lodine
IInjjectiions

– Hyaluronic Acid; Cortisone; PRP
subjective evaluation of the knee
Present Status 
. . . better, worse, or same
work status

ppaaiinn ccoommppllaaiinntt 

location, nature, severity, 
•
duration, time, aggravated or 
rreelliieevveedd bbyy,, 
neurological or effusion complaints

crepitation, popping, catching, 

lloocckkiinngg, bbuucckklliinngg, eettcc.
subjective evaluation of the knee
Past Medical History
SYSTEMS REVIEW
general medical or family history 
–
previious rellattedd iinjjuriies
–
diagnostic studies
–
• x‐ray, CT scan, MRI, EMG/NCV, arthrography

imaging may reveal pathology but
musculoskeletal exam and patient
historyy pprovides relevance
objective knee evaluation
tests and measures
OBSERVATION:
General Appearance
•
Posture
–
Weight Bearing Status
–
Symmetrical Appearance
–
SSofft TTiissue swelllliing, effffusiion, atrophhy, etc.
–
Body Type
•
EEnddo//MMeso//EEcttomorphhiic
–
structural abnormalities
Sagittal Plane
• Genu Recurvatum
• Patella Alta/Baja
Transverse Plane
• Femoral Anteversion-Retroversion
• Femoral Torsion