The regional musculoskeletal examination (RMSE) of the knee is designed to build on the sequences and techniques taught in the SMSE and GMSE. It is intended to provide a comprehensive assessment of structure and function combined with special testing to permit you to evaluate common, important musculoskeletal problems of the knee seen in an ambulatory setting. The skills involved require practice and careful attention to technique. However, they can be learned and mastered on normal individuals.
The RMSE of the knee is clinically useful as the initial examination in individuals whose history clearly suggests an acute knee injury or an isolated knee problem. In individuals whose history is less straightforward (a seemingly local, nontraumatic knee problem with additional musculoskeletal complaints of unclear relevance), a rapid SMSE may be the most appropriate first step in physical assessment. If significant, possibly related, abnormalities are found (and the patient's presenting knee complaint appears to be part of a more generalized musculoskeletal process), then performing a GMSE would be most appropriate.
With practice, a systematic, efficient RMSE of the knee can be performed in ∼3 to 4 minutes.
Furthermore, the RMSE of the knee provides the foundation for learning additional, more refined diagnostic techniques through your later exposure to orthopedic surgeons, rheumatologists, physiatrists, physical therapists, and others specifically involved in the diagnosis and treatment of knee problems.
This instructional program will enable you to identify important anatomical, functional, and pathologic relationships at the knee, including
- Important surface anatomy
- Presence of knee effusions
- Patellofemoral and tibiofemoral joints
- Anterior cruciate, medial and lateral collateral and posterior cruciate ligaments
- Meniscal cartilages
- Prepatellar and anserine bursae
Most importantly, this program will prepare you to perform an organized, integrated, and clinically useful examination of the knee.
Structural and Functional Anatomy
The knee joint is made up of four bones: the distal femur, proximal tibia, patella (a large, sesamoid within the quadriceps tendon), and the proximal fibula (Fig. 5–1). These bones form three articulations: the tibiofemoral joint (hinge-like), the patellofemoral joint (gliding pulley), and the tibiofibular joint (small, lateral stabilizer) (Fig. 5–2).
(Modified with permission from Lawry GV, Kreder HJ, Hawker G, Jerome D. Fam's Musculoskeletal Examination and Joint Injection Techniques, 2nd ed. Mosby/Elsevier, 2010, p. 66.)
Because the knee is an inherently unstable joint, it has two external (collateral) stabilizing ligaments: the long, broad medial collateral ligament (MCL) (between the medial femoral epicondyle and the medial tibia) and the smaller diameter lateral collateral ligament (LCL) (between the lateral femoral epicondyle and the head of the fibula) (Fig. 5–3A, B). The knee also has two internal (crossing ...