What is a physical examination?
The musculature should be symmetric bilaterally. In particular, the vastus medialis obliquus of the quadriceps should be evaluated to determine if it appears normal or shows signs of atrophy.
The knee is then palpated and checked for pain, warmth, and effusion. Point tenderness should be sought, particularly at the patella, tibial tubercle, patellar tendon, quadriceps tendon, anterolateral and anteromedial joint line, medial joint line, and lateral joint line.
Moving the patient's knee through a short arc of motion helps identify the joint lines. Range of motion should be assessed by extending and flexing the knee as far as possible normal range of motion: The suprapatellar pouch should be milked to determine whether an effusion is present.
Patellofemoral tracking is assessed by observing the patella for smooth motion while the patient contracts the quadriceps muscle. The presence of crepitus should be noted during palpation of the patella.
The quadriceps angle Q angle is determined by drawing one line from the anterior superior iliac spine through the center of the patella and a second line from the center of the patella through the tibial tuberosity Figure 2.
Quadriceps angle Q angle. Reprinted from Juhn MS. Am Fam Physician ; A patellar apprehension test is then performed. With fingers placed at the medial aspect of the patella, the physician attempts to sublux the patella laterally.
If this maneuver reproduces the patient's pain or a giving-way sensation, patellar subluxation is the likely cause of the patient's symptoms. The physician fixes the patient's foot in slight external rotation by sitting on the foot and then places thumbs at the tibial tubercle and fingers at the posterior calf.
With the patient's hamstring muscles relaxed, the physician pulls anteriorly and assesses anterior displacement of the tibia anterior drawer sign.
The Lachman test is another means of assessing the integrity of the anterior cruciate ligament Figure 3. The physician stabilizes the distal femur with one hand, grasps the proximal tibia in the other hand, and then attempts to sublux the tibia anteriorly.
Lack of a clear end point indicates a positive Lachman test. History and physical examination. Posterior Cruciate Ligament For the posterior drawer test, the patient assumes a supine position with knees flexed to 90 degrees. While standing at the side of the examination table, the physician looks for posterior displacement of the tibia posterior sag sign.
The physician then pushes posteriorly and assesses for posterior displacement of the tibia. The physician places one hand at the lateral aspect of the knee joint and the other hand at the medial aspect of the distal tibia. Next, valgus stress is applied to the knee at both zero degrees full extension and 30 degrees of flexion Figure 4 7.
With the knee at zero degrees i. Varus and valgus stress test. The maneuvers should be performed with the knee unflexed and at 30 degrees of flexion.
Lateral Collateral Ligament To perform the varus stress test, the physician places one hand at the medial aspect of the patient's knee and the other hand at the lateral aspect of the distal fibula. Next, varus stress is applied to the knee, first at full extension i.
The McMurray test is performed with the patient lying supine 9 Figure 5. The test has been described variously in the literature, but the author suggests the following technique. McMurray test to assess the medial meniscus. Top The test is performed with the patient supine and the knee flexed to 90 degrees.
To test the medial meniscus, the examiner grasps the patient's heel with one hand to hold the tibia in external rotation, with the thumb at the lateral joint line, the fingers at the medial joint line. Middle The examiner flexes the patient's knee maximally to impinge the posterior horn of the meniscus against the medial femoral condyle.
Bottom A varus stress is applied as the examiner extends the knee. The physician grasps the patient's heel with one hand and the knee with the other hand.Definition of physical examination from the Collins English Dictionary Aspect When we use a verb, we often need to be able to refer to more than the time at which an event took place.
Jul 07, · The history and physical examination of the hip is the key component for evaluation of patients presenting with hip pain. As our understanding of the anatomy and biomechanics of the normal hip vs the pathologic hip advances, the physical examination progresses as well. Physical Examination Appointments & Access; Contact Us; What should you bring to your doctor's visit?
Patients often ask what they should bring to their doctor visit. This is a very important question because bringing the right things helps your physician have as much information as possible when making a diagnosis and creating a treatment plan.
A urinalysis is a group of physical, chemical, and microscopic tests. As part of the investigation, a healthcare practitioner will evaluate an individual's medical history, physical examination, and accompanying signs and symptoms.
Additional urine and blood . Evaluation of Patients Presenting with Knee Pain: Part I. History, Physical Examination, Radiographs, and Laboratory Tests A more recent article on evaluation of knee pain in adults is available. The comprehensive physical exam experience with Affiliated Physicians is an enhanced version of your annual physical.
It includes an extensive battery of advanced diagnostic tests, a longer, more personalized visit with a physician, the comfort and convenience of a well-appointed facility, and a detailed results report.