Patients Name

DOB
MRN
Date of Visit

Knee Pain H & P

HPI

KEY: Y = Yes(positive)

N = No(negative)

NE= Not Examined

History elements to ask:

- Knee clicking, catching, or locking
- Give-way episodes
- Provoking/alleviating factor
- Effect on pts normal level of activity

- Mechanism of injury
- Acute traumatic, overuse, or spontaneous onset
- Pop or tear with injury
- Location of pain
- Swelling (Y/N), if yes how long after injury ____ hrs

PMH/PSH
Prior knee injury or surgery
Other orthopedic history (surgeries, arthritis, trauma, injuries etc)

--------------------------------------------------------------------------------------------------------------------------------------------------Physical exam
Inspection
Limping gait
Y
Weightbearing Y
Swelling
Y
Bruising
Y
Atrophy
Y
Alignment
Varus
ROM
Extension
Full
Flexion
Full
Strength
Extension
Full
Flexion
Full
Special Tests
Effusion
Ballotable effusion
Fluid wave
Patellar testing
Patellar compression
Patellar inhibition
Patellar apprehension
Tenderness patella facets
Meniscal Tear Assessment
McMurrays
Apleys

N
N
N
N
N
Valgus

NE
NE
NE
NE
NE
Neutral
Limited
Limited

Weak
Weak

Painful
Painful

Y
Y
Y

N
N
N

NE
NE
NE

Y
Y
Y
Y

N
N
N
N

NE
NE
NE
NE

Y
Y

N
N

NE
NE

Ligamentous tests
Anterior drawer (ACL)
Posterior drawer (PCL)
Lachmans (ACL)
Varus stress (LCL)
Valgus stress (MCL)
Palpation
Medial jt line tenderness
Lateral jt line tenderness
Patellar tendon
MCL
LCL
Neurovascular
Sensation
Distal pulses

Y
Y
Y
Y
Y

N
N
N
N
N

NE
NE
NE
NE
NE

Y
Y
Y
Y
Y

N
N
N
N
N

NE
NE
NE
NE
NE

Y
Y

N
N

NE
NE

OTTOWA KNEE RULES - Cosider X RAY if:

- Age 55 or older with acute trauma
- Isolated tenderness of patella following trauma
- Tenderness at head of fibula
- Inability to flex to 90 degrees following trauma
- Inability to bear weight immediately or in ED
- 4 step ambulation (disregarding limp)

Y
Y
Y
Y
Y
Y

N
N
N
N
N
N

--------------------------------------------------------------------------------------------------------------------------------------------------Asssessment (circle suspected diagnosis - all that apply)

Knee contusion
Osteoarthritis
ACL tear
Patellofemoral syndrome
PCL tear
Patellar tendinopathy
MCL strain/tear
Iliotibial band syndrome
LCL strain/tear
Osgood-Schlatter syndrome

Medial meniscus tear

Lateral meniscus tear
Patellar dislocation
Patella fracture
Other: ___________________

Plan:
1) Treatment (Circle all employed)
Knee brace/Immobilizer
RICE (Rest, Ice, Compression, Elevation)
Aspiration/Injection
Exercises: (specify)___________________________
Crutches/reduced weight bearing
2) Medications
NSAIDs
Y
N
Specify:________________________
Other:______________________________
3) Imaging
X-rays
Y
N
MRI
Y
N
If yes, specify test ordered:_____________________
4) Referral
Sports Med
Y
N
Orthopedics
Y
N
Physical Therapy
Y
N
5) Follow up: ______ wks

KNEE EXAM- Demonstration

Figure 1- External landmarks of the knee

Figure 2- Clinical anatomy of the knee, including bony,

ligamentous, and meniscal structures

Figures 3 and 4- Anterior and Posterior Drawer: These tests assess for stability of the anterior and
posterior cruciate ligaments, respectively. With the knee flexed to 90 o, stabilize leg by sitting on foot.
Grasp the proximal tibia with both hands, insuring relaxation of hamstrings. Push the tibia anteriorly
to test ACL stability and posteiorly to test PCL stability, looking for a stable endpoint in each case.
Compare with the uninjured knee.

Figure 6- McMurrays Test: This test

assesses for meniscal tears. Flex the
knee to maximum pain-free position.
Hold that position while externally
rotating the foot, and then gradually
extending the knee (while maintaining
foot in external rotation). Medial
compartment pain or clicking suggests a
medial meniscal tear. Performing the
same steps with the foot in internal
rotation assesses for lateral meniscal
tears.

Figure 7- Apleys Test: This is an

alternative test for meniscal tears. With the
patient laid prone, flex the knee to 90 o.
Applying force vertically, rotate the knee
internally
and
externally.
Pain
reproduction.

Figure 5- Lachmans Test This test is the most

sensitive for identifying ACL tears. Grasp the
thigh to support it, allowing the thigh muscles to
relax. Flex the knee to 25 o and grasp the distal
femur from the lateral side with other hand.
Initiate a shucking motion by pulling
anteriorly on the tibia while pushing posteriorly
on femur. Increased anterior translation
indicates a partial or complete tear of the ACL

Figure 8- Varus and Valgus Stress tests: These tests assess for LCL and
MCL injury, respectively. For the varus stress test, stabilize the knee in both
extension and 30o flexion. Press on the medial aspect of the knee. If the knee
opens up more that the opposite (non-injured) knee in the varus direction,
this suggests partial or complete LCL tear. For the valgus stress test.
stabilize the knee and place valgus stress (pressure inward upon the lateral
aspect of the knee) in both full extension and at 30 o knee flexion. Compare
with opposite knee. If knee opens up more in the valgus compartment, this
suggests are partial or complete tear of the MCL.

Images obtained via Google Images; Captions adapted from Greene, Essentials of Musculoskeletal Care, ed. 2

Ashwin Rao & Jonathan Drezner, 2007