Lateral meniscus tear: With patient supine, fully flex the knee, place forefingers on lateral side of joint line, then with applying valgus stress and internal rotation of leg, extend the knee looking for both pop/click and pain.McMurray test (meniscus cartilage tear):.Crepitus is significant only when accompanied by tenderness, in which case it is consistent with patellar cartilage pathology. Apley's grind test (patellar cartilage tear): By placing palm on patella and applying firm pressure while manipulating the patella in the sagittal plane.In the patient with direct patellar trauma & isolated patellar tenderness, an x-ray is indicated to evaluate for fracture.Tenderness at the inferior insertion is consistent with patellar tendonitis, "Jumpers knee.".Tenderness at the superior insertion is consistent with quadriceps tendon pathology.Assess for tendon pathology by firmly palpating the superior pole of the patella and then the inferior to assess patellar femoral syndrome.A palpated or audible tap indicates a "ballotable" knee and is consistent with at least a moderate amount of fluid.If there is an effusion, the patellar will bounce off the underlying bone (patella tap test). Next use the other hand to push to push on the patella. Method 2: Assess for fluid by placing one hand superior to the patella and with slight downward pressure milk the suprapatellar pouch which emptys into the knee joint.A medial aspect that does not bulge but tensely reflects lateral pressure is consistent with a large amount of fluid.A medial aspect that 'bulges' out after lateral pressure (positive "bulge sign") is consistent with a moderate amount of fluid.Commonly, no fluid will be appreciated.Then press firmly on the lateral aspect of the knee. Method 1: Gently press just medial of the patella, then move the hand in an ascending motion.
If there's a temperature difference, it will be exagerated by this maneuver. Next, cross the hands to test the opposite knee. Decide if there's a temperature difference. Try the "crossover test" with one hand on one knee and one on the other knee.If knee feels warmer than shin, suspect inflammation.Commonly, the knee will feel cooler than the shin.Assess temperature by placing back of hand to shin then ipsilateral knee, repeated for both legs.Whenever possible, ensure patient can lie comfortably with head back, legs straight, and toes up Note any asymmetry of the joint or quadriceps muscles. Inspection: Observe both knees together.
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