Osteopathic Pediatric Knee Examination

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Osteopathic Pediatric Knee Examination

• American College of Osteopathic Pediatricians
• Robert W Hostoffer, DO, FACOP, FAAP

edited by Eric Hegybeli, DO, FACOP
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Review Structure of the knee
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(No Transcript)
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Knee joint orientation

• Up until about 2 yoa, the knee joint has a more
  varus positioning
• Persistence of this positioning leads to the
  deformity Genu Varus (Bowed legged)
• After age two, a more valgus position is assumed
• Progression of this positioning leads to the
  deformity Genu Valgus (Knock knee-ed)

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Knee Mechanics

• Flexion
• External rotation of the femur
• Internal rotation of the tibia
• (Tibial motion due to contraction of the
• popliteus muscle)
• Extension
• Internal rotation of the femur
• External rotation of the tibia
  
• (Due to relaxation of the popliteus)

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Sprains

• Grade I sprain - Stretching but no tearing of the
  ligament, local tenderness, minimal edema, no
  gross instability with stress testing, firm end
  point
• Grade II sprain - Partial tears of the ligaments,
  moderate local tenderness, mild instability with
  stress testing (but firm end point), moderately
  incapacitating
• Grade III sprain - Complete tear, discomfort with
  manipulation but less than expected for degree of
  injury, variable amount of edema (ranging from
  negligible to grossly conspicuous), clear
  instability with stress testing (expressing a
  mushy end point), severe disability

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Knee Inspection
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Demonstrate the procedure on patient in front of
director
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Walking inspection
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Demonstrate the procedure on patient in front of
director
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Varus strain
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Demonstrate the procedure on patient in front of
director
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Valgus strain
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Demonstrate the procedure on patient in front of
director
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Flexion of knee
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Demonstrate the procedure on patient in front of
director
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Extension of knee
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Demonstrate the procedure on patient in front of
director
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Patellar Grind
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Demonstrate the procedure on patient in front of
director
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Anterior Draw Test
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Demonstrate the procedure on patient in front of
director
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Posterior draw test
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Demonstrate the procedure on patient in front of
director
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Knee ballottement
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Demonstrate the procedure on patient in front of
director
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Lachman test
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Demonstrate the procedure on patient in front of
director
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McMurray test.
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Demonstrate the procedure on patient in front of
director
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Apley compression test
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Demonstrate the procedure on patient in front of
director
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Innervation Table
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Perform again the entire exam for your director.
Print the check list.
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Check list

• Inspection
• Walk
• Varus
• Valgus
• Flexion
• Extension
• Patellar grind
• Anterior draw
• Posterior draw
• Knee ballottement

• Lachman test
• McMurray test
• Apley

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Certificate of Completion

• I, _________________________, successfully
  completed the Pediatric OMT Module on __ __ 20__
• Signatures
• Pediatric Resident ____________________
• Pediatric Residency Director____________
• ( Please print and give to program director.)

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Congratulations