Patients Name

DOB
MRN
Date of Visit
Knee Pain H & P
HPI KEY: Y = Yes(positive) N = No(negative) NE= Not Examined





History elements to ask:
- Mechanism of injury
- Acute traumatic, overuse, or spontaneous onset
- Pop or tear with injury
- Location of pain
- Swelling (Y/N), if yes how long after injury ____ hrs
- Knee clicking, catching, or locking
- Give-way episodes
- Provoking/alleviating factor
- Effect on pts normal level of activity

PMH/PSH
Prior knee injury or surgery
Other orthopedic history (surgeries, arthritis, trauma, injuries etc)

Physical exam
Inspection
Limping gait Y N NE
Weightbearing Y N NE
Swelling Y N NE
Bruising Y N NE
Atrophy Y N NE
Alignment Varus Valgus Neutral
ROM
Extension Full Limited
Flexion Full Limited
Strength
Extension Full Weak Painful
Flexion Full Weak Painful
Special Tests
Effusion Y N NE
Ballotable effusion Y N NE
Fluid wave Y N NE
Patellar testing
Patellar compression Y N NE
Patellar inhibition Y N NE
Patellar apprehension Y N NE
Tenderness patella facets Y N NE
Meniscal Tear Assessment
McMurrays Y N NE
Apleys Y N NE
Ligamentous tests
Anterior drawer (ACL) Y N NE
Posterior drawer (PCL) Y N NE
Lachmans (ACL) Y N NE
Varus stress (LCL) Y N NE
Valgus stress (MCL) Y N NE
Palpation
Medial jt line tenderness Y N NE
Lateral jt line tenderness Y N NE
Patellar tendon Y N NE
MCL Y N NE
LCL Y N NE
Neurovascular
Sensation Y N NE
Distal pulses Y N NE

OTTOWA KNEE RULES - Cosider X RAY if:
- Age 55 or older with acute trauma Y N
- Isolated tenderness of patella following trauma Y N
- Tenderness at head of fibula Y N
- Inability to flex to 90 degrees following trauma Y N
- Inability to bear weight immediately or in ED Y N
- 4 step ambulation (disregarding limp) Y N

Asssessment (circle suspected diagnosis - all that apply)
Osteoarthritis
Patellofemoral syndrome
Patellar tendinopathy
Iliotibial band syndrome
Osgood-Schlatter syndrome
Knee contusion
ACL tear
PCL tear
MCL strain/tear
LCL strain/tear
Medial meniscus tear
Lateral meniscus tear
Patellar dislocation
Patella fracture
Other: ___________________

Plan:
1) Treatment (Circle all employed)
RICE (Rest, Ice, Compression, Elevation)
Exercises: (specify)___________________________
Crutches/reduced weight bearing
Knee brace/Immobilizer
Aspiration/Injection
2) Medications
NSAIDs Y N Specify:________________________ Other:______________________________
3) Imaging
X-rays Y N MRI Y N If yes, specify test ordered:_____________________
4) Referral Sports Med Y N Orthopedics Y N Physical Therapy Y N
5) Follow up: ______ wks

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KNEE EXAM- Demonstration





















Images obtained via Google Images; Captions adapted from Greene, Essentials of Musculoskeletal Care, ed. 2 Ashwin Rao & J onathan Drezner, 2007
Figure 1- External landmarks of the knee Figure 2- Clinical anatomy of the knee, including bony,
ligamentous, and meniscal structures
Figures 3 and 4- Anterior and Posterior Drawer: These tests assess for stability of the anterior and
posterior cruciate ligaments, respectively. With the knee flexed to 90
o
, stabilize leg by sitting on foot.
Grasp the proximal tibia with both hands, insuring relaxation of hamstrings. Push the tibia anteriorly
to test ACL stability and posteiorly to test PCL stability, looking for a stable endpoint in each case.
Compare with the uninjured knee.
Figure 5- Lachmans Test This test is the most
sensitive for identifying ACL tears. Grasp the
thigh to support it, allowing the thigh muscles to
relax. Flex the knee to 25
o
and grasp the distal
femur from the lateral side with other hand.
Initiate a shucking motion by pulling
anteriorly on the tibia while pushing posteriorly
on femur. Increased anterior translation
indicates a partial or complete tear of the ACL
Figure 6- McMurrays Test: This test
assesses for meniscal tears. Flex the
knee to maximum pain-free position.
Hold that position while externally
rotating the foot, and then gradually
extending the knee (while maintaining
foot in external rotation). Medial
compartment pain or clicking suggests a
medial meniscal tear. Performing the
same steps with the foot in internal
rotation assesses for lateral meniscal
tears.
Figure 7- Apleys Test: This is an
alternative test for meniscal tears. With the
patient laid prone, flex the knee to 90
o
.
Applying force vertically, rotate the knee
internally and externally. Pain
reproduction.
Figure 8- Varus and Valgus Stress tests: These tests assess for LCL and
MCL injury, respectively. For the varus stress test, stabilize the knee in both
extension and 30
o
flexion. Press on the medial aspect of the knee. If the knee
opens up more that the opposite (non-injured) knee in the varus direction,
this suggests partial or complete LCL tear. For the valgus stress test.
stabilize the knee and place valgus stress (pressure inward upon the lateral
aspect of the knee) in both full extension and at 30
o
knee flexion. Compare
with opposite knee. If knee opens up more in the valgus compartment, this
suggests are partial or complete tear of the MCL.