Rehab Protocols
Interactive Knee Exam

It is important to observe the symptomatic knee for any deformities, abnormal alignment, surgical scars, lacerations or miscoloration. If this is the case, it is often helpful to observe the normal contralateral limb to determine if there are subtle differences between the two knees.



Swelling around the knee can be either extraarticular or intraarticular. It is important to recognize that there are differences between the two because the treatments can be different. An intraarticular knee effusion occurs due to swelling inside the knee joint. The swelling will result in loss of the normal contour of the extensor mechanism, usually with an increased fullness seen on both the medial and lateral aspects of the quadriceps tendon. Larger effusions can result in increased ballotability of the patella. In addition, a fluid wave can sometimes be created by palpating one side of the joint and feeling the fluid wave hitting ones fingers on the other side of the joint. Other extraarticular locations of swelling around the joint depend upon the patient's symptoms. Localized swelling and a traumatic etiology can indicate either a localized hematoma or a localized joint injury. For example, an incomplete tear of the medial collateral ligament complex may result in a rectangular-shaped area of swelling over the medial aspect of the knee. Other types of swelling around the joint include bursitis in the prepatella bursa over the anterior aspect of the knee, as well as swelling in the pes anserine bursa on the anteromedial aspect of the knee. A Baker's cyst is swelling which occurs on the posterior aspect of the knee. A Baker's cyst is usually due to intraarticular fluid being forced out through a hole in the posteromedial joint capsule. This hole occurs between the direct arm of the semimembranosis and the medial head of the gastrocnemius tendon. A Baker's cyst usually indicates that there is some sort of intraarticular pathology in the joint (usually a medial meniscus tear).