KNEE R L
Injury_____________________________________________________ (Date)________
Noninjury_____ How long has the problem been active _________
Sharp (when) _______________ Dull/Ache (when) ______________ Constant (at rest) __________
Pain Level (sitting)____/10 (activity)____/10
Give way (with what activity) _________ Catching (with what activity) _________ Pop-ing (with what activity) __________
Maximum point of pain_____
What makes it worse: ______________________ Better: _____________________
Been seen for this in the past: ______________________ What tests or treatment_____________________
Gait: Antalgic?
Inspection: Ecchymosis Effusion Erythema or warmth Edema/Swelling
Leg Examination: Normal ______________________________
Alignment: Normal_______
Palpation: Tenderness _____________
Range of Motion: Flexion _______ Extension_______ Passive: Flexion _______ Extension _______
Ligament laxity:
Lachman________ Anterior Drawer____________ Posterior Drawer___________ Varus LCL (foot in) ________
Valgus MCL (foot out) _____ Stability______ Unable to assess due to guarding
Meniscal:
McMurray (flex rotate in extend then rotate out) ______ Thessaly ______
Patellofemoral:
Patella Grind (hand behind knee pt to try to flex) _______
Patella Apprehension: (knee outside table press patella/move lateral direction _____
Neurovascularly Intact: __________
OA:
Medial and/or Latera tibiofemoral join tenderness ___ Patellofemoral joint tenderness _____ Anserine tenderness _____ Joint
effusion. Anserine (medial/distal patella_____
X-ray: Tricompartmental joint with marginal osteophytes. No acute bony abnormality.
