Introduction to Musculoskeletal Exam of the Knee

View the complete knee examination learning module at https://sites.google.com/a/umich.edu/fammed-modules/

Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition.

CC: BY-NC University of Michigan Family Medicine Residency Program. This material is licensed under a Creative Commons Attribution - Noncommercial 3.0 License http://creativecommons.org/licenses/by-nc/3.0/.

(English captions by Trisha Paul from the University of Michigan)

To ensure a thorough assessment, it is best to perform the musculoskeletal exam of the knee in a

systematic way.

The following is a suggested order of
exam that incorporates many of the common

techniques used for evaluating the
injuries.

Begin the exam with the patient in the standing
position.

Look for evidence of gross deformity, muscular atrophy,

symmetry of the patellar alignment,

evidence of varus or valgas
positioning of the knee

or presence of pes planus and pes cavus of the foot.

From a posterior view, observe for more than two toes laterally also called the too

many toes sign.

This can indicate an over-pronated
foot or an abducted fore foot.

Have the patient perform a toe raise and evaluate the heel position.

Normally the heel should change from a
neutral to a varus position.

Next observe the gait,

looking for an antalgic gate

or excessive pronation or supination.

Next, evaluate active range of motion.

If pain or limitation exists, repeat the
range of motion passively. In a seated

position, test for knee extension.

In this position, also observe

patellar tracking.

and internal and external rotation of
the hip

which can help identify referred knee pain
caused by hip pathology.

Also in this seated position, palpate anatomic landmarks for tenderness.

Palpate the distal quadriceps, quadriceps tendon,

the patella,

and patellar tendon,

the tibial tuberosity,

and the fat pads beneath the patella.

On the medial side,

palpate the medial collateral ligament,

the medial joint line,

the pes anserine bursa,

and on the lateral side, the lateral
collateral ligament,

the lateral joint line,

and the fibular head.

Posteriorly palpate the popliteal fossa
and the distal hamstrings.