Palpation
Palpation of the knee should attempt to cover the following points:
- tenderness - systematically examine the joint line, the collateral ligaments, the tibial tubercle and the femoral condyles
- swelling } as above: the precise anatomical
- effusion } location is important
- synovial thickening
- muscle tone: - feel the quad muscle tone above the knee while the muscle is being contracted - in the same place, ask the patient to dorsiflex the foot; this is a gauge of vastus medialis
- measure quadriceps - 18 cm up from the joint line in adults; the site is important due to suprapatellar bursa position
- temperature: - compare both sides - a warm knee with a cold foot may indicate popliteal artery block
There are three tests for fluid, listed in order of increasing sensitivity:
- cross-fluctuation
- patellar tap
- bulge test
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