- Discussion:
- serial diagnostic exam should take into consideration static deformities of
the lower extremities, gait, ROM, tenderness, and knee stability;
- in the child w/ a painful knee, it is essential to closely examine the
hip as hip pathology can refer pain to the hip;
- Examination:
- Gait:
- Effusion:
-
Bursitis
-
Hemarthrosis;
- ROM:
- Nl functional ROM: 3 deg of hyperext and 140 deg of flexion;
- ADL ROM: for routines ADL's need 115 deg of flexion;
-
acute extension block:
- may be due to bucket handle meniscus tear, ACL tear (from interposition of the ACL between the femur and
the tibia), or from fat pad adhesions to a torn ACL;
- as is pointed out by KD Shelbourne MD (Arthroscopy Aug 1996 p 492), an acute knee block associated with an
ACL tear is usually due to interposition of the ACL between the femur and tibia in the intercondylar notch;
- this author emphasizes, the need to perform dedicated physical therapy to restore motion;
- physical therapy should consists of ROM, stretching, and patellar mobilization;
- references:
- The locked knee. JR Jones and RL Allum.
JBJS. 67-B. 1985. p 488.
- Fat pad adhesion to partially torn anterior cruciate ligament: a cause of knee locking.
A Finsterbush et al.
Am J. Sports Med. Vol 17. 1989. p 92-95.
- Tenderness:
-
popliteal tenderness:
-
deep venous thrombosis
- popliteal cyst
- pain radiating down the medial gastrocnemius can represent a ruptured Baker's cyst;
- medial
gastrocnemius head rupture;
- popliteal artery aneuysm; (see
popliteal artery);
-
Ruptured popliteal artery aneurysm. An insidious complication.
-
joint line tenderness:
-
meniscal tear:
-
McMurray test
- Squat Test:
- attempts to reproduce meniscal symptoms by performing repetitions of a full squat with the feet and legs alternately
internally and externally rotated as the squat is performed, testing the lateral and medial menisci, respectively;
- w/ the patient in the squat position, look for joint line tenderness;
- differential dx: (peri-articular tenderness)
- medial:
- semimembranosus-tibial collateral ligament bursitis;
-
MCL and/or
post oblique ligament tears;
- lateral:
-
LCL tears;
-
Popliteus Tendinitis
- femoral condyle tenderness (
chondral defect)
- masses in
popliteal fossa;
-
extensor mechanism:
-
quad tendon
-
patellar tendon
-
patella
- tenderness along margins of patella, with knee in extension
- feel for tenderness of the back of the patella by pushing the patella alternately to either side with one hand,
while the other is used to feel the exposed posterior surface of the patella;
-
Stability:
- ACL:
-
Lachman
-
Pivot shift
-
Anterior Drawer
-
Internal Rotation
-
Clunk Test
-
Losee Test
-
Anterolateral Rotatory Instability
-
Anteromedial Rotatory Stability:
- PCL Exam:
- need to rule out
posterolateral rotary instability w/
reversed pivot shift
-
Varus and Valgus Stress Test:
-
MCL and
Post Oblique Ligament tears;
-
LCL tears;
- need to rule out
posterolateral rotary instability:
-
arcuate complex
- Examination of the Patellofemoral Joint:
The accuracy of the clinical knee examination documented by arthroscopy: a prospective study.
MA Oberlander et al.
Am. J. Sports Medicine. Vol 21. p 773-778. 1993.
Femoral morphometry and anterior knee pain.
