Medically Fit For Exams
Medically Fit For Exams

Knee examination

  • Wash your hands and introduce yourself
  • Check the patient’s name and DOB
  • Explain what you are about to do and gain consent
  • Reassure about pain
  • Ask the patient to undress sufficiently to assess both knees and thighs



  • Assess around the patient for walking aids
  • Ask the patient to stand
  • Look from the front, sides and back
  • Ask the patient to lay on the couch
  • Assess for:
    • Alignment – eg varus (bow legged) and valgus (knock-knees) deformities
    • Scars
    • Swelling
    • Wasting of quadriceps (lack of use)
    • Skin changes



  • Start on the normal knee
  • Palpate around the patella for tenderness
  • Compare the temperature with calf and thigh and other knee
  • Flex knee to 90 degrees and feel along the joint line (at lower pole of patella)
  • Feel in the popliteal fossa (for a Baker’s cyst)
  • Assess for a knee effusion
    • Loss of dimple medial to patella
    • Patella tap: Milk fluid out of the suprapatellar pouch towards the patella. Occlude the pouch with your hand, and tap the patella. If a tap is heard, an effusion is present
    • Sweep test: Firmly stroke the medial side of the patella, distal to proximal. Quickly switch to the lateral side. If fluid bulges back to the medial side, a synovial effusion is present



  • Start with active movement, and with the normal knee followed by the bad knee
  • Ask the patient to flex and extend the knee as far as they can. Note whether movement is limited by stiffness or pain
  • Ask the patient to lift their leg off the bed with the knee extended. Look for the ability to maintain extension. Lack of ability to maintain extension suggests quadriceps weakness or extensor lag
  • Carry out passive movements of the knee, with one hand over the patella feeling for crepitus



  • Patella apprehension test/previous dislocation
    • Stand beside the patient, fully extend the knee. Push on the lateral aspect of the patella whilst slowly flexing the knee
    • Observe for apprehension (look at patient’s face), resistance to flexion counts as a positive result
  • Anterior draw test – anterior cruciate
    • Position the patient with the knee flexed and the foot flat on the bed
    • Sit on the patient’s foot, and hold behind their calf
    • Ask the patient to relax
    • Pull the tibia towards you, observing for any movement away from the femur
    • Significant movement suggests abnormality of the anterior cruciate ligament
  • Posterior draw test – posterior cruciate
    • As with the anterior draw test, but push the tibia away from you
    • Significant movement suggests posterior cruciate ligament instability
  • Medial and lateral collateral ligaments
    • Fully extend the patient’s knee, hold the leg just below the knee and lift from the bed, secure the ankle between your body and your wrist
    • Apply valgus strain by pulling the leg outwards to assess medial collateral ligament
    • Apply varus strain by pulling the leg inwards (medially) to assess lateral collateral ligament
    • Movement suggests damage to the ligaments. There is likely to be damage to other ligaments in addition
  • Meniscal tear/McMurray’s test
    • Warn the patient that this may be uncomfortable
    • Medial meniscus:
      • Flex the knee to 90 degrees or further
      • Place fingers on medial joint line
      • Externally rotate the foot while abducting the hip
      • Flex and extend the knee while feeling for a click or clunk
    • Lateral meniscus
      • Flex knee to at least 90 degrees, place fingers on lateral joint line
      • Internally rotate foot while adducting hip
      • Flex and extend assessing for click/clunk



  • Palpate dorsalis pedis (posterior tibial and popliteal if not present)
  • Assess for sensation on dorsum and sole of foot
  • State that you would like to carry out a full neurovascular exam



  • Ask about pain in the hip and ankle
  • State that you would like to carry out a full assessment on these joints

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