MSK examination of the knee

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MSK examination of the knee

• Matthew Malone
• Advanced Podiatrist (MSK)
• Manchester PCT

20/2/08
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The Knee

• Knee pain accounts for approx 1/3 of MSK problems
  seen in primary care.
• Most prevalent in active patient.
• Female gt Males. Female athletes increased risk
  for knee injuries
• differences in sports undertaken
• gender anatomy and structure
• baseline level of conditioning,
• lower extremity alignment,
• physiological laxity,
• pelvis width,
• tibial rotation and foot alignment
• Hutchinson MR, Ireland ML .Knee injuries in
  female athletes. Sports Med. 1995
  Apr19(4)288-302.

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The Knee

• 2762 athletes were admitted to the Turku Sports
  Medical Research Unit's outpatient sports clinic
  from 1976 to 1983 and 886 (32) of them, 697 male
  and 189 female athletes, had suffered knee
  disorders. The mean age of all athletes with knee
  disorders was 20.8 years.
• Kujala UM, Kvist M, Osterman K .Knee injuries in
  athletes. Review of exertion injuries and
  retrospective study of outpatient sports clinic
  material. Sports Med. 1986 Nov-Dec3(6)447-60. .
  

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The knee

• Location of pain
• Anterior
• Medial
• Lateral
• Posterior
• Type of pain
• - Dull ache
• - Sharp stabbing
• - General achy niggle
• - Locking sensation

• Onset of pain
• - Rapid
• - Insidious
• - Just with sports
• - Relieved by rest
• - going down stairs
• - knee flexed
• - knee extended

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The Knee

• HOW? Activity at the time? If any?
• Knee hyper-extended / hyperflexed?
• Kicking a ball- leg suddenly gave way?
• Twisting component?
• Anterior force applied with knee flexed hitting
  dashboard in RTA?
• Pop heard or felt?
• Swelling after injury (immediate vs delayed)
• Catching / Locking
• Buckling / Instability (giving way)

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The Knee

• Historical Clues to Knee Injury Diagnoses

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Common knee pathologies

• Osgood Schlatters
• Patella tendonitis
• Quadracep tendonitis
• Bicep femoris tendonitis
• Co-lateral ligament
• ACL PCL
• Meniscal
• Plica syndrome
• Bakers / popliteal cyst
• Pes anserine bursae
• ITB friction syndrome
• Pre- patella bursitis

• Anterior knee pain
• Patella femoral dysfunction
• Chondromalacia patella

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Special testing

• Assess stability of 6 knee ligaments via applied
  stresses

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Co-lateral Ligaments
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Co-lateral Ligaments
Medial Collateral Ligament (MCL)
Pes anserine bursa
Medial joint line
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Co-lateral Ligaments
Lateral Collateral Ligament (LCL)
Lateral joint line
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Valgus stress test for MCL
Leg flexed at 30
Note Direction Of Forces
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Varus Stress test for LCL
Note direction of forces
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ACL and PCL
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ACL and PCL -Lachman Test
Bend the knee to about 30 degrees. Then,
stabilize the femur with one hand. Place the
other hand behind the proximal tibia at the level
of the joint line and then pull forward.
Note direction of forces