[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.03,0:00:03.73,Default,,0000,0000,0000,,(English captions by Andrea Matsumoto from the University of Michigan)
Dialogue: 0,0:00:03.73,0:00:08.07,Default,,0000,0000,0000,,To ensure a thorough assessment it is best\Nto preform the musculoskeletal exam of the
Dialogue: 0,0:00:08.07,0:00:10.14,Default,,0000,0000,0000,,knee in a systematic way.
Dialogue: 0,0:00:10.14,0:00:14.39,Default,,0000,0000,0000,,The following is a suggested order of exam\Nthat incorporates many of the common techniques
Dialogue: 0,0:00:14.39,0:00:18.09,Default,,0000,0000,0000,,used for evaluating knee injuries.
Dialogue: 0,0:00:18.09,0:00:22.01,Default,,0000,0000,0000,,Begin the exam with the patient in the standing\Nposition.
Dialogue: 0,0:00:22.01,0:00:27.07,Default,,0000,0000,0000,,Look for evidence of gross deformity, muscular\Natrophy, symmetry of the patellar alignment,
Dialogue: 0,0:00:27.07,0:00:32.33,Default,,0000,0000,0000,,evidence of varus or valgus positioning of\Nthe knee, or presence of pes planus or pes
Dialogue: 0,0:00:32.33,0:00:33.05,Default,,0000,0000,0000,,cavus of the foot.
Dialogue: 0,0:00:33.05,0:00:38.05,Default,,0000,0000,0000,,From a posterior view observe for more than\Ntwo toes laterally, also called the "too
Dialogue: 0,0:00:38.05,0:00:39.90,Default,,0000,0000,0000,,many toes" sign.
Dialogue: 0,0:00:39.90,0:00:43.99,Default,,0000,0000,0000,,This can indicate an over-pronated foot or\Nan abducted forefoot.
Dialogue: 0,0:00:43.99,0:00:47.00,Default,,0000,0000,0000,,Have the patient perform a toe raise and evaluate\Nthe heel position.
Dialogue: 0,0:00:47.00,0:00:55.74,Default,,0000,0000,0000,,Normally the heel should change from a neutral\Nto a varus position.
Dialogue: 0,0:00:55.74,0:01:09.02,Default,,0000,0000,0000,,Next observe the gait looking for an antalgic\Ngait or excessive pronation or supination.
Dialogue: 0,0:01:09.02,0:01:11.08,Default,,0000,0000,0000,,Next evaluate active range of motion.
Dialogue: 0,0:01:11.08,0:01:15.08,Default,,0000,0000,0000,,If pain or limitation exists repeat the range\Nof motion passively.
Dialogue: 0,0:01:15.08,0:01:22.02,Default,,0000,0000,0000,,In a seated position test for knee extension.
Dialogue: 0,0:01:22.02,0:01:28.07,Default,,0000,0000,0000,,In this position also observe patellar tracking.
Dialogue: 0,0:01:28.07,0:01:36.09,Default,,0000,0000,0000,,And, internal and external rotation of the\Nhip which can help identify referred knee
Dialogue: 0,0:01:36.09,0:01:41.02,Default,,0000,0000,0000,,pain caused by hip pathology.
Dialogue: 0,0:01:41.02,0:01:47.05,Default,,0000,0000,0000,,Also in the seated position, palpate anatomic\Nlandmarks for tenderness.
Dialogue: 0,0:01:47.05,0:02:05.03,Default,,0000,0000,0000,,Palpate the distal quadriceps, quadriceps\Ntendon, the patella, patellar tendon, the
Dialogue: 0,0:02:05.03,0:02:14.10,Default,,0000,0000,0000,,tibial tuberosity, and the fat pads beneath\Nthe patella.
Dialogue: 0,0:02:14.10,0:02:36.08,Default,,0000,0000,0000,,On the medial side palpate the medial collateral\Nligament, the medial joint line, the pes anserine
Dialogue: 0,0:02:36.08,0:02:40.74,Default,,0000,0000,0000,,bursa.
Dialogue: 0,0:02:40.74,0:02:54.06,Default,,0000,0000,0000,,On the lateral side, the lateral collateral\Nligament, the lateral joint line, and the
Dialogue: 0,0:02:54.06,0:03:01.82,Default,,0000,0000,0000,,fibular head.
Dialogue: 0,0:03:01.82,0:03:16.14,Default,,0000,0000,0000,,Posteriorly palpate the popliteal fossa and\Nthe distal hamstrings.
Dialogue: 0,0:03:16.14,0:03:23.21,Default,,0000,0000,0000,,With the patient supine the leg can be fully\Nextended to assess better for joint diffusion.
Dialogue: 0,0:03:23.21,0:03:27.41,Default,,0000,0000,0000,,Compress the suprapatellar pouch, pushing\Nthe contents distally, and assess for increased
Dialogue: 0,0:03:27.41,0:03:29.03,Default,,0000,0000,0000,,fluid.
Dialogue: 0,0:03:29.03,0:03:37.02,Default,,0000,0000,0000,,Patellar ballottement can also be performed\Nby compressing the patella and releasing quickly.
Dialogue: 0,0:03:37.02,0:03:40.03,Default,,0000,0000,0000,,Observe for rapid rebound, which also indicated\Nincreased fluid pressure.
Dialogue: 0,0:03:40.03,0:03:46.02,Default,,0000,0000,0000,,If a click or tap is felt a large effusion\Nis present, also called the ballottable patella.
Dialogue: 0,0:03:46.02,0:03:49.72,Default,,0000,0000,0000,,The patellar grind test assesses for patella-femoral\Nsyndrome.
Dialogue: 0,0:03:49.72,0:03:54.06,Default,,0000,0000,0000,,With the knee extended push the patella into\Nthe trochlear groove of the femur.
Dialogue: 0,0:03:54.06,0:03:57.71,Default,,0000,0000,0000,,Pain is a positive test.
Dialogue: 0,0:03:57.71,0:04:01.08,Default,,0000,0000,0000,,The patellar inhibition test assess for patella-femoral\Nsyndrome also.
Dialogue: 0,0:04:01.08,0:04:06.06,Default,,0000,0000,0000,,With the knee extended, push the superior\Naspect of the patella inferiorly as the patient
Dialogue: 0,0:04:06.06,0:04:08.94,Default,,0000,0000,0000,,tightens the quadriceps muscle.
Dialogue: 0,0:04:08.94,0:04:12.32,Default,,0000,0000,0000,,Pain or crepitus is considered a positive\Ntest.
Dialogue: 0,0:04:12.32,0:04:17.08,Default,,0000,0000,0000,,The patellar apprehension test evaluates for\Npatellar subluxation of dislocation.
Dialogue: 0,0:04:17.08,0:04:22.09,Default,,0000,0000,0000,,With the knee extended push medially and laterally\Non the patella in an attempt to sublux the
Dialogue: 0,0:04:22.09,0:04:24.00,Default,,0000,0000,0000,,patella.
Dialogue: 0,0:04:24.00,0:04:30.05,Default,,0000,0000,0000,,If it is painful or the patient becomes apprehensive\Nabout the movement it is a positive test.
Dialogue: 0,0:04:30.05,0:04:34.06,Default,,0000,0000,0000,,There are several tests commonly performed\Nto evaluate for ligamentous laxity of the
Dialogue: 0,0:04:34.06,0:04:37.01,Default,,0000,0000,0000,,knee.
Dialogue: 0,0:04:37.01,0:04:41.04,Default,,0000,0000,0000,,Medial collateral ligament stability can be\Ntested at zero degrees and thirty degrees
Dialogue: 0,0:04:41.04,0:04:52.02,Default,,0000,0000,0000,,of flexion by applying a valgus force on the\Nknee.
Dialogue: 0,0:04:52.02,0:04:56.05,Default,,0000,0000,0000,,Lateral collateral ligament stability can\Nalso be tested at zero degrees and thirty
Dialogue: 0,0:04:56.05,0:05:01.02,Default,,0000,0000,0000,,degrees of flexion by applying a varus force\Nto the knee.
Dialogue: 0,0:05:01.02,0:05:06.09,Default,,0000,0000,0000,,Laxity indicates a partial or complete ligamentous\Ntear.
Dialogue: 0,0:05:06.09,0:05:10.07,Default,,0000,0000,0000,,The Lachman�s test evaluates for a tear\Nof the anterior cruciate ligament.
Dialogue: 0,0:05:10.07,0:05:17.01,Default,,0000,0000,0000,,With the knee flexed to thirty degrees, stabilize\Nthe femur and pull the proximal tibia anteriorly.
Dialogue: 0,0:05:17.01,0:05:24.03,Default,,0000,0000,0000,,Excessive motion or soft endpoint is a positive\Ntest.
Dialogue: 0,0:05:24.03,0:05:28.07,Default,,0000,0000,0000,,The anterior drawer test assesses of a tear\Nof the anterior cruciate ligament also.
Dialogue: 0,0:05:28.07,0:05:32.09,Default,,0000,0000,0000,,With the knee flexed to ninety degrees and\Nthe foot planted on the table, push the proximal
Dialogue: 0,0:05:32.09,0:05:34.08,Default,,0000,0000,0000,,tibia anteriorly.
Dialogue: 0,0:05:34.08,0:05:39.05,Default,,0000,0000,0000,,Excessive motion or soft endpoint is a positive\Ntest.
Dialogue: 0,0:05:39.05,0:05:43.06,Default,,0000,0000,0000,,The posterior drawer test assesses for a tear\Nof the posterior cruciate ligament.
Dialogue: 0,0:05:43.06,0:05:47.08,Default,,0000,0000,0000,,With the knee flexed at ninety degrees and\Nthe foot planted on the table, push the proximal
Dialogue: 0,0:05:47.08,0:05:49.07,Default,,0000,0000,0000,,tibia posteriorly.
Dialogue: 0,0:05:49.07,0:05:54.02,Default,,0000,0000,0000,,Excessive motion or a soft endpoint is a positive\Ntest.
Dialogue: 0,0:05:54.02,0:05:58.04,Default,,0000,0000,0000,,The PCL sag test evaluates for a tear of the\Nposterior cruciate ligament.
Dialogue: 0,0:05:58.04,0:06:02.08,Default,,0000,0000,0000,,With both knees flexed to ninety degrees and\Nfeet planted on the table, view the knees
Dialogue: 0,0:06:02.08,0:06:06.06,Default,,0000,0000,0000,,from the side to compare the position of the\Ntibia.
Dialogue: 0,0:06:06.06,0:06:10.05,Default,,0000,0000,0000,,Increased posterior sag of one of the tibias\Nis considered a positive test.
Dialogue: 0,0:06:10.05,0:06:13.01,Default,,0000,0000,0000,,The McMurray�s test evaluates for a miniscule\Ntear.
Dialogue: 0,0:06:13.01,0:06:18.02,Default,,0000,0000,0000,,With the patient supine and knee fully flexed,\Npalpate the medial joint line and apply an
Dialogue: 0,0:06:18.02,0:06:22.01,Default,,0000,0000,0000,,axial force along the tibia while externally\Nrotating and extending the knee.
Dialogue: 0,0:06:22.01,0:06:27.02,Default,,0000,0000,0000,,This maneuver is repeated palpating the lateral\Njoint line while internally rotating the foot.
Dialogue: 0,0:06:27.02,0:06:31.06,Default,,0000,0000,0000,,Pain, catching, or palpable clunk indicates\Na miniscule tear.
Dialogue: 0,0:06:31.06,0:06:34.04,Default,,0000,0000,0000,,The bounce test also evaluates for a miniscule\Ntear.
Dialogue: 0,0:06:34.04,0:06:39.03,Default,,0000,0000,0000,,Grasp the heel, extend, and bounce the leg,\Ngently forcing hyperextension.
Dialogue: 0,0:06:39.03,0:06:41.07,Default,,0000,0000,0000,,Pain is a positive test.
Dialogue: 0,0:06:41.07,0:06:46.02,Default,,0000,0000,0000,,In the prone position, Apley�s compression\Ntest evaluates for a miniscule tear.
Dialogue: 0,0:06:46.02,0:06:50.09,Default,,0000,0000,0000,,Flex the knee to ninety degrees, apply an\Naxial force along the tibia, and rotate the
Dialogue: 0,0:06:50.09,0:06:51.08,Default,,0000,0000,0000,,tibia.
Dialogue: 0,0:06:51.08,0:06:53.06,Default,,0000,0000,0000,,Pain is a positive test.
Dialogue: 0,0:06:53.06,0:06:57.00,Default,,0000,0000,0000,,Ober�s test assesses for iliotibial band\Nsyndrome.
Dialogue: 0,0:06:57.00,0:07:00.03,Default,,0000,0000,0000,,With the patient in the lateral position,\Nthe knee is supported and flexed to ninety
Dialogue: 0,0:07:00.03,0:07:01.02,Default,,0000,0000,0000,,degrees.
Dialogue: 0,0:07:01.02,0:07:06.01,Default,,0000,0000,0000,,Then extend and abduct the hip and release\Nthe knee support.
Dialogue: 0,0:07:06.01,0:07:09.10,Default,,0000,0000,0000,,Failure of the knee to adduct is a positive\Ntest.
Dialogue: 0,0:07:09.10,0:07:14.08,Default,,0000,0000,0000,,In the seated position, Noble�s test can\Nalso be used to evaluate for iliotibial band
Dialogue: 0,0:07:14.08,0:07:16.02,Default,,0000,0000,0000,,syndrome.
Dialogue: 0,0:07:16.02,0:07:20.01,Default,,0000,0000,0000,,With the knee flexed to ninety degrees, apply\Npressure over the lateral femoral chondral
Dialogue: 0,0:07:20.01,0:07:22.07,Default,,0000,0000,0000,,and passively extend the knee.
Dialogue: 0,0:07:22.07,0:07:27.00,Default,,0000,0000,0000,,Lateral pain around thirty degrees of flexion\Nis a positive test.
Dialogue: 0,0:07:27.00,0:07:31.01,Default,,0000,0000,0000,,In concluding the knee exam, it's important\Nto document a neurovascular exam.
Dialogue: 0,0:07:31.01,0:07:36.04,Default,,0000,0000,0000,,Here we demonstrate dorsalis pedis artery\Npulse, posterior tibial artery pulse, and
Dialogue: 0,0:07:36.04,0:07:38.03,Default,,0000,0000,0000,,capillary refill testing.
Dialogue: 0,0:07:38.03,0:07:42.23,Default,,0000,0000,0000,,A more thorough exam may be indicated based\Non patient history.