A comprehensive clinical examination is the basis for selecting further diagnostic steps:
General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
- Gait pattern in terms of knee extension, Schonhinken, leg axes, etc. [Gait instability due to the instability (sliding away or buckling of the knee joint – even with minor, normal load, called: Giving-way phenomenon)]
- Body or joint posture (upright, bent, gentle posture).
- Malpositions (deformities, contractures, shortenings).
- Muscle atrophies (side comparison!, if necessary circumference measurements).
- Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment).
- Palpation (palpation): examination for pressure dolence of individual structures: [pain in the medial joint space: suspected meniscus lesion; crepitation (audible and palpable crackling sounds): retropatellar arthrosis (patellar arthrosis); insertion tendinopathy (pain conditions caused by irritation in the insertion area, ie. i.e., at the junction between tendons and bones) of the pes anserinus; effusion: patella saltans (snapping phenomenon); popliteal cyst: Baker’s cyst; temperature: overheating (calor), i.e., inflammation or infection signs]
- Measurement of joint mobility and range of motion of the joint(according to the neutral zero method: the range of motion is given as the maximum displacement of the joint from the neutral position in angular degrees, where the neutral position is designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. The standard is that the value away from the body is given first. )By comparison measurements with the contralateral joint (side comparison), even small lateral differences can be revealed.
- Functional tests for differentialdianostic clarification:
- Testing of joint mobility in the sagittal plane (running anterior to posterior):[extension deficit due to osteoarthritis, entrapped meniscus (basket handle rupture), flexion inhibition due to effusion, osteoarthritis, capsular shrinkage].
- Meniscus diagnostics: [pressure dolence of the menisci in the medial or lateral joint space (indication of meniscal lesion)]
- Assessment of ligamentous structures:
- Increased medial and lateral hinging of the joint in the extended position due to collateral ligament rupture.
- Lachman test to detect anterior cruciate ligament rupturePerformance:Both knees are always examined: The lower leg is flexed approximately 20-30 degrees relative to the thigh and passively moved forward.Positive: if no hard stop is felt when the lower leg is moved forward; the anterior cruciate ligament (ACL) is almost certainly torn.Negative: if a hard stop is felt; rupture of the anterior cruciate ligament is unlikely.
- Drawer test (performance: lower leg hanging down, for example, from the examination couch).
- Anterior drawer test: lower leg is displaced ventrally (“abdominally”) against the thigh; the test is positive if the lower leg is displaceable ventrally against the thigh by more than 0.5 cm (= positive anterior drawer), i.e., the anterior cruciate ligament is damaged
- Posterior drawer test: lower leg displaced against the thigh dorsal (“dorsal”);the test is positive if the lower leg is displaced against the thigh dorsal by more than 0.5 cm (= positive posterior drawer), i.e. the posterior cruciate ligament (ACL) is damaged
Square brackets [ ] indicate possible pathological (pathological) physical findings.
