Pediatric emergency medicine trisk 0852 0852
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TABLE 42.2
SUMMARY OF DIAGNOSTIC MANEUVERS FOR THE INJURED
KNEE
Maneuver
Diagnosis
Collateral laxity test
(Fig. 42.4 )
Lachman test (Fig.
42.3 )
Posterior drawer test
(Fig. 42.5 )
McMurray test (Fig.
42.6 )
Apley compression
test (Fig. 42.7 )
Patellar apprehension
test
Patellar stress test
Collateral ligament injury
Anterior cruciate ligament injury
Posterior cruciate ligament injury
Meniscal injury
Meniscal injury
Patellar subluxation
Patellofemoral pain syndrome
A neurovascular examination should include palpation of the posterior tibial
and dorsalis pedis pulses and testing of the peroneal nerve function. The deep
peroneal nerve innervates the ankle dorsiflexors and the extensor hallucis longus,
which can be tested by opposing dorsiflexion of the great toe. It also supplies
sensation to the web space between the great and second toes.
Patients with knee symptoms should have a careful hip examination because
patients with avascular necrosis of the femoral head or a slipped capital femoral
epiphysis may present with anterior thigh or knee pain.
All patients with acute knee injuries should have AP and lateral radiographs,
and if indicated, a patellar (or skyline view) radiograph. The Ottawa Knee Rules
have demonstrated 100% sensitivity for knee fractures in large, prospective,
multicentered adult trials. Studies in children are limited but they also
demonstrated a sensitivity of 100% (95% confidence interval = 95% to 100%) in
a study involving 750 children of whom 70 had fractures. According to these
rules, radiographs are required of children only if the patient has any of the
following findings: (i) isolated tenderness of the patella, (ii) tenderness of the
