chapter 3: History and Physical Examination


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Figure 3.1. Patient‑drawn knee pain diagrams direct the examiner to areas of tenderness. Reprinted with permission from Post WR, Fulkerson JP. Knee pain diagrams. Correlation with physical exam findings in patients with anterior knee pain. Arthroscopy 1994; 10(6): 618‑623.

Figure 3.2. Evaluate the Q angle with the pa­tient standing.

Figure 3.3. Standing estimation of pelvic obliquity/leg length discrepancy.

Figure 3.4. Evaluate weightbearing hind­foot alignment.

Figure 3.5. Seated evaluation of tubercle sulcus angle. Markers are placed on center of patella and tibial tubercle for purpose of illustration only.

Figure 3.6. Patellar tilt test with knee extended. Tilt should correct to neutral.

Figure 3.7. A, Medial glide test, knee extended. B, Lateral glide (apprehension) test, knee extended.

Figure 3.8. A, Superior glide test, knee extended. B, Inferior glide test, knee extended.

Figure 3.9. Place soft tissues under tension before palpation. Reprinted with permission from Fulkerson JP. Awareness of the retinaculum in evaluating patellofemoral pain. Am J Sports Med 1982;10:147‑149.

Figure 3.10. Patient had saphenous nerve entrapment with hypesthesia as illustrated. Saphenous decompression relieved her pain. Reprinted with permission from Post WR, Surgical Decision Making in Patellar Pain and Instability. 1994;2(4):273‑284.

Figure 3.11. Perform direct articular compression at various angles of flexion. Be careful to avoid compressing the peripatellar soft tissues.

Figure 3.11. (continued) Articular compression at various angles of flexion helps to localize articular le­sions.

Figure 3.12. Evaluate hamstring tightness while the patient is supine.

Figure 3.13. Check for gastrocnemius tightness.

Figure 3.14. Evaluate for hip flexion contracture.

Figure 3.15. Test for quadriceps flexibility while the patient is prone.

Figure 3.16. Drawing demonstrating the lateral prominence of the greater trochanter and the measurement of femoral anteversion in the prone position. Reprinted with permission from Ruwe PA, Gage JR, Ozonoff MB, DeLuca PA. Clinical determination of femoral aversion. JBJS 1992;74A(6):821.

Figure 3.17. A, The contralateral hip is maximally flexed to eliminate lumbar lordosis. B, Flex the hip of the leg to be tested.

Figure 3.17. (continued) C, While the hip is flexed, abduct the hip maximally. D, Extend the hip while sta­bilizing the pelvis to keep it perpendicular to the examination table.

Figure 3.17. (continued) E, Allow the thigh to adduct while controlling femoral rotation in neutral. Note continued control of the pelvis with the examiner's left hand. F, At the position of maximal adduction, pal­pation over the distal iliotibial band often reproduces the patient s pain.

Figure 3.18. A, Lachman's test for excessive anterior tibial translation. B, Posterior drawer test: Palpate nor­mal position of tibia anterior to femoral condyle with the knee flexed 90 degrees



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