Download - ALL ABOUT KNEE ORTHOPAEDIC
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by RYS
The Knee physical examination
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Symptoms
• Pain– Diffuse– localized
• Swelling– Immediate– Some hours
• Stiffness• Locking• Deformity• Limp
SomebodyHelp my knee ??
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knee
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Observation
• Anterior view,standing
– Normally tibia has a slight valgus • Genu varum until about 18-19 months• Genu valgum until about 3-4 years
– Patella should symetrical and level• Squinting patella
– Deformity :• Valgus or knock knee
– Normal intermaleolar less than 6cm
• Varus or bowlegs– Normal intercondyler less than 8 cm
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• Analyze gaitLook knee at– Heelstrike fully extended?– Swingphase flexion?
• Swelling– Intracapsuler ?
• generalized
– Extracapsuler ?• localized
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• Lateral view, standing
– Genu recurvatum (hiperextended knee)– Patella displace
• High (alta)• Lower (baja)
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• Posterior view, standing
– Similar to those in anterior– Baker’s cyst
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• Anterior and lateral view, sitting
– Knee flexed 90 degree, feet dangling free– Patella face forward and on distal end femur– Displaced patella
• Frog’s eyes patella alta with lateral displaced
– Note tibial torsion• Medial associated with genu varum
– Pigeon toed foot deformity
• Lateral for genu valgum
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Feel
• Warmth, intraarticular fluid
• Anterior– Quadriceps
• wasting
– Infrapatellar tendon• Insertion into tibial tubercle
– Prepatellar bursa• Housemaid knee
– Pes anserinus bursa
Prepatellar bursa
Superficial infrapatellar bursa
Deep infrapatellar bursa
Pes anserine bursa
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• Medial– Medial meniscus
• Tenderness If detached due tears coronay ligament
– Medial collateral ligament• Move medially and posterior
– Sartorius,gracillis,and semitendinosus muscle• Position resistance against knee flexion
• Lateral– Lateral meniscus– Lateral collateral ligament– Common peroneal nerve
Lateral meniscus
Medial meniscus
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• Posterior– Popliteal fossa– Posterior tibial nerve– Popliteal vein,artery– Gastrocnemius muscle
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Move• Active
– Flexion (0°-135°)– Extension ( 0-15°)– Internal rotation (10°)– External rotation ( 10°)
Passive
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Joint stability• Ligament
• Medial collateral ligament– Tes : abduction( VALGUS STRESS ) test
• Lateral collateral ligament– Tes : adduction ( VARUS STRESS ) test
Collateral ligaments
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Anatomy
Posterior cruciatum ligamentAnterior cruciatum ligament
Medial collateral ligamentLateral collateral ligament
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• Anterior cruciatum ligament– Knee flexed 90° hip 45 °
– Tes : ANTERIOR DRAWER TEST– Positive (+) there is forward movement tibia
• Posterior cruciatum ligaments– Tes : POSTERIOR DRAWER TEST– Positive (+) reverse anterior
• LACHMAN test– Knee flexed 20 degree– Positive(+) soft end feel forward tibia
slope (-)
Cruciatum ligaments
DRAWER TEST
LACHMAN test
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Special test
• Meniscus injury– Mc Murray test
• Loose tag induced palpable and audible click
– Apley’s compresion distraction test• Grinding reproduces symptoms from meniscus torn• Distraction from ligament damage
Mc Murray test Apley’s test
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Test for swelling
• Patellar tap test( ballotable patella )– Positive(+) Ballotement +
• Cross fluctuation test– Positive(+)Fluid impulse transmitted across the joint
• Bulge test– Positive(+) Distinct ripple seen
• Patellar hollow test– Normal : hollow +
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Neurologic
• Muscle– Extension
• Primary extensor– Quadriceps ,femoral nerve L234
– Flexion• Primary flexor
– Hamstring » Semimembranosus, sciathic L5» Semitendinosus, sciathic L5» Biceps femoris, sciathic S1
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• Sensation
L4L3L2S2
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• Reflexes– Patellar reflexs, L234
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Healthy Knee Joint ?May Be….
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Terima Kasih
Ronny Sutanto
Uluwatu BeachUluwatu BeachSunset viewSunset view
BaliBali
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Other special test
• Patellofemoral angle ( Q angle )– Angle between Q muscle and patellar tendon.– Normally 13° -18° – <13° patella alta or chondromalacia patella– >18° chondromalacia patella,sublux patella, genu
valgum,lateral tibial torsion.– If knee full extended normal 8-10°
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• Apprehension test– For dislocation patella– Knee flexed 30°, slowly passive move patella
laterally– Positive if patient become apprehension
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Observation
• Anterior view,standing
– Normally tibia has a slight valgus • Genu varum until about 18-19 months• Genu valgum until about 3-4 years
– Patella should symetrical and level• Squinting patella
– Deformity :• Valgus or knock knee
– Normal intermaleolar less than 6cm
• Varus or bowlegs– Normal intercondyler less than 8 cm
Tibiofemoral shaft angle normal 6º
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Gravity Drawer test ( posterior sag sign )
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Feel
Patient sit on the edge of examining tableknee flexed 90 degree relaxed,non weigthbearing.
• Medial aspect– Medial tibial plateau– Tibial tubercle– Medial femoral condyle– Adductor tubercle
• Lateral aspect– Lateral tibial plateau– Lateral tubercle
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– Lateral tibial plateau– Lateral tubercle– Lateral femoral condyle– Lateral femoral epicondyle– Head of the fibula
• Trochlear groove and patella– Patella fixed in trochlear groove in flexion and mobile
in extension.
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• Anterior and lateral view, sitting
– Excessive tibial torsion
-Chondromalacia patella
-Patellofemoral instability
-Fat pad entrapment
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Osgood sclatter disease