Musculoskeletal Examination — Knee and OmpathStudy

Musculoskeletal Examination — Knee & Shoulder Complete study guide adapted from Charlie Goldberg, M.D. (UCSD School of Medicine). Original slide-deck source; content below preserves every clinical point from the source, reorganized into a clean, readable structure. General Principles A musculoskeletal exam is performed when there are symptoms (injury, pain, decreased function) — this is different from a routine "screening exam." Focus the exam on the symptomatic area. Musculoskeletal complaints are common and frequently examined in clinical practice. Historical clues to gather first What is the functional limitation? Are symptoms in a single joint or multiple joints? Acute onset or slowly progressive? If due to injury — what was the mechanism? Any prior problems with this area? Any systemic symptoms? Keys to evaluating any joint Fully expose the area — no shirts, pants, etc.; use gowns as needed. Inspect the joint(s) in question for signs of inflammation or injury (swelling, redness, warmth), deformity, and compare with the opposite side. Understand the normal functional anatomy. Observe normal activity — what can't the patient do? Specific limitations? A discrete event (e.g. trauma)? Mechanism of injury? Palpate the joint — warmth? Point tenderness? Over what structure(s)? Assess range of motion, both active (patient moves it) and passive (you move it). Assess strength and perform a neuro-vascular assessment. Perform specific provocative maneuvers. If there is an acute injury with pain, the patient may "protect" the joint, limiting movement and making examination difficult — examine the unaffected side first to build confidence and a sense of the patient's normal range. Terminology: flexion/extension, abduction/adduction Flexion: moving forward out of the frontal plane of the body (except at the knee and foot). Extension: movement in the direction opposite to flexion. Abduction: movement that brings a structure away from the body (along the frontal plane). Adduction: movement that brings a structure towards the body (along the frontal plane). --- The Knee Exam Knee anatomy — observation and identification of landmarks The knee is a hinge-type joint that tolerates significant force and weight. Its anatomy is straightforward, which makes the exam logical. Fully expose the knee — pants off, use a gown or shorts. Surface landmarks: patella (kneecap), patellar tendon, medial joint line, lateral joint line, quadriceps muscle, hamstring muscle group, tibia, anterior tibial tuberosity (insertion of the patellar tendon), and femur. Observation Obvious pain with walking? Landmarks visible/palpable? Scars from past surgery? Swelling — fluid in the joint (effusion)? Atrophic muscles (e.g. from chronic disuse)? Bowing of the legs (inward = valgus, outward = varus)? Range of motion (ROM) 1. Assess active, then passive range of motion (you move the joint). 2. With a hand on the patella during extension and flexion, osteoarthritis may produce a palpable grinding sensation (crepitus). Normal range of motion: full flexion 140°, full extension 0°. Assessing for a large effusion — ballottement An effusion is fluid within the joint space; large effusions are usually obvious. 1. Flex the knee. 2. Place a hand on the suprapatellar pouch (above the patella), which communicates with the joint space. 3. Push down and towards the patella to move fluid toward the center of the joint. 4. Push down on the patella with your thumb. 5. If there is a large effusion, the patella "floats" and bounces back up when pushed down. Menisci — normal function and anatomy The medial and lateral menisci sit on top of the tibia, providing a cushioned articulating surface between the femur and tibia. They provide joint stability, distribute force, and protect the underlying articular cartilage. Menisci are damaged by trauma or degenerative changes with age. Symptoms when a torn piece interrupts normal joint movement: pain, instability ("giving out"), locking, and/or swelling. Evaluating for meniscal injury — joint line palpation Joint line tenderness suggests medial or lateral meniscal injury (or osteoarthritis). 1. Slightly flex the knee. 2. Find the joint space along the lateral and medial margins — the joint line runs perpendicular to the long axis of the tibia. 3. Palpate along the medial, then lateral, margins. 4. Pain suggests underlying meniscus damage or osteoarthritis. Additional tests for meniscal injury McMurray's test — medial meniscus 1. Place your left hand with middle, index and ring fingers on the medial joint line. 2. Grasp the heel with your right hand and fully flex the knee. 3. Turn the ankle so the foot points outward (everted), directing the knee to point outward. 4. Holding the foot in the everted position, extend and flex the knee. 5. If there is a medial meniscal injury, you may feel a "click" under your hand on knee extension, possibly with pain. McMurray's test — lateral meniscus 1. Return the knee to fully flexed, turn the fo