WEBVTT

00:00:00.000 --> 00:00:04.007
(English captions by Trisha Paul from the University of Michigan)

00:00:04.007 --> 00:00:08.035
To ensure a thorough assessment, it is best to perform the musculoskeletal exam of the knee in a

00:00:08.035 --> 00:00:10.059
systematic way.

00:00:10.059 --> 00:00:13.809
The following is a suggested order of
exam that incorporates many of the common

00:00:13.809 --> 00:00:19.027
techniques used for evaluating the
injuries.

00:00:19.027 --> 00:00:21.939
Begin the exam with the patient in the standing
position.

00:00:21.939 --> 00:00:25.289
Look for evidence of gross deformity, muscular atrophy,

00:00:25.289 --> 00:00:27.063
symmetry of the patellar alignment,

00:00:27.063 --> 00:00:31.109
evidence of varus or valgas
positioning of the knee

00:00:31.109 --> 00:00:34.009
or presence of pes planus and pes cavus of the foot.

00:00:34.009 --> 00:00:38.039
From a posterior view, observe for more than two toes laterally also called the too

00:00:38.039 --> 00:00:39.081
many toes sign.

00:00:39.081 --> 00:00:44.028
This can indicate an over-pronated
foot or an abducted fore foot.

00:00:44.028 --> 00:00:47.006
Have the patient perform a toe raise and evaluate the heel position.

00:00:47.006 --> 00:00:55.073
Normally the heel should change from a
neutral to a varus position.

00:00:55.073 --> 00:00:57.078
Next observe the gait,

00:00:57.078 --> 00:00:59.044
looking for an antalgic gate

00:00:59.044 --> 00:01:09.023
or excessive pronation or supination.

00:01:09.023 --> 00:01:11.089
Next, evaluate active range of motion.

00:01:11.089 --> 00:01:16.022
If pain or limitation exists, repeat the
range of motion passively. In a seated

00:01:16.022 --> 00:01:22.579
position, test for knee extension.

00:01:22.579 --> 00:01:24.019
In this position, also observe

00:01:24.019 --> 00:01:32.006
patellar tracking.

00:01:32.006 --> 00:01:35.001
and internal and external rotation of
the hip

00:01:35.001 --> 00:01:40.084
which can help identify referred knee pain
caused by hip pathology.

00:01:40.084 --> 00:01:47.149
Also in this seated position, palpate anatomic landmarks for tenderness.

00:01:47.149 --> 00:01:54.057
Palpate the distal quadriceps, quadriceps tendon,

00:01:54.057 --> 00:01:58.004
the patella,

00:01:58.004 --> 00:02:04.092
and patellar tendon,

00:02:04.092 --> 00:02:09.889
the tibial tuberosity,

00:02:09.889 --> 00:02:14.819
and the fat pads beneath the patella.

00:02:14.819 --> 00:02:16.093
On the medial side,

00:02:16.093 --> 00:02:27.009
palpate the medial collateral ligament,

00:02:27.009 --> 00:02:35.004
the medial joint line,

00:02:35.004 --> 00:02:40.489
the pes anserine bursa,

00:02:40.489 --> 00:02:47.169
and on the lateral side, the lateral
collateral ligament,

00:02:47.169 --> 00:02:54.349
the lateral joint line,

00:02:54.349 --> 00:03:01.289
and the fibular head.

00:03:01.289 --> 99:59:59.999
Posteriorly palpate the popliteal fossa
and the distal hamstrings.