Inspect standing and lying:
Ask about any pain and then start by examining the normal side with the patient supine.
Patella tap test
Fluid displacement (stroke) test
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Test active then passive movements, keeping one hand on the knee to feel for crepitus.
Collateral ligaments
Hold the patientβs 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 0Λ and 30Λ of knee flexion. (You can hold their foot between your elbow and your side.) Look/feel for excessive movement (collateral ligament laxity).
Drawer test
Flex knee to 90Λ. With your hands around their upper tibia (thumbs on tibial plateau), pull anteriorly (anterior lag = anterior cruciate ligament laxity); then push posteriorly (posterior lag = posterior cruciate ligament laxity).
Lachmanβs test
With the patientβs knee flexed to 30Λ, 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).
McMurrayβs test
Fully flex the patientβs knee. 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).
Apleyβs grind test
With patient prone and knee flexed to 90Λ, apply axial load to the knee and rotate foot (pain = meniscal damage)
β’ Grade 1: pain but knee stable
β’ Grade 2: pain and laxity
β’ Grade 3: very lax (no end point)
A patient presents to ED with chest pain and this trace. What would you do?
Interpretation management
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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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A patient presents to ED with chest pain and this trace. What would you do?
Interpretation management