Question

You patient reports pain in their right knee while ascending stairs.

Outline your passive movement examination to differentiate any articular causes of pain

Answer 1

The passive movement examination of the knee flexion and extension are, always tested even if these were not impaired during the active movement examination. This is because the only physical-diagnostic finding for some knee abnormalities may be palpable crepitations.
Therefore, in principle, endorotation and exorotation are only tested in the passive examination.

Procedure
Step 1:-The patient lies completely flat with extended hips and knees. For flexion and extension, palpate the knee with one hand, during which the thumb palpates one side of the joint space and the index or middle finger palpates on the other side of the joint space, to locate the joint space, the knee can best be brought into 90° flexion, during this palpation the palm of the hand should rest gently on the patella. The common hand should be placed around the ankle or the calcaneus of the leg concerned.
Note to be taken, If during the active movement examination you observed abnormal lateralisation, it might be worthwhile to perform this palpation again while loosely palpating the patella between the thumb and index finger. In this way you might be able to objectify the ‘poor tracking’ of the patella.

Step 2:- For exorotation and endorotation, the grip is the same as described above. However, now use your hand placed around the calcaneus to rotate the leg that is held in 90° flexion first outwards exorotation and then inwards endorotation.

While making these movements assess once again:

The course of movement
The maximum range of motion
The occurrence of pain
The presence or disappearance of crepitations

Note to be taken, If you do not observe any abnormalities, the movement examination of the hip should be performed next. Bear in mind that knee complaints may be due to referred pain and that this is especially the case in children.