The Exam for Knee Pain – Stanford Medicine 25



hello my name is dr. Brenda Christopher and I'm a sports and exercise medicine physician this is a clinical examination video for the approach to a painful knee we will start the knee examination by looking at specific tests for ligamentous and meniscal injuries the ACL is assessed with an anterior draw noting any laxity in comparing right to left and here they're both equal so I don't think there's any ACL pathology so you can also assess the integrity of the ACL with the Lachman so here I'm grasping the tibia and then anterior motion as you can see I struggle here so modified lachman's is by placing my thigh under the patient's femur and this frees up my hands so if laxity is noted on either the Laxman's or the anterior draw you want to ensure that this is coming from the ACL and not the PCL so a way of discriminating this is to ensure that the posterior draw test is negative or positive so a posterior draw sign assesses the PCL and I'm pushing downwards on the tibial tuberosity with my films so here we note whether there's a posterior sag sign and if one of the tibial tuberosity is is more prominent than the other that's indicative of a posterior sac I next power pecked the medial collateral ligament and the lateral collateral ligament feeling for any crepes tassel tenderness I stress the MCL at zero degrees and 30 degrees of knee flexion I feel for any I look for any opening of the joint and feel for any laxity whilst applying an outward force with my bottom hand and using my top hand as a fulcrum I always compare left to right I in test the integrity of the LCL zero degrees was pushing the lower leg inwards and at 30 degrees this movement is also known as a varus movement assessing for any joint opening we assess the integrity of the menisci which are to see shaped shock absorbers which lie on top of the tibial plateaus by applying a compressive and twisting force so this is testing the lateral meniscus and this is testing the medial meniscus that please test is for miniscule injuries and I provided downward pressure or force in to cease so I'm stressing each meniscus the medial and the lateral Thessaly is a useful test because it uses the patient's body weight and it loads the meniscus so here I ask the patient to wait there on one flex knee and I turn them which will load the medial meniscus and the lateral meniscus dark waddling is a useful test as this loads the posterior aspect of both Minnis Chi anterior knee pain is pain originating from the patella femoral joint Clark's test is often positive where I ask the patient to tense this muscle and I apply a downward pressure relax tense relaxed and tense and relax and if you can see I'm resisting the upward motion of the patella if this is painful that's a positive clocks test palpation of the underside of the patella is useful the first I palpate the underside of the lateral aspect of the patella and then the medial Fassett patellar tendinopathy often presents as pain on palpation of the superior pole inferior pole and insertion on tibial tuberosity if there is pain either side of the tendon this is usually impingement of hafez fat pad for signs of bursitis it's important to know the anatomy of the knee for pre patellar bursitis and PES anserine bursitis you're looking for tenderness and fluctuations for baker's cyst you're feeling for a palpable mass there are a couple of tests for effusions which are usually down to degenerative sceptic or crystal arthropathy the first test for moderate to large effusions where you milk the suprapatellar pouch in a downward motion and blot the patella the second test is for a smaller effusion and it's called the medial bulge test where I empty the medial compartment and then push the fluid back with a downward motion on the lateral aspect of the knee whilst looking here for a fluid bulge knee osteoarthritis is common in the older age group and often you'll be able to demonstrate a tender medial or lateral joint line patients may exhibit a varus deformity of the knee joint and there may be associated muscle atrophy and a bland joint effusion the diagnosis that shouldn't be missed that can present as knee pain is a stress fracture of the tibia it's useful to palpate the entire length of the tibia usually on the medial aspect and identify any points of tenderness if the tenderness is here you can also pick us down the length of the tibia and this should reproduce pain and symptoms where the tenderness was identified another way to test for a stress fracture is to ask the patient to wait bear through one leg the painful leg and to hop pain on hopping single leg hopping is indicative of a stress fracture Thank You Chad thank you for watching this done for 25 knee examination video please subscribe and visit our website for further information the preceding program is copyrighted by the Board of Trustees of the Leland Stanford junior University please visit us at med.stanford.edu

21 comments

  1. If she was my doctor. I would always be sick. I have a belly ache. Rub my tummy

  2. I'm often somewhat critical of the commonly-encountered mediocre YT medical videos but this one is actually good. Diagrams and other illustrations to show how loading stresses the various structures might be helpful.

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