Обследование коленного сустава: диагностика и основные аспекты.

The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint. The exam includes several parts:
position/lighting/draping
inspection
palpation
motion

The latter three steps are often remembered with the saying look, feel, move.

Before performing a physical examination of the knee joint, a comprehensive history should be asked. A thorough history can be helpful in locating the possible pathological site during the physical examination. The mechanism of injury, location, character of the knee pain, the presence of a "pop" sound at the time of the injury (indicates ligamentous tear or fracture), swelling, infections, ability to stand or walk, sensation of instability (suggestive of subluxation), or any previous traumatic injuries to the joint are all important historical features. The most common knee problems are: soft tissue inflammation, injury, or osteoarthritis. The mechanism of the knee injury can give a clue of the possible structures that can be injured. For example, applying valgus stress on the knee can cause medial collateral ligament rupture, meanwhile a varus force can cause lateral collateral ligament rupture. When a person suddenly slows down during running, twisting, or pivoting with valgus force applying on the knee, the anterior cruciate ligament can rupture. Posterior dislocation of the tibia can cause posterior cruciate ligament injury. Twisting and pivoting while bearing weight can cause tearing of the meniscus. Fractures of the knee are less common but should be considered if direct trauma to the knee has occurred such as during a fall. Examples of fractures involving knee joints are: tibial plateau fractures, fractures of the lateral condyle of femur, medial condyle of femur, and patellar fractures. For non traumatic causes of knee pain, history such as fever, morning stiffness, pain after exercise, infections, history of gout or psoriasis, and previous activities that contributes to long term overuse of the knee joint should be asked. Knee pain due to long term overuse are reproducible. For example, repetitive jumping can cause inflammation of patellar tendon. Repetitive kneeling can cause prepatellar inflammation of synovial bursa.

Posterior drawer test and tibial sag tests can determine the integrity of the posterior cruciate ligament. Similar to anterior drawer test, the knee should be flexed 90 degrees and the tibia is pushed backwards. If the tibia can be pushed posteriorly, then the posterior drawer test is positive. In tibial sag test, both knees are flexed at 90 degrees with the person in supine position and bilateral feet touching the bed. Bilateral knees are then watch for posterior displacement of tibia. If the affected tibia slowly displaced posteriorly, the posterior cruciate ligament is affected.