Knee exam

Q: A knee is usually cooler than the surrounding tissues.

A) True

B) False

Answer: A

Knee is a relatively avascular structure with "warm-cold-warm" pattern on normal physical exams. Knee exam should be performed by placing back of the hand on the thigh several centimeters above the kոee. The thigh usually feels slightly warm. Now, the back of the hand should be placed over the patella or just medial to it. This region will usually feel cooler. Finally, the back of the hand should be placed on lateral calf, and it should feel warmer. This indicates a normal "warm-cold-warm" pattern and a normal knee exam.

If the pattern changes to "warm-warm-warm," it indicates kոee irritation due to injury or inflammation. The knee may or may not appear swollen. 

A "warm-hot-warm" pattern almost always indicates joint infection. Swelling and redness around the kոеe usually present. An urgent approach is needed.

#physical-exam

#rheumatology

Further readings:

1. Herbort M, Kittl C, Domnick C, Glasbrenner J, Fink C, Herbst E. Klinische Untersuchung des Knies [Clinical examination of the knee]. Unfallchirurg. 2019 Dec;122(12):977-991. German. doi: 10.1007/s00113-019-00739-9. PMID: 31728556.

2. Malanga GA, Andrus S, Nadler SF, McLean J. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. Arch Phys Med Rehabil. 2003 Apr;84(4):592-603. doi: 10.1053/apmr.2003.50026. PMID: 12690600.

3. Bronstein RD, Schaffer JC. Physical Examination of Knee Ligament Injuries. J Am Acad Orthop Surg. 2017 Apr;25(4):280-287. doi: 10.5435/JAAOS-D-15-00463. PMID: 28291144.