Knee+Exam

__ ** Knee Pain ** __ ** Questions to ask: ** Date of Injury Mechanism of Injury Able to walk or continue activity immediately after injury Able to walk or bear weight since injury Effusion/Bruising Mechanical symptoms 1st Injury? Inspection/Palpation: obvious deformity, joint line tenderness,effusion ROM Ligaments:Lachman Menisci:McMurray Patellofemoral assessment:VMO,Patellar grind Gait ACL: Lachman’s 30 degree flexion PCL: Posterior sag sign, Posterior drawer test MCL:Valgus stress 30 degree flexion LCL:Varus stress 30 degree flexion ** Menisci: ** Joint line tenderness: //tender medially//:medical meniscus, //tender laterally//: lateral meniscus McMurrays: pain/pop on extension means + Lateral meniscus- IR tibia + valgus Medical meniscus-ER tibia + varus ** Patellofemoral: ** Effusion Crepitus VMO tone Patellar grind “Theater sign”-pain with standing up   “circle sign”: pts point to knee and draw a circle around patella when asked where pain is   Bilateral AP weight bearing Lateral Merchants View
 * To evaluate on PE: **
 * Ligaments: **
 * Xrays to order: **

** Knee Exam **** : ** **// Always compare sides when examining!! //**   ** Lachmans **: [] sensitivity 84% and specificity 93% +:the tibia will feel unrestrained in forward movement Suggests: ACL tear ** Posterior Drawer Test: ** [] Clinician pushes in on tibia +: if no discrete endpoint suggests: PCL tear ** Posterior Sag Sign:  **[] +:difference in contour suggests: PCL tear ** McMurray Test: ** [] sensitivity 53-59% and specificity 59-97% ** +:  ** pain/pop as you extend the externally rotated leg while applying varus stress suggests: Medial Meniscus teat +: pain/pop as you extend the internally rotated leg while applying valgus stress suggests: Lateral Meniscus tear ** Varus and Valgus Stress: ** ** : ** [] +Valgus: if joint laxity/reproducible pain present suggests: MCL(look for joint line tenderness) +Varus: if joint laxity/reproducible pain present suggests: LCL(look for joint line tenderness) ** Patellar Grind Test **: [] Hold the patella in place with your hand and ask the patient to contract their quadriceps muscle +: if you reproduce pain suggests: patellofemoral pain syndrome ** VMO tone:  **[] +: if poor tone suggests: patellofemoral pain syndrome ** Effusion:  **[] Ballotable Patella, milking of knee inferior to superior

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