Ask about any pain and then start by examining the normal side with the patient supine.
Cross fluctuation test
Patella tap test
Bulge test
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Test active then passive movements, keeping one hand on the knee to feel for crepitus.
Collateral ligaments
Hold the patient’s ankle/lower leg in one hand and their knee in the other. Apply varus and valgus knee forces to the knee. This stresses lateral and medial collateral ligaments respectively. Test at 0˚ and 30˚ of knee flexion. (You can hold their foot between your elbow and your side.) Look/feel for excessive movement (collateral ligament laxity).
Drawer test
First check for foot pain, then flex knee to 90˚, sit on the side of their foot, and hold upper tibia with thumbs on tibial tuberosity and fingers in popliteal fossa. Pull anteriorly (anterior lag = anterior cruciate ligament laxity); then push posteriorly (posterior lag = posterior cruciate ligament laxity).
Lachman’s test
With the patient’s knee flexed to 30˚, hold one hand on top of their thigh and the other on their posteromedial proximal tibia. Pull tibia anteriorly (more sensitive for anterior cruciate ligament laxity).
McMurray’s test
Warn patient this test may cause pain. Flex knee as much as possible. Use one hand to externally rotate their foot and hold it over to the contralateral side of the patient. Then apply varus force to knee with the other hand, while extending the knee joint (stresses medial meniscus). Then test the opposite side (stresses lateral meniscus). Positive test = painful click felt or heard (meniscal tear).
Patellofemoral apprehension test
Flex knee while pressing patella laterally. If patella is unstable, patient will anticipate dislocation and stop you.
Apley’s grind test
With patient prone and knee flexed to 90˚, apply axial load to the knee and rotate foot (pain = meniscal damage)
• Grade 1: pain but knee stable
• Grade 2: pain and laxity
• Grade 3: very lax (no end point)
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Please list some causes of a knee effusion
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The ‘unhappy triad’ also known as a ‘blown knee’ refers to which three injuries?
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A patient presents with a red, hot and swollen knee, what are your differentials?
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Anterior lag on the anterior drawer test would indicate which pathology?
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What is a bursa and how does a bursitis develop?
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