Physical Examination Specialty Manoeuvres of the Knee

The knee is a complex joint, and its assessment requires a systematic approach. This guide provides an overview of the specialty manoeuvres used in the physical examination of the knee, intended for healthcare professionals such as nurses and doctors.

1. Inspection and Palpation

The examination begins with a visual inspection of the knee for any signs of swelling, redness, or deformity. Following this, palpate the knee joint to assess for warmth, tenderness, or effusion.

2. Range of Motion (ROM)

Next, assess both active and passive ROM. This includes flexion, extension, internal rotation, and external rotation.

3. Ligamentous Tests

These tests are performed to assess the integrity of the knee ligaments:

• Anterior Drawer Test: This test checks for an ACL (anterior cruciate ligament) injury in the knee. The patient lies on their back with the knee at a 90-degree angle and the foot in a neutral position. The examiner pulls the lower leg forward to see if the knee is stable.

• Posterior Drawer Test: This test is used to assess for posterior cruciate ligament tears. The examiner inspects and manipulates the knee to assess its movement and level of resistance.

• Lachman’s Test: This test determines the strength of the knee’s anterior cruciate ligament (ACL). It involves pulling the lower leg forward while stabilizing the thigh.

• Varus Stress Test: This test assesses the stability of the lateral collateral ligament (LCL) of the knee. The examiner applies a varus force while stabilizing the upper part of the joint.

• Valgus Stress Test: This test diagnoses damage to the medial collateral ligament of the knee. It involves placing one hand as a pivot on the knee and applying an abducting force with the other hand.

4. Meniscal Tests

These tests help identify meniscal tears:

• McMurray’s Test: This test diagnoses tears in the meniscus of the knee by rotating it in different directions.

• Apley’s Grind Test: This test evaluates for meniscal injury. The patient lies prone with their knee flexed to 90° while their leg is rotated internally and externally.

5. Patellar Tests

These tests identify patellar tracking disorders or patellofemoral pain syndrome:

• Patellar Grind Test: Also known as Clarke’s sign, this test helps assess whether pain around your patella is caused by cartilage breakdown under the kneecap.

• Patellar Apprehension Test: This test assesses whether the patella (kneecap) is likely to dislocate laterally.

Remember, these tests are part of a comprehensive assessment of the knee joint. Clinical decision making should be based on findings from the entire history and physical examination. Always compare with the contralateral side when possible. If there’s any doubt about a diagnosis, further imaging or referral may be necessary.

For those interested in furthering their knowledge and skills in this area, consider enrolling in these courses:

Minor Injury Essentials Face-to-Face: Accredited by RCN Centre for Professional Accreditation. This interactive programme focuses on community practitioners who are now expected to include basic injury review and care. The course will enable you to tackle injuries with confidence and skill.

Acute Wound Management for Urgent & Primary Care Practitioners: This workshop provides attendees with core knowledge and skills in assessing and treating acute wounds and infections. Some minor clinical procedures commonly used in general practice, minor injury units, urgent care, and walk-in centres are included.

References:

1.         Stanford Medicine 25 (2023) ‘Knee Exam’, Stanford Medicine 25, available at Stanford Medicine 25.

2.         NPS MedicineWise (2023) ‘Physical examination of acute ankle and knee injuries’, NPS MedicineWise, available at NPS MedicineWise.

3.         Physiopedia (2023) ‘Knee Examination’, Physiopedia, available at Physiopedia.

4.         Geeky Medics (2023) ‘Knee Examination - OSCE Guide’, Geeky Medics, available at Geeky Medics.

5.         Debette, C., Neyret, P., Magnussen, R.A., Servien, E. and Lustig, S. (2023) ‘Degenerative Knee Assessment: Physical Examination and Outcome’, SpringerLink Sports Injuries, available at SpringerLink Sports Injuries