Knee Examination Inspection & Palpation - Everything You Need To Know - Dr. Nabil Ebraheim
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- เผยแพร่เมื่อ 3 พ.ย. 2016
- Dr. Ebraheim’s educational animated video illustrates the knee examination.
The immediate swelling is probably a large hemarthrosis.
And if the patient stated they had a twisting injury and now they feel locking and catching which we call it mechanical symptoms and the patient gets some swelling later on then this is probably meniscal tear.
The if the patient stated that they have pain with stairs and anterior knee pain and feel some crepitus then this is probably a patellar problem.
If the patient said they have pain in the inside of the knee after a blow to the outside of the knee, that's probably an MCL tear.
If it is a dashboard injury or a fall with the foot plantar flexed then this is probably a posterior cruciate ligament ( I was texting you about itPCL) injury.
Is a patient stated that they had a fall with the foot dorsiflexed then this is a patellar problem.
Inspection:
Where are going to inspected the knee area for swelling, scars, ecchymosis, and muscle atrophy.
We check the quadriceps on the right and left sides.
Compare the condition of both quadriceps muscles to each other.
Then ask the patient to stand and check the alignment.
If they have varus bow legs, or valgus knock knees,
Does the patient have a cavus foot, high arched foot, internal tibial torsion or flat foot?
That will increase the patellofemoral abnormality.
After that we check the gait:
Check if a patient has quadriceps avoidance gait, which occurs with ACL injury.
The patient will walk with slightly bent knee to avoid making the quadriceps work.
Check if the patient has an anatalgic gait, which is a painful gait, it is done to lift the painful extremity quickly off the ground, it is usually caused by a hih or a knee pathology or from severe disc radiation symptoms.
Make sure that the pain is not radiating from the spine so we ask the patient questions related to the spine.
Straight leg raising test:
- the test is positive when the painful limb is elevated and that causes severe ciatica and radicular pain.
Make sure you check the dorsiflexion and plantar flexion of the ankle and toes, specially the big toe.
Chick the sensation in different dermatomes.
Then don't forget about the hip exam specially in children, they may have a slipped epiphysis so we need to check the internal and external rotation of the hip.
Questions about the hip and hip Exam May detect hip pathology with pain radiating to the medial aspect of the knee.
Range of motion:
The patient will be supine.
Extension should be full.
Election should be about 130°.
Compare to the other side.
When you evaluate and compare flexion contracture on both sides you can do it supine or prone position.
as every Orthopedic patient, you'll also do distal neurovascular exam.
the neurovascular exam will include the sensation, at the foot level.
will examine the strength and the power of the muscles of the quadriceps, hamstrings, and gastrocnemius muscles.
Don't forget about the pulses.
Especially in patient with knee dislocation or multiple ligamentous injury of the knee.
You may get assistance from the ankle brachial index which should be at least 0.9.
Palpation:
palpation is usually done with the patient in the Supine position.
The first thing I do is palpate the joint line tenderness in order to rule out a meniscal tear or arthritis.
Then I palpate the anatomical landmarks around the knee, like the quadriceps tendon, patella and the distal pole of the patella, to see if the patient has Jumper's knee.
I palpate paid around the patellar tendon, tibial tubercle to rule out Osgood schlatter disease.
Patella pathology, the most specific test is the patella apprehension test.
You put your fingers on the patella and then try to push the patella that's really, if this causes pain and apprehension then the test is considered positive.
Evaluate patellar tracking, do full range of motion, to see if the patella will stay in the position or if it will sublux.
Check the medial side tenderness over the medial patellofemoral ligament.
Check the patellar stability by moving the patella from side to side.
Try to check the underside of the patella for any sign of arthritis or chondral lesion, both medially and laterally.
Check for the hamstring muscle insertion for the as in pes anserine bursitis.
pes anserine Bursa is located several fingers breadth below the level of the joint.
The most important thing is not to miss him hemarthrosis or effusion in the knee joint, at that point I started looking for an ACL tear, meniscal injury, patellar dislocation or intra-articular fracture.
Look for effusion check the suprapatellar pouch and around the knee for effusion or swelling.
Try to push the fluid from one side to the other top to the bottom or vice versa, try to feel the fusion.
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Thank you for all your time and efforts to provide these instructional videos which I find very valuable and advance my patient care. Well done!
Thank you for sharing this great video to help me with my pain.
Thanks for your time and effort to dedicate your time to explain to us indeed about the kneed examination
Another great video to help me with my work!
Thanks Doc !! Very well explained!
Thank you Dr❤
they are very helpful.
very nice sorted all common problems a d examination
thanks
Thank you dr
I love this chanel, thank you so much 😊 🙏🙏⚘️⚘️
Thanks
Outstanding video. Thanks for sharing your information
Nice explanation and nice guidance
thanks
very nice
Thank you
I have multiple ligament tears on falling from bike. My legs gets locked and twisted in such a way that this happened. I gave my affected right knee a complete rest for 6 weeks with gauze wraps. After going to PT for 2 months, I got the full ROM on my right knee now effusion was almost reduced. Still have miles of exercises to go in PT for strengthening and stabilizing my knee. As of now I can climb up stairs but couldn't descend from stairs. Hope victims like us will all recover soon.
Very nice presentation. I enjoyed it.
I did fall on a cement floor, I am suffering of a chronic pain on my left side knee(Patella), the pain shoots down to my foot.
Sei grande medico...grazie mille 👍🏻👍🏻💪💪💪
Great information thank u
I was playing rugby and my knee bent inward causing excruciating pain, now I can kneel or stretch my right leg without pain. I have some swelling on the outside of my knee. Does anyone have any suggestions for recovery? I want to go back and play
When i stand for a lobg time my knees hurt bad and my ankles swell what could this be
hi doc i have history of accident from motorcycle10 years ago then my knee i always feel pain specially if i am walking if i take operation how much it cost
my knee has no pain but there is usually weak feeling inside my knee or a tingly sensation...I cannot climb the stairs much or run cause then it'll hurt with sharp pain and there is a clicking feeling on beside my patellar
والله انك رهيب
I am experiencing these kind of symptom to my left knee from a previous injury due to hitting it everytime I have an episode of seizure. What can be done about it?.
Hi where can i contact you.for my Knee problem .im using two walking sticks please help
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رائع
broken patella can bend 100 %???? after surgery
Tq sir
Wow, my doctors have never done any of that. They look at xrays, or maybe just read the rad doctor's note. Then they tell me nothing is wrong. I don't do much of anything because of pain, every one of those points hurt. I started doing my own exercises to strengthen my legs. Wish I had a real doctor.
Update. Dr says "you have arthritis. Nothing to do except a knee replacement ". Although he did spend nearly 60 sec with me to tell me that. We're done.
@@SF-cq6bg I have a pool but its about 70 deg! I think a personal trainer is the key. PTs only do what the doctor asks. I have pain from the sacrum to foot but they separate it into sections. Each doctor only treats one joint these days.
@@mohergenrader2113 i had the exact same experience with a 2nd recommended Dr...60 secs turns and walks out door....never went back. Still limp...and pain but stretching and moderate exercise helps alot
I hv all this symptoms what shd I do
Where are you Doc?
Please i want your contact doctor
I feel like I have all 😂😂
It means u have ligamentous laxity...
Barmelu gewarges
:D
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lpllllll