Knee:

- History: 4 majors complains (pain-SRCOPDSARApoint with one finger where is the pain
worst, localizing and what might be driving it), swelling (When, what causes it, is it
progressing, where is it), locking(where a patients knee is stuck bent and they cant unbend it
for long periods, shake there leg to free it up is what they say, gravity distracts the tibia from
femurfrees it up), giving way (when was the last time you fell?--> true giving away isn’t
associated with pain, its painless and associated with ligament problems)
- Talk about physiotherapy and NSAID before jumping to surgery
- Back pain might be associated with knee pain (which is first?) also hip pain might be knee
painreferred pain from an arthritic hip; ask do you have trouble putting shoes and socks
onif they say it is bad, it is probably the hip.
- ADLs=activities and daily livingwhat do they expect? Make sure you tell them the knee is
never going to be like beforeset them straight and explain that they wont be the
sameask what they do for a living.
- Medial: MCL8 cm below the knee. Swelling will be below then.
- LCL
- ACL
- PCL from back of tibia to femoral condyle
- Iliotibial band syndromeusually runners
- Pes anserinus
- Minisci shape: big medial meniscal tear. Arthroscopyif they point with one point. BUT if it
is vague they might not have such a good outcome with arthroscopy.
- Medial is bigger than lateral meniscus. Forces less since the larger surface area vs lateral
meniscal tear, don’t do as well since it’s a smaller area (esp in valgus knee)
- Varusmedial compartment (all the forces will be placed there) vs valgus will be lateral
compartment shows importance of watching gait
- Antalgic gaitlimit the amount of time they spend on the affected leg (they have a limp)
- Trendelenburghip pathology gait
- Short leg gait
- Heel walking L4(EHL)/L5 (TA)
- Rotate hipknee pain=hip problem
- Look for nerve root problems in spine that affect the knee—Bring knee up and they will go
into tripod where they bring thre back up if move lateral or medial while sitting and get knee
pain look at hip
- Vastus medialis is the first muscle to waste
- Extensor lag (on bed its flexed=arthritis when up in=extensor muscle problems)
- Check neurovascular status below the knee in serious knee injuriesfoot drop