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EXAMINATION OF THE KNEE AND ASPIRATION TECHNIQUE C SNYCKERS INTRODUCTION The largest joint in the body subject to a great variety of traumatic and degenerative conditions Outwardly simple but is actually quite complex Not just a hinge joint. INTRODUCTION The tibia femoral joint is inherently unstable Relies heavily on ligaments for stability Patella is the largest sesamoid bone in the body – acts as a fulcrum increasing mechanical advantage of quads. INSPECTIONSurface anatomy Anterior: Patella Fracture Bipartite Infra-patellar tendon and Hoffa’s fat pad Rupture Tendonitis Tibial tubercle Osgood – Schlatter avulsions INSPECTIONSurface anatomy Femoral condyles Pre-patellar bursa Bursitis Extensor mechanism Rectus femoris Vastus intermedius Vastus medialis (VMO) Vastus lateralis INSPECTION:Surface anatomy Medial: Pes anserinus “Say Grace before Tea” MCL Lateral: ITB (Gerdy’s Tuburcle) LCL INSPECTION:Surface anatomy Posterior: Popliteal fossa Baker’s Cyst Popliteal aneurism INSPECTION:Limb alignment INSPECTION: Genu Valgum Intra-maleolar distance Genu Varum Intra-condylar distance Windswept deformity INSPECTION:Patella alignment Squinting patellae Increased femoral ante-version Increased external tibial torsion Q angle Anterior ASIS to center of patella Center of patella to tibial tubercle 14° in men, 17° in women Patella Alta Patella baja INSPECTION:GAIT Varus thrust Valgus thrust Recur vatum thrust Antalgic gait Stiff knee gait Flexed knee gait INSPECTION:Range of movement Extension: Normal range Active : 0° Passive: - 10° (prone hanging test) Flexion: Normal range Active: 0° - 130° Passive: 0° - 150° PALPATION: Be systematic Start and end at same spot Helpful system is to start anteriorly PALPATION: Patella Infra-patella tendon Tibial tubercle Pes anserinus MCL Medial joint space and meniscus Medial femoral condyle VMO PALPATION: Rectus femoris Vastus intermedius Vastus lateralis Lateral femoral condyle LCL Lateral joint space and men