Knee examination

Follow the scheme below:

• Inspection
• Palpation  
• Movement

Before starting

• Introduce yourself
• Explain what the examination entails
• Ask permission to perform examination
• Expose the patient appropriately - from waist down exposing both the lower limbs, but leaving the underwear on
• Preserve dignity by using a blanket appropriately
• Tell the patient to let you know if anything you do is uncomfortable
• Remember - always watch the patients face 

Inspection

• General observation
  • Does the patient look well?
  • Is there a walking aid?
  • Hands (Rheumatoid arthritis?)

Patient Standing

• Remember to inspect from all sides (front, laterally and from behind):
  • Skin
    • Scars (previous injuries or surgical scars)
    • Sinuses
    • Ulcers
    • Colour - erythema, bruising
  • Deformity
    • Varus / valgus
    • Fixed flexion
    • Hyperextension (recurvatum) 
  • Limb length discrepanancy - characterised by a pelvic tilt
  • Knobbly knees (Osteoarthritis)
  • Swelling
    • Effusion?
    • Soft tissue? 
  • Muscle wasting - quadraceps?
  • Patella alignment - position

Patient Walking

• Observe the patient walking.
  • Gait pattern. There are different types of gait:
    • Stiff knee
    • Antalgic
    • Varus thrust - collapse into more varus in stance loading
  • Range of movement  

Patient Lying down - supine with one pillow under the head

• Deformity - fixed flexion (gap between bed and knee)
• Quadriceps
  • Ask patient to contract quadriceps
  • Measure circumference of each thigh at a fixed distance from the tibial tuberosity if a difference has been observed
• Detailed check:
  • Skin
    • Scars 
  • Effusion

Palpation

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