hi everyone my name is Jackie and I'm a family nurse practitioner and instructor here at smnp reviews in this video I'm going to walk you through how to assess the knees for the most common injuries which are injuries to the meniscus and the anterior cruciate ligament or the ACL you are probably going to encounter this topic on your NP board exam but you also need to know how to assess the knee for injuries when caring for your patients in clinical practice and if you would like to dive deeper into this and other muscular skeletal topics you should check out one of our review courses and go ahead and click that subscribe button so that you can continue to stay upate on all of our latest videos the knee is the largest joint in the human body and is definitely one of the most crucial joints to Everyday activities it is a type of hinge joint that bears most of the weight on our bodies the anterior and posterior cruciate ligaments the ACL and PCL connect the femur and tibia while the medial and lateral meniscus both help in stabilizing the knee and lubricating The Joint the knee is very susceptible to injury whether while playing sports or from some other activity asking about the mechanism of injury or understanding the motion of the body when the injury occurred is super helpful to determining the underlying injury let's start by talking about the ACL or the anterior cruciate ligament which is is the ligament in the knee that is injured the most the ACL helps to stabilize the knee during rotational movements typically during activities where athletes have to Pivot making it a common sports injury with ACL injuries patients will usually report that they heard and felt a sudden pop and then their knee gave way on them also another helpful diagnostic assessment is that with ACL injuries pain and swelling occur almost immediately usually in less than an hour to assess for an ACL injury there are two different tests we can do the lockman test or the anterior drawer test for the lockman test the patient will lay on their back and bend their knee to about a 20° angle then the nurse practitioner with one hand on the lower thigh and another on the lower leg we will pull the lower leg forward while keeping that thigh stable what we're feeling for is increased joint laxity or joint movement a positive lockman test which would be indicative of an ACL tear will feel soft or mushy like having a soft end point and you should always compare it with the non-injured knee which is super helpful the anterior drawer sign can also be used to evaluate the ACL but it is not as specific or sensitive as the lockman test is the main difference with the anterior drawer test is that the angle of the knee will be at about 90° but you are still feeling for that laxity in the joint if there is a positive lockman or anterior drawer test then we're going to refer to Ortho we can instruct the patient on care with rice or rest ice compression and elevation however the rest of the plan of care and any decision about possible surgery will be made by Orthopedics now let's talk about some meniscal injuries in the knee whenever a patient tears their meniscus they might feel a pop and afterwards it really wants to lock up on them a meniscus injury also tends to be more stable than an ACL injury and most of the time the patient can still finish their game or activity despite the injury in terms of a mechanism of injury meniscal injuries are usually due to a twisting maneuver another difference with meniscal injuries is that there is a delay in swelling typically up to 24 hours which is a quick clue to differentiate it from an ACL tear now to assess for a meniscus injury we're going to use the McMurray test we will have the patient lay on their back and then we will grab the heel with one hand and the knee with the other then we're going to internally and externally rotate the leg to see if there's any reproduction of pain or if we feel clicking if so we would call that a positive McMurray test and to remember this think of the m in meniscus and the M's Inc McMurray the treatment is very similar to what we talked about for ACL tears we can encourage rest ice compression and elevation but ultimately we are going to refer them to Orthopedics for further management and to decide if any surgical intervention is going to be necessary let's do a quick review of what we learned between the ACL and the meniscus which one is most likely to be injured the ACL which one has a common mechanism of injury from pivoting ACL again a meniscus is usually injured with what kind of motion twisting which type of injury has immediate swelling yep an ACL injury with ACL injuries is the lockman test or anterior drawer test more sensitive and specific the lockman test and then what is the name of the assessment test for menisc injuries the McMurray test nice job there are a lot more muscular schedle topics to nail down for your exams but I hope you found this video helpful and feel more confident to assess the knee if you interested in learning more about how to pass boards and other NP practice topics definitely check out our review courses and if you want to join a wonderful free community of students prepping just like you make sure you join our Facebook group here's the source for more information you are so close to becoming a real deal NP make sure you check out our other videos and we believe here with the right preparation you can absolutely pass your boards we are all rooting for you here at smnp reviews