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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The initial evaluation by the physician or health-care provider will begin with a medical history. Whether the evaluation is occurring immediately after the injury or weeks later, the physician may ask about the mechanism of injury to help isolate what structures in the knee might be damaged. Is the injury due to a direct blow that might suggest a fracture or contusion (bruise)? Was it a twisting injury that causes a cartilage or meniscus tear? Was there an injury associated with a planted foot to place stress and potentially tear a ligament?

Further questions will address other symptoms. Was swelling present, and if so, did it occur right away or was it delayed by hours? Did the injury prevent weight-bearing or walking? Does going up or down steps cause pain? Is there associated hip or ankle pain?

Physical examination of the knee begins with inspection, in which the physician will look at the bones and make certain they are where they belong. With fractures of the kneecap or patellar tendon injuries, the kneecap can slide high out of position. Also, patellar dislocations, where the kneecap slides to the outside or lateral part of the knee, are easily evident on inspection. Looking at how the knee is held is also important. If the knee is held slightly flexed, it can be a clue that there is fluid in the joint space, since joint space is maximal at 15 degrees of flexion.

Palpation (feeling) is the next part of the exam, and knowing the anatomy, the physician can feel where any pain might exist and correlate that to the underlying structures like ligaments or muscle-insertion points. Palpation over the joint line, the space between the bones in the front part of the knee, can uncover fluid or tenderness associated with a meniscus injury. This is also the part of the exam when the ligaments are stressed to make certain that they are intact. Sometimes, the physician will also exert stress on the uninjured knee to see how loose or tight the normal ligaments are as a comparison. Finally, the blood supply and nerve supply to the leg and foot will be assessed.

Sometimes X-rays of the knee are required to make certain there are no broken bones, but often with stress or overuse injuries where no direct blow has occurred, plain X-rays may not be needed and imaging of the knee may wait until a later date, where an MRI might be considered.

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