mymrcgp

Physical Examination

Painful Knee

 

 

 

 

 

 

 

 

 

 

 

Common Examination Components:

(You are likely to be expected to examine the common components in each case)


Introduction:

  • ‘What you have told me suggests I need to examine your right/left knee. Please could you roll up your trousers or take them off if necessary so I can see your knee joint'

 

Inspection:

(inspect gait, expose the knee, look for deformity, swelling, effusion)

 

Palpation: 
Limit palpation to the affected side only

  • palpate from quadriceps to patella tendon for tendonitis, joint line tenderness

 

Range of Movement:

Compare range of movement on either side 

  • Flexion (loss of flexion may indicate arthritis or meniscal injury)
  • Extension

 

Joint Stability:

  • Draw test (for ACL stability)
  • Collateral ligament (with limb at 15 degrees of flexion)

 

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Additional Examination Components:

(Examine an additional component If the specified indication is present)

 

Indication: History suggestive of meniscal tear (twisting knee injury)

 

Components: Meniscal testing - either McMurray or Thessaly tests.
 

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What CSA Examiners and Trainers Expect - A Typical Scenario

(Study by N.Boeckx: Data from 300 GP Trainers and 16 CSA examiners)


Case Details: A 48 year old man presents with knee pain. The cause is a meniscal tear. The history and examination is consistent with a medial meniscal tear.    Choose the examinations you would expect from a safe GP in a 10 minute consultation.

Case Discussion: If you get a knee exam you should rejoice because the knee examination is a relatively straight forward one. Why? Because the number of components are relatively few, little selection of components is required and each examination component is brief and simple to interpret.

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