Knee Pain (Gonalgia): Examination

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.
    • Body or joint posture (upright, bent, Schonhaltung).
    • 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. signs of inflammation or infection]Note: pain in the knee, never forget the hip!
  • 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:
    • 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: to detect an anterior cruciate ligament tear (ACL tear) of the knee jointPerformance: both knees are always examined. The lower leg is flexed by approx. 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.
    • Test of lateral ligament stability: examination of the medial (“oriented towards 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 °.
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.