Stanford’s Exam for Knee Pain

In my last post, I posted a video to Oxford University’s approach to a knee examination. In this video, we review Stanford’s approach. A school a little closer to home:

Brought to you by Dr. Brinda Christopher, a Sports Medicine Physician.

Start the examination by looking at tests for ligament injury. The anterior drawer test for ACL injury, then Lachman’s test. For Lachman’s test, the knee is flexed at 20-30 degrees, and the leg is grasped below the knee joint. You pull anterior to test the ACL.

The Posterior drawer test is done to screen for a PCL injury. Look for sag sign.

The medial collateral ligament and lateral collateral ligament is stress-tested at 0 degrees and 30 degrees. Varus movement.

Test the menisci by applying a compressive and twisting force. Do this supine, and prone (with Aply’s test.)

Thessaly’s test is done with the patient weight bearing, standing. Bear weight on one flexed knee. Turning the patient medially, toward their big toe, will load the medial meniscus. Turning away, toward their little toe, will load the lateral meniscus.

Duck waddling is also a weight bearing test where the patient squats deep, and waddles like a duck. This loads the posterior part of the menisci.

Anterior knee pain is pain that comes from the patellofemoral knee joint. Clarke’s test is where the examiner asks the patient to tense their quads, pulling the patella up, while squeezing the top of the knee cap like a chokehold. This test can be painful. You can palpate the underside of the patella. Also palpate the length of the patellar tendon (ligament.) Palpate for bursitis under the kneecap and at the pet anserinus. Palpate for a Baker’s cyst at the posterior.

if a patient has effusion, you can milk the effusion downward, and test ballottment of the patella. Also, do a medial bulge test. See how the fluid moves and causes bulges from lateral to medial.

Don’t miss any stress fractures of the tibia. Palpate along the line of the tibia for tender spots. You can percuss the bone to confirm. Also, weight bearing on the leg and hopping will produce pain in a stress fracture.

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