Knee Assessment and Patient History Patient DetailsName Mr.Mrs.MissMs.Dr.Prof.Rev. Title First name Last name Date of Birth MM slash DD slash YYYY Patient Mobile PhonePatient Email Patient ID Number Patient Age Describe the nature of the injury.Has the patient had an MRI? Yes No HiddenSection BreakUpload MRIMax. file size: 32 MB.Has the patient had X-rays? Yes No HiddenSection BreakUpload X- raysMax. file size: 32 MB.Has the patient had an ultrasound? Yes No HiddenUpload imagesMax. file size: 32 MB.Has the patient had an arthrography? Yes No HiddenSection BreakUpload imagesMax. file size: 32 MB.Has the patient had an electromygraphy Yes No HiddenSection BreakUpload reportMax. file size: 32 MB.Have nerve conduction studies been performed? Yes No HiddenSection BreakUpload findingsMax. file size: 32 MB.Has joint aspiration been performed and has the fluid been sent for analysis? Yes No HiddenSection BreakUpload laboratory reportsMax. file size: 32 MB.Knee Assessment- please be exceedingly careful and gentle when performing these tests.Lachman Test Is there is a 10mm anterior translation while preforming the Lachman test? Yes No Additional Comments:Is there is more than 2mm anterior translation compared to the uninvolved knee while preforming the Lachman test?: Yes No Additional Comments:Is there is an increased forward translation without decisive endpoint while performing the Lachman test? Yes No Additional Comments:Has a KT-1000 or a similar device been used? Yes No HiddenSection BreakDescribe the magnitude in millimeters:HiddenSection BreakAnterior Drawer Test Is there excessive displacement of the tibia anteriorly while preforming the Anterior Drawer Test? Yes No Additional Comments:Is there an increased amount of anterior tibial translation compared with the opposite limb or lack of end-point while preforming the Anterior Drawer Test? Yes No Additional Comments:Is there excessive posterior displacement of the tibia while performing the Anterior Drawer test? Yes No Additional Comments:Patellar Apprenhension Test Is there apprehensive of quadriceps recruitment while preforming the Patellar Apprehension Test? Yes No Additional CommentsDid the patient express oral apprehension while preforming the Patellar Apprehension Test? Yes No Additional CommentsPatellar Grind Test Did the patient experience pain while contracting their quadriceps muscles while preforming the Patellar Grind Test? Yes No Additional Comments:Patellar Tracking TestWhile the patient is walking or standing which of the following are apparent with regards to Patellar Tracking: The kneecap is not in a normal position. The Kneecap is moving out of place, towards the outer side. The kneecap remains in a normal position. Additional Comments:While the patient is sitting with knees bent over the edge of the exam table, which of the following are apparent with regard to Patellar Tracking? The kneecap is face upwards. The kneecap is tilted off-center. When the patient straightens his/her leg the kneecap shifts towards of the knee. When bending his/her knee there are noticeable tendon, muscular or other soft tissue problems. The kneecap is properly positioned. Additional Comments:Posterior Sag Test During the Posterior Sag Test is there a posterior drop of the tibia? Yes No Valgus Stress Test Is the knee seen to open on the medial side? Yes No Additional Comments:Varus Stress Test Upon performing the Varus stress test please indicate if the Fibular collateral ligament is intact. Yes No Additional Comments:Apley's Grinding test Did the patient experience pain while the Apley's gringing test was performed? Yes No Additional Comments:Mcmurray's TestDid the patient experience pain during the Mcmuarry test of determining damage to either the lateral or medial meniscus? Yes No Additional Comments:
