Comprehensive Guide to Acute Knee Examination in Urgent Care

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This detailed guide covers the essential components of the acute knee exam conducted in an urgent care setting by Dr. Gregory Jones, including chief complaints, anatomy, examination techniques, ligament assessments, practical aspects, and more. The examination process involves assessing functional limitations, localized or systemic issues, acute or chronic conditions, and specific signs like snapping, locking, or dislocation sensations. Various tests are performed to evaluate gait, joint line pain, effusion, muscle symmetry, range of motion, neurovascular status, ligament integrity (ACL, PCL, LCL, MCL), patellar subluxation, and practical examination aspects which are more sensitive in the absence of severe pain and swelling.

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THE ACUTE KNEE EXAM IN THE URGENT CARE CLINIC GREGORY JONES MD

ANATOMY

Chief Complaint HISTORY Are there any functional limitations? Localized or systemic ? Acute or Chronic? Mechanism of injury? Snapping, locking, buckling or sensation of "dislocation"

EXAM GAIT VARUS-BOWING VALGUS-KNOCK KNEES JOINT LINE PAIN, SNAPPING, EFFUSION,EXTENSION LAG-LOCKING

EXAM SKIN MUSCLE ASYMMETRY GAIT

PALPATION CHECK LANDMARKS JOINT LINE TENDERNESS POINT OF MAXIMUM TENDERNESS ON PALPATION EFFUSION WARMTH

ROM CHECK BOTH ACTIVE AND PASSIVE COMPARE WITH UNAFFECTED KNEE FLEXION TO 130 DEGREES EXTENSION TO 10 DEGREES

NEUROVASCULAR SENSORY MOTOR VASCULAR

LIGAMENTS ACL: WHEN FOOT IS PLANTED AND ROTATION OCCURS IN LATERAL DIRECTION. USUALLY NON-CONTACT. TEST:LACHMAN PCL: DASHBOARD POSTERIOR PAIN. TEST: POSTERIOR DRAWER LCL: FORCE APPLIED TO MEDIAL ASPECT OF KNEE WHILE FOOT IS PLANTED. MCL: FORCE APPLIED TO LATERAL ASPECT OF KNEE WHILE FOOT IS PLANTED OFTEN WITH SEVERE CLIPPING TYPE INJURY ONE GETS ACL,MCL AND MEDIAL MENISCUS "TERRIBLE TRIAD"

PATELLA SUBLUXATION INJURY OFTEN CONFUSING MAY SAY THE KNEE FELT DISLOCATED TEST: PATELLAR APPREHENSION CREPITANCE

PRACTICAL ASPECTS OF KNEE EXAM MANY OF THESE TEST ARE MORE SENSITIVE WHEN THERE IS NOT SEVERE PAIN AND SWELLING. APPLY GRIND TEST- NON SPECIFIC LACHMAN S TEST-ACL ANTERIOR DRAWER TEST-ACL (best in acute injury) SAG TEST -PCL PIVOT SHIFT-ANTEROLATERAL INSTABILITY (Not practical acutely) PATELLAR APPREHENSION ( GRIND TEST) C/W CHONDROMALACIA,PATELLO-FEMORAL SYNDROME

COLLATERAL LIGAMENTS TESTS

INTERPRETATION OF LIGAMENT TESTS grade 1 sprain- Just Pain grade 2-3 sprain-excessive motion complete rupture of the ligament-doesn't seem to have a definitive end VALGUS,VARUS KNEE TEST ANTERIOR POSTERIOR DRAWER TEST SAG TEST

MENISCAL TEARS

MENISCUS CATCHING, POPPING OR EVEN LOCKING SENSATION JOINT LINE PAIN EFFUSION MAY BE DELAYED

McMurray test TEST FOR MEDIAL AND LATERAL MENISCAL INJURY

BURSITIS

BURSITIS POSSIBLE FB/INFECTION

IS IT A BAKER'S CYST (POPLITEAL CYST) POPLITEAL AREA PULATILE OR NOT-NORMAL OR ENALARGED( ANEURYSM)DISTAL PULSES WRISK FACTORS:TRAUMA,ASCVD, MENISCAL TEAR,DJD SYNOVIAL CYST

BAKER'S CYST

PEDIATRIC PATELLAR SUBLUXATION OSGOOD SLCHLATTER LESION ( TIBIAL APOPHYSITIS) JUMPER KNEE REFERRED PAIN:SLIPPED CAPITAL EPIPHYSIS OSTEOCHONDRITIS DESSECANS ILLEO TIBIAL BAND