Physical examination

physical examination

Important aspects of the physical examination include:

• inspection
• confirm any swelling or ecchymosis of the joint and lower extremity
• observe gait of the patient - for initial evaluation as well as for follow up after treatment
• palpation
• evaluate the neurovascular status of the limb
• identify the point of maximal tenderness along the joint line and length of the MCL which may be helpful in identifying the origin of the injury, midsubstance or insertion of the ligament
• pain during palpation along the medial joint line may be due to a meniscal injury, chondral injury or synovial inflammation
• stress examination
• aim is to evaluate the integrity of the MCL
• includes valgus stress testing and dial or external rotation test
• evaluation for associated injuries
• assess the ACL and PCL since these can be often associated with high grade injuries
  • anterior drawer test to identify anteromedial rotatory instability (with or without an associated ACL injur) (2)
  • Lachman's testing - to evaluate the ACL ( even in the face of MCL injury)
• meniscal damage - McMurray test

Reference:

• (1) Duffy PS, Miyamoto RG. Management of medial collateral ligament injuries in the knee: an update and review. Phys Sportsmed. 2010;38(2):48-54
• (2) Phisitkul P et al. MCL injuries of the knee: current concepts review. Iowa Orthop J. 2006;26:77-90