- Discussion:
- serial diagnostic exam should take into consideration static deformities
of the lower extremities, gait,
ROM, tenderness, and knee stability;
- in the child w/ a painful knee, it is essential to closely examine the hip
as hip pathology can refer pain
to the hip;
- Examination:
- Gait:
- Effusion:
-
Bursitis
-
Hemarthrosis;
- ROM:
- Nl functional ROM: 3 deg of hyperext and 140 deg of flexion;
- ADL ROM: for routines ADL's need 115 deg of flexion;
-
acute extension block:
- may be due to bucket handle meniscus tear, ACL tear (from
interposition of the ACL between the
femur and
the tibia), or from fat pad adhesions to a torn ACL;
- as is pointed out by KD Shelbourne MD (Arthroscopy Aug 1996 p
492), an acute knee block
associated with an ACL tear is usually due to interposition of the ACL between
the femur and
tibia in the intercondylar notch;
- this author emphasizes, the need to perform dedicated
physical therapy to restore motion;
- physical therapy should consists of ROM, stretching, and
patellar mobilization;
- references:
- The locked knee. JR Jones and RL Allum. JBJS. 67-B.
1985. p 488.
- Fat pad adhesion to partially torn anterior cruciate
ligament: a cause of knee locking.
A Finsterbush et al. Am J. Sports Med. Vol 17. 1989. p 92-95.
- Tenderness:
-
popliteal tenderness:
-
deep venous
thrombosis
- popliteal cyst
- pain radiating down the medial gastrocnemius can
represent a ruptured Baker's cyst;
- medial
gastrocnemius
head rupture;
- popliteal artery aneuysm; (see
popliteal artery);
-
Ruptured popliteal artery aneurysm. An insidious complication.
-
joint line tenderness:
-
meniscal
tear:
-
McMurray test
- Squat Test:
- attempts to reproduce meniscal symptoms by
performing repetitions of a full squat
with the feet and legs alternately internally and externally rotated as the
squat is
performed, testing the lateral and medial menisci, respectively;
- w/ the patient in the squat position, look for
joint line tenderness;
- differential dx: (peri-articular tenderness)
- medial:
- semimembranosus-tibial collateral ligament
bursitis;
-
MCL
and/or
post oblique ligament tears;
- lateral:
-
LCL
tears;
-
Popliteus
Tendinitis
- femoral condyle tenderness (
chondral
defect)
- masses in
popliteal fossa;
-
extensor mechanism:
-
quad
tendon
-
patellar
tendon
-
patella
- tenderness along margins of patella, with knee in extension
- feel for tenderness of the back of the patella by pushing the
patella alternately to either side with
one hand, while the other is used to feel the exposed posterior surface of the
patella;
-
Stability:
-
ACL:
-
Lachman
-
Pivot shift
-
Anterior
Drawer
-
Internal
Rotation
-
Clunk Test
-
Losee Test
-
Anterolateral Rotatory Instability
-
Anteromedial Rotatory Stability:
-
PCL Exam:
- need to rule out
posterolateral rotary instability w/
reversed
pivot shift
-
Varus and
Valgus Stress Test:
-
MCL
and
Post Oblique Ligament tears;
-
LCL
tears;
- need to rule out
posterolateral rotary instability:
-
arcuate complex