MUSCULOSKELETA

L ASSESSMENT of
KNEE

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 Content
Applied Anatomy
Patient History
Systems Review
Examination
Diagnostic imaging/Investigations
Reference

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 Tibiofemoral Joint
The tibiofemoral joint is the largest joint in the
body. It is a modified hinge joint having two
degrees of freedom.
It consists of the distal end of the femur and
the proximal end of the tibia. The tibiofemoral
joint has great demands placed upon it in
terms of both stability and mobility.

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 Tibiofemoral Joint
Resting position: 25 flexion

Close packed position: Full extension, lateral

rotation of Tibia

Capsular pattern: Flexion, extension

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 Patellofemoral Joint
The patellofemoral joint is a modified plane
joint. The patellofemoral joint functions to:
Provide an articulation with low friction.
Protect the distal aspect of the femur from
trauma and the quadriceps from attritional
wear.
Improve the cosmetic appearance of the knee.
Improve the moment arm (distance between
the center of gravity and the center of
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Patient History

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 Patient History
What is the exact nature and location of the
patients chief complaint?
What was the mechanism of injury?
Is there any "clicking," or was there a "pop
when the injury occurred?
What is the patient able or unable to do
functionally?
Do certain positions or activities have an
increased or decreased effect on the pain?
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Does the knee "give way"?
 Patient History
Has the knee ever locked?
On movement, is there any grating or clicking
in the knee?
Is the joint swollen?
Is the gait normal?
What type of shoes does the patient wear?

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Interpretation from
Patient History

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 Patients Chief Complaint

Is the Patient complaint Pain or Instability, or both?

If the chief complaint is pain

(Traumatic Pain versus Insidious Pain)

If Traumatic Pain
Mechanism of Injury ???
Traumatic Blow, Contact, Non-contact, Fall 10
 Position of the joint??
Direction of forces??

Anatomic structures are at risk for injury

If Insidious Pain

Look for Referred Pain to Knee

Assess Hip, SI Joint, Lumbar Spine
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 MOI & Structure Injured
Mechanism Of Injury Structures Involved

Direct trauma to anterior 1. Patellar injury

knee &
Overuse Injury
With 1. ACL
Valgus Rotation 2. Posteromedial Capsule
force
Without 1. Medial meniscus,
Rotation 2. Med Collateral ligament,
3. Epiphyseal Plate,
4. Patellar Dislocation/subluxation.

Varus force with rotation 1. LCL

2. Posterolateral capsule, and 12
 MOI & Structure Injured
Mechanism Of Injury Structures Involved

Hyperextension 1. ACL injuries

2. Medial meniscal tears
Flexion Longitudinal Tear of Medial
Meniscus
Torsional Force = Compression Meniscal injuries
+ Rotation
Torsional Force + Valgus Force The ACL
Torsional Force + Varus Force The PCL

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 Location of the Pain
The location of the pain may afford the
clinician clues as to the cause.
According to location, Knee pain can be

o Anterior Knee Pain

o Posterior Knee Pain
o Medial Knee Pain
o Lateral Knee Pain

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Medial Knee Pain and
Possible Causes
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Lateral Knee
Pain and
Possible
Causes

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Anterior
Knee
Pain and
Possible
Causes

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Posterior Knee Pain and Possible Causes

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 Insidious Onset of Pain
Insidious: Working or spreading in a hidden and
usually injurious way.
An insidious onset of pain should alert the
clinician to the possibility of a serious condition.
Pain in the knee can be referred from
the hip,
the back, and
the sacroiliac joint.
Complaints of shooting pain, burning pain, and 19
 If Chief Complaint Is Instability
Check the Nature of Sensation during Movement
Giving W ay
Meniscus Pathology
Patellar Subluxation
Retropatellar Lesion
Locking (W ith Extension)
Loose Bodies
Meniscus Lesion
hamstring Muscle Spasm
Entrapment of the Cruciate Ligament 20
Systems Review

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 Systems Review
Macnab recommends the following classification
for referred symptoms:

1. Viscerogenic
2. Vasculogenic
3. Neurogenic
4. Psychogenic
5. Spondylogenic

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 Systems Review
Neurogenic pain referred to the knee from the
lumbosacral region (L3 to S2 segments).

Arthrogenic pain is referred to knee from hip,

ankle and lumbar spine.

Systemic diseases referred to knee include

rheumatoid arthritis, or OA , Lyme disease.

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Referred Pain to Knee and
from the Knee

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Examination

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 General Principles of Orthopedic
Examination
1. Exposure for examination
2. Observation/ Inspection
3. Palpation
4. Measurement
* Length
* Circumference
5. Movements
* Active Movement
* Passive Movement 26
 General Principles of
Orthopedic Examination
6. Movement Patterns/ Functional Assessment
7. Neurological Examination
* Sensations/ Cutaneous Distribution
* Dermatomes & Myotomes
* Reflexes
8. Peripheral Circulation
9. Special Test

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 Exposure

For a proper observation, the patient must be

suitably undressed so that the examiner can
observe the posture of the spine as well as the
hips, knees, and ankles.

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 Observation/ Inspection
Observation is divided into:
i. Informal observation
This observation component of the examination begins as
the clinician meets the patient and ends as the patient is
leaving. This informal observation should occur at every
visit.
i. Formal observation
The formal observation of the patient with knee pain is
divided into following sections:
Standing : Anterior View , Posterior View, Lateral View
Sitting : Anterior and Lateral Views, 29
 Anterior View, Standing
From the anterior aspect,
The examiner should note any mal-alignment,
including genu varum (bow-leg) or genu
valgum (knock-knee)deformity.
Intra-capsular (entire joint) swelling or extra-
capsular (localized) swelling.
Any visible wasting of the muscles.
Any bruising or discoloration around the knee
should also be noted, as well as any scars or
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 Anterior View, Standing
Position of the patella tilt outward
("grasshopper eyes" patellae), tilt inward
("squinting" patellae).
To test for tibial torsion, the examiner aligns
the patient's straight legs (knees extended)
that the patellae face straight ahead. The
examiner then looks at the feet to determine
their angle relative to the shaft of the tibia.

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 Lateral View, Standing
The examiner then views the patient from
both sides for comparison. It should be noted
whether genu recurvatum (hyperextended
knee) is present and whether one or both
patellae are higher (patella alta) or lower
(patella baja) than normal.
With an abnormally high patella, a "camel
sign" may be present ; because of the high
patella (one "hump"), the infrapatellar fat pad
(second hump) or an inflammed infrapatellar 32
 Posterior View, Standing

The examiner looks for abnormal swellings

such as a popliteal (Baker's) cyst,

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Anterior and Lateral Views, Sitting
For the final part of the observation, the
patient sits with the knee flexed to 90 and
the feet either partial bearing weight (on a
stool) or dangling free.
The patient is observed from the front and
from the side.
Check for patella alta or patella is laterally
displaced with a patella alta.
Any bony enlargements such as those seen in
Osgood ScWatter disease (i.e., an enlarged
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Anterior and Lateral Views, Sitting
Swelling of the pes-anserine bursa and a
meniscal cyst are best visualized in the seated
position. Meniscal cysts may also present as
isolated medial swelling.
If patellar position deviations are seen in the
observation phase, they are considered static
problems, and the examiner should test
patellar movement passively and watch the
patellae during active movements to see
whether it is a dynamic problem as well. 35
 Palpation
Dryness or excessive moisture
Abnormal sensation
Temperature variation
Skin
Increased local temperature denotes increased
vascularity which indicates an inflammatory
reaction or rapidly growing tumor.
Differences in tissue tension and texture
Differences in tissue thickness
Pulses, tremors, and fasciculation
The Soft
Muscles...are they in spasm or wasted?
tissue
Joints.......is synovial membrane
Contour
thickened or joint distended with fluid?
Any local swelling cyst ? tumor? or general
swelling of the part? 36
 General shape and outline of bone,
The Bone feel for particular thickness , abnormal
Alignment prominence, disturbed relationship of
normal relationship.

Relate the exact site of local tenderness to

Local Tenderness particular anatomical structure.
Assess for comorbid myo-fascial pain

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 Measurement
Amount of Swelling
Degree of Femoral Torsion/Retroversion or
Anteversion.
Degree of Genu Varus.
Degree of Genu Valgus.
Q-Angle Assessment.
Degree of Tibial Torsion.
Patella Tendon-to-Patella Height Ratio.
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 Amount of Swelling
Swelling may be diffused or localized. Diffuse
swelling indicates fluid in the joint or synovial
swelling, or both.
The amount of swelling present may provide the
clinician with valuable information regarding the
internal damage that may have resulted.
The swelling is examined with the patient positioned
supine, in the following manner:
Ballottement test which is a palpatory maneuver to
test for a floating object.
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 Patellar Ballottement
(Maximum Effusion)
Using one hand, the clinician grasps the patients thigh at
the anterior aspect about 10 cm above the patella,
placing the fingers medial and the thumb lateral.
The patients knee is extended.
With the other hand, grasps the patients lower leg about
5 cm distal to the patella, same position of hand.
The proximal hand exerts compression against the
anterior, lateral, and medial aspects of the thigh and,
while maintaining this pressure, slides distally. The distal
hand exerts compression in a similar way and slides
proximally. 40
 Patellar Ballottement
(Maximum Effusion)
Using the index finger of the distal hand, the clinician
now taps the patella against the femur.
In normal knee joint, there is no tapping sensation
underneath the clinicians fingertips. However, in the
knee with excess fluid, the patella is floating; thus,
ballottement causes the patella to tap against the
femoral condyle. This sensation is transmitted to the
clinicians fingertips.
This test can produce false-positive results. When this is
the case, the uninvolved side usually tests positive as
well. 41
 Degree of Femoral Torsion
Degree of Femoral torsion is indicated by
whether the feet are rotated outward or
inward, in the relaxed standing position.
Femoral anteversion results in internal
rotation of the femoral sulcus, an increase in
the Q angle, squinting patella and toe in or
pigeon toeing.
Femoral retroversion results in out
toeing(external rotation).
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 Degree of Genu Varus/Valgus
Degree of Genu Varus
Genu varus can be the result of bowing of the tibia
or an increase in the normal angle of inclination
(neck shaft angle)at the hip (coxa valga).
Degree of Genu Valgus
Genu valgus can result from a change of
angulation of the femur caused by femoral
anteversion, tibial torsion, or excessive foot
pronation.
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 Degree of Knee
Flexion/Hyperextension
Degree of Knee Flexion
A flexed knee in the relaxed standing position is
often indicative of arthritic changes of the knee.

Degree of Genu Recurvatum or Hyperextension

Knee recurvatum may be an expression of a
generalized ligamentous laxity or may be
associated with patella alta.
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 Q-Angle Assessment
The Q-angle should be assessed dynamically
and statically.
The normal ranges are
8140 for males and
15170 for females.
Angles of greater than 200
are considered abnormal
and may be indicative of
potential displacement of
the patella.
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 Measurement of Q-Angle
A measurement is then taken using an imaginary line
drawn from the ASIS to the center of the patella, and a
second line from the tibial tuberosity to the center of
the patella
Dynamically
The preferred position for this test is the one-legged
standing position without shoes.
Statically
The preferred position for the static test is the supine
position.
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 Degree of Tibial Torsion
This measurement is indicated by the position of the
feet in relation to the patella.
External tibial torsion increases the Q angle, whereas
internal tibial torsion decreases it.
Few studies have addressed the rotational
relationships, specifically the rotational orientation
of the tibia to the femur. This rotational relationship
of the tibia to the femur in the transverse plane is
referred to as knee version.

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 Patella Tendon-to-Patella
Height Ratio
This measurement is best performed
radiographically.

The patella tendon length should be equal, or

slightly longer than the height of the patella.
If a ratio of greater than 1520% exists, patella
alta should be suspected.
If the ratio is less than 1520%, patella baja
should be suspected. 49
 Active Movements
The active movements are performed initially with
the patient sitting and then with the patient in lying
position.

The most painful movements should be done last.

Repetitive or combined movements or sustained

postures that have resulted in symptoms, these
movements should also be tested.
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 Active Movements
During the active movements, the examiner
should observe:

i. The excursion of the patella, to ensure that it

tracks freely and smoothly;
ii. The range of motion (ROM) available;
iii. Whether pain occurs during the movement,
and if so, where; and
iv. What appears to be limiting the movement.
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Active Range of Motion of the
Knee Complex

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 Passive Movements
During passive movement testing, we perform
Passive Physiological Motion Testing
Passive Accessory Motion Testing
Of tibiofemoral joint and patellofemoral joint.

To observe the following:

The end feel
Capsular pattern
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Passive Movements of the Knee
Complex and Normal End Feel

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 Resisted Isometric Movements
For a proper test of the muscles, resisted
isometric movements must be performed.
Ideally, these resisted isometric movements
are performed with the joint in its resting
position.
Ankle movements are tested because the
gastrocnemius muscle crossing the posterior
knee and both plantar and dorsiflexion
movements cause movement of the fibula,
hence respectively decreases or increases the 55
 Resisted Isometric Movements

Resisted Isometric Movements of the Knee

Complex
Knee Flexion
Knee Extension
Ankle Plantar flexion
Ankle Dorsiflexion

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 Econcentric Movements

If the history has indicated concentric,

eccentric, or econcentric movements have
caused symptoms, these types of contractions
should be tested as well, but only after
isometric testing has been performed.

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 Functional Assessment
If the active, passive, and resisted isometric
movements are performed with little
difficulty, the examiner may put the patient
through a series of functional tests to see
whether these sequential activities produce
pain or other symptoms.

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 Approximate Range of Motion
Required for Common
Activities of Daily Living
Activity Required Flexion Range of
Motion (degrees)
Running 120140
Squatting 120
Tying shoelace 120
Donning a sock 120
Climbing downstairs 110
Sitting and rising 85
Climbing upstairs 80
Swing phase of gait 70
Stance phase of gait 20 59
 Testing of
Ligamentous Injury

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 When testing the ligaments of the knee, the
examiner must watch for four one-plane
instabilities and four rotational instabilities

Instabilities About the Knee & Related Tests

One-plane medial instability Valgus Stress Test
One-plane lateral instability Varus stress Test
One-plane anterior instability Lachman Test
One-plane posterior instability Posterior Drawer Test
Anteromedial rotary instability Slocum Test
Anterolateral rotary instability Pivot Shift Test
Posteromedial rotary Posteromedial Pivot Shift
instability Test
Tibial External Rotation
Posterolateral rotary instability 61
Test
62
 Abduction (Valgus Stress) Test
The patient is positioned supine,
with the involved knee extended,
while the ankle is stabilized in
slight lateral rotation either with
the hand or with the leg held
between the examiner's arm
and trunk.
The clinician applies a strong valgus force.
If pain or an excessive amount of motion is detected
compared with the other extremity, a hypermobility or
instability should be suspected. 63
 Abduction (Valgus Stress) Test
The following structures may be implicated:
Superficial and deep fibers of the MCL
Posterior oblique ligament
Posteromedial capsule & Medial capsular ligament
ACL & PCL
One plane valgus instability in
300 of flexion usually denotes
a tearing of at least a second
degree, of the middle third of
the capsular ligament and the
parallel fibers of the MCL. 64
 Abduction (Valgus Stress) Test
This flexed part of the valgus stress test would be
classified as the true test for one-plane medial
instability.
If a stress radiograph is taken when the test is
performed in full extension:

5-mm opening is indicative of a grade 1 injury

up to 10 mm is of a grade 2 injury
more than 10 mm is of a grade 3 injury

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 Lachman test
The patient lies supine with the involved leg
beside the examiner. The examiner holds the
patient's knee between full extension and 300 of
flexion , and the tibia should be slightly laterally
rotated.
The patient's femur is stabilized with one of the
examiner's hands (the "outside" hand) while the
proximal aspect of the tibia is moved forward
with the other ("inside") hand and the anterior
tibial translation force should be applied from the
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 Lachman test
A positive sign is indicated by a "mushy" or soft end
feel when the tibia is moved forward on the femur
and disappearance of the infrapatellar tendon slope.
A positive sign indicates that the following structures
may have been injured to some degree:

1. Anterior cruciate ligament

(especially the posterolateral bundle)
2. Posterior oblique ligament
3. Arcuate-popliteus complex.

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 Tests for
Meniscus Injury

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 McMurray Test
The patient lies in the supine position with
the knee completely flexed (the heel to the
buttock).
Test for lateral meniscus:
The examiner then medially rotates the tibia
and extends the knee.
If there is a loose fragment of the lateral
meniscus, this action causes a snap or click
that is often accompanied by pain.
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 McMurray Test
Test for lateral meniscus:
To test the medial meniscus, the examiner performs
the same procedure with the knee laterally rotated.

Test for Medial Meniscus Test for Lateral Meniscus 70

 Apley's Test
The patient lies in the prone position with the
knee flexed to 90. The patient's thigh is then
anchored to the examining table with the
examiner's knee.
For Ligamentous Injury:
The examiner medially and laterally rotates the
tibia, combined first with distraction, while
noting any restriction, excessive movement, or
discomfort.
If rotation plus distraction is more painful or 71
 Apley's Test

Distraction + Rotation= Compression + Rotation=

Pain= Ligamentous Injury Pain= Meniscal Injury 72
 Apley's Test
For Meniscal Injury:
Then the examiner medially and laterally rotates
the tibia, using compression instead of
distraction.
If the rotation plus compression is more painful
or shows decreased rotation relative to the
normal side, the lesion is probably a meniscus
injury.

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 Test for
Plica Lesions
Plica an extension of the protective
synovial capsule of the knee, are
embryological remnant's that have
remained in some people after birth.
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 Mediopatellar Plica Test
The patient lies in the supine position, and the
examiner flexes the affected knee to 30.

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 Mediopatellar Plica Test
If the examiner then moves the patella
medially, the patient complains of pain.
This pain, indicating a positive test, is caused
by pinching of the edge of the plica between
the medial femoral condyle and the patella.
The pain may be indicative of a mediopatellar
plica.

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 Test for the
Patellar Instability
Apprehension test

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 Fairbank's Apprehension Test
The patient lies in the supine position with the
quadriceps muscles relaxed and the knee flexed
to 30 while the examiner carefully and slowly
pushes the
patella laterally.

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 Fairbank's Apprehension Test
If the patient feels the patella is going to
dislocate, the patient will contract the
quadriceps muscles to bring the patella back
"into line.

This action indicates a positive test. The

patient will also have an apprehensive look.

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 Patellofemoral
syndrome
Clarke's sign
McConnell test

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 Clarke's Sign (Patellar Grind Test)
The examiner presses down slightly proximal to
the upper pole or base of the patella with the
web of the hand as the patient lies relaxed with
the knee extended.

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 Clarke's Sign (Patellar Grind Test)
The patient is then asked to contract the
quadriceps muscles while the examiner pushes
down.
If the patient can complete and maintain the
contraction without pain, the test is considered
negative.
The best way to do this is to repeat the procedure
several times, increasing the pressure each time
and comparing the results with those of the
unaffected side.
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 Iliotibial Band
Friction Syndrome
Noble compression test

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 Noble Compression Test
The patient lies in the supine position, and the
examiner flexes the patient's knee to 90,
accompanied by hip flexion.
Pressure is then applied to the lateral femoral
epicondyle, or 1 to 2 cm (0.4 to 0.8 inch)
proximal to it, with the thumb. While the
pressure is maintained the patient's knee is
passively extended.

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 Noble Compression Test
At approximately 30 of flexion (0 being straight
leg), the patient complains of severe pain over the
lateral femoral condyle. Pain indicates a positive
test. The patient states that it is the same pain that
occurs with activity.

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Quadriceps Pull
Q-angle
Tubercle sulcus angle

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 Tubercle Sulcus Angle
(Q-Angle at 90)
A vertical line is drawn from the center of the
patella to the center of the tibial tubercle.
A second horizontal line is drawn through the
femoral epicondyle. Normally the lines are
perpendicular.
Angles greater than l0 from the perpendicular
are considered abnormal. Lateral patellar
subluxation may affect the results.

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Tubercle Sulcus Angle (Q-Angle at
90)

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 Test for
Osteochondritis
Dissecans

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 Wilson Test
The patient sits with the knee flexed over the
examining table. The knee is then actively
extended with the tibia medially rotated.
At approximately 30of flexion (0 being
straight leg), the pain in the knee increases,
and the patient is asked to stop the flexion
movement.
The patient is then asked to rotate the tibia
laterally, and the pain disappears.
This finding indicates a positive test, which is 90
 Test for
Muscle Imbalance

91
 Tripod Sign
(Test for Hamstrings Contracture)
The patient is seated with both knees flexed to
90 over the edge of the examining table.
The examiner then passively extends one knee.
If the hamstring muscles on that side are tight,
the patient extends the trunk to relieve the
tension in the hamstring muscles.
The leg is returned to its starting position, and
the other leg is tested and compared with the
first side.
92
 Tripod Sign
(Test for Hamstrings Contracture)
Extension of the spine is indicative of a positive
test.

93
 Test for Knee Extension
Contracture (Heel Height
Difference)
The patient lies prone with the thighs
supported and the legs relaxed. The examiner
measures the difference in heel height .

94
 Test for Knee Extension
Contracture (Heel Height
Difference)
One centimeter of difference approximates 1,
depending on leg length.
The test, along with the
accompanying end feel,
would be used to test for
joint contracture and
possibly tight hamstrings.
Swelling may also cause
a positive test. 95
Test for Leg Length
Measurement

96
 Measurement of Leg Length
The patient lies in the supine position with the
legs at a right angle to a line joining the two
ASISs. With a tape measure, the examiner obtains
the distance from one ASIS to the lateral or
medial malleolus on that side, and the reading
on the tape measure is noted.

The other side is

tested similarly.
97
 If there is a difference, the examiner can
determine its site of occurrence by measuring:
From the high point on the iliac crest to the
greater trochanter (for coxa vara),
From the greater trochanter to the lateral
knee joint line (for femoral shaft length), and
From the medial knee joint line to the medial
malleolus (for tibial length).
The two legs are then compared.

98
 Functional Leg Length
The patient stands in the normal relaxed
stance. The examiner palpates the ASISs and
then the posterior superior iliac spines (PSISs)
and notes any differences.
The examiner then positions the patient so
that the patient's subtalar joints are in neutral
while bearing weight. While the patient holds
this position with the toes straight ahead and
the knee straight, the examiner repalpates the
ASISs and the PSISs.
99
 Functional Leg Length
If the previously noted differences remain, the
pelvis and sacroiliac joints should be
evaluated further.
The examiner should suspect a functional leg
length difference caused by hip, knee, ankle,
or foot problems-primarily, ankle or foot
problems.

100
Neurological
Examination

101
 Neurological Examination
I. Sensory Examination
a. Sensations/ Cutaneous Distribution
a. Superficial sensation
b. Deep Sensation
c. Complicated Sensation

II. Motor Examination

a. Muscle Tone
b. Muscle Power
c. Muscle Bulk
III. Reflexes 102
 Interpretation from
Sensory Examination
Superficial sensation loss
Spinothalamic Tract Lesion
Deep Sensation loss
Dorsal Column Tract Lesion
Complicated Sensation loss
Hemispheric Diseases
Cutaneous Distribution (sensation loss)
Peripheral Nerve Lesion
Dermatomes (sensation loss) 103
 Myotomes
1. Test with resistive exercises.
2. The trainer will check for weakness in strength.
3. All tests should be compared bilaterally.

L3,4: Knee extension

L5,S1: Knee flexion

104
 Dermatomes & Myotomes

Reduced sensory input:.

Sensory changes are due to a lesion of the sensory nerves
anywhere from the spinal nerve root to its terminal branches in
the skin.
A knowledge of cutaneous distribution of nerve roots
(dermatome) and peripheral nerves enables the clinician to
distinguish the sensory loss due to nerve root lesion from that of
peripheral nerve lesion.

Reduced motor impulses along the nerve:

A loss of muscle strength is indicative of either a lesion of the
 Dermatomes & Myotomes

If the lesion occurs at nerve root level then all the muscles
supplied by the nerve root (the myotome) will be affected.
If the lesion occurs in a peripheral nerve then the muscles
that it supplies will be affected.

A working knowledge of the muscular distribution of nerve

roots (myotomes) and peripheral nerves enables the
clinician to distinguish the motor loss due to a root lesion
from that due to a peripheral nerve lesion.
 Reflexes

Reflexes should be checked

for differences between
the two sides.
The reflexes around
knee are:
i. The medial hamstring (L5-S1)
ii. The patellar (L3-L4)

107
Diagnostic Imaging

108
 Plain Film Radiography
When looking at radiographs of the knee, the examiner
should note any possible:

Fractures (e.g. Diminished joint space

osteochondral), (possible osteoarthritis)
Epiphyseal damage Alterations in bone texture
Lipping, Varus or Valgus Deformity
Ossification or Tumors Patellar position
Abnormal calcification Loose bodies

109
 Others Imaging Techniques
Arthrography
Arthrograms of the knee are used primarily to diagnose
tears in the menisci and plica.
Arthroscopy
The arthroscope is being used increasingly to diagnose
lesions of the knee and to repair many of them surgically.
Computed Tomography
CT scans are often used to view soft tissue as well as
bone.
110
 Others Imaging Techniques

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is advantageous
because of its ability to show soft tissue as well as bone
tissue while providing no exposure to ionizing radiation.

Xeroradiography
Xeroradiography may be used to delineate the edge of
bone.

111
 Completion of the Examination
On completion of the physical examination the clinician should:

Warn of the patient the possibility of exacerbation of

symptoms as a result of the assessment up to 24-48 hours.
Request the patient to report details on the behavior of the
symptoms following examination at the next attendance.
Explain the findings of the physical examination and how
these findings relate to the subjective assessment.
Evaluate the findings , formulate a clinical hypothesis and
write up a problem list.
Determine the objectives of treatment.
Devise an initial treatment plan.
 References

Therapeutics Exercise, Foundations and

Techniques by Carolyn Kisner
Orthopaedic Physical Examination by David. J.
Magee
Orthopaedic Examination ,Evaluation and
Intervention by Mark Dutton
Outlines of Orthopaedics by Adams
Neuromusculoskeletal Examination and
Assessment by G D Maitland 113