Knee Injuries: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Examination of the knee joint (side to side) – including blood flow, motor function, sensitivity; meniscus tests, drawer tests, etc.[leading symptoms: pain, instability][other possible symptoms: joint effusion, joint swelling, deformity].
    • Inspection (viewing) of the skin and mucous membranes.
  • Orthopedic examination
    • Examination of the patella (kneecap):
      • “Dancing patella”: this indicates a knee effusion; the effusion causes the patella to spring back on palpation (palpation) and appear to float in the effusion fluid.
      • Test for retropatellar arthrosis (osteoarthritis (cartilage degradation) on the back surface of the patella): painful palpation of the patella with the leg extended; the patella, each moving at the edge, is shifted medially or laterally.
    • Meniscus test according to Steinmann I + II:
      • Steinmann I: Inner meniscus: during external rotation (rotational movement of an extremity about its longitudinal axis, with the direction of rotation pointing outward when viewed from the front) pain in the inner joint spaceOuter meniscus: during internal rotation (rotational movement of an extremity about its longitudinal axis, with the direction of rotation pointing inward when viewed from the front) pain in the outer joint space.
      • Steinmann II: during flexion of the knee to dorsal (“belonging to the back”) migrating pressure pain.
    • Lachmann test:
      • So-called anterior drawer test (anterior tibial translation in 20 ° flexion position): to determine an anterior cruciate ligament tear (ACL tear) of the knee jointPerformance: both knees are always examined. The lower leg is flexed by approximately 20-30 degrees relative to the thigh and passively moved forward. The degree of displaceability of the lower leg relative to the thigh (drawer) provides information about whether or not there is an injury to the cruciate ligament.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 (tear) of the anterior cruciate ligament is unlikely.
      • So-called posterior drawer test: to determine a posterior cruciate ligament tear (HKB tear) of the knee jointExecution: lower leg is displaced against the thigh dorsal (“back”);Positive: If the lower leg is displaceable against the thigh dorsal by more than 0.5 cm (= positive posterior drawer), i.e. the posterior cruciate ligament (HKB) is damaged.
    • (Pivot shift test:
      • Subluxation of the tibial head in the dynamic test to analyze rotational instability): to detect an anterior cruciate ligament (ACL) tear of the knee joint; often only possible in anesthetized patients).
    • Test of lateral ligament stability: examination of medial (“oriented toward the center of the body”) or lateral (lateral) unfolding. For this purpose, the thigh is fixed and in the extension position, the test of lateral stability is performed by a flexion of 10-20 °.
  • If necessary, neurological examination [due topossible secondary disease: nerve damage to the affected region].

* Meniscus test

Principle of most meniscus tests is to apply a force to the meniscus to irritate the nociceptors (pain receptors) of the outer portion of the menisci or the adjacent portion of the joint capsule. This is done either directly by manual pressure at the joint space or by internal or external rotation or valgus or varus stress (low sensitivity (percentage of diseased patients in whom the disease is detected by the use of the test, i.e. a positive test result occurs); false positive findings occur, for example, in degenerative cartilage damage). Square brackets [ ] indicate possible pathological (pathological) physical findings.