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Video is an excellent introduction to Hysterosalpingography and summarizes different pathologies. While the information on this presentation is about health care issues, it is not medical advice. People seeking specific medical advice or assistance should contact their personal physician. Although we believe the information in this presentation to be accurate and timely, because of the rapid advances in health care and our reliance on information provided by outside sources, we make no warranty or guarantee concerning the accuracy or reliability of the content or other material which we may reference. When clinical matters are discussed, the opinions presented are those of the discussants only. The material discussed on the presentation is not intended to present the only or necessarily the best method or procedure, but rather presents the approach or opinion of the discussant. This presentation is provided in an “as is” format without warranties of any kind, expressed or implied, including but not limited to warranties of title, non-infringement or implied warranties of merchantability or fitness for a particular purpose.

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The Knee Exam
Observation:
1. Make sure that both knees are fully exposed. The patient should be in either a gown or shorts. Rolled up pant legs do not provide good exposure!
2. Watch the patient walk. Do they limp or appear to be in pain? When standing, is there evidence of bowing (varus) or knock-kneed (valgus) deformity? There is a predilection for degenerative joint disease to affect the medical aspect of the knee, a common cause of bowing. Varus Knee Deformity, more marked on the left leg. 3. Make note of any scars or asymmetry. Chronic/progressive damage, as in degenerative joint disease, may lead to abnormal contours and appearance. Is there obvious swelling as would occur in an effusion? Redness suggesting inflammation? 4. Is there evidence of atrophy of the quadriceps, hamstring, or calf muscle groups? Knee problems/pain can limit the use of the affected leg, leading to wasting of the muscles.

While both legs have well developed musculature,
the left calf and hamstring are bulkier than the right. 5. Look at the external anatomy, noting structures above and below the knee itself: 1. Patella 2. Patellar tendon 3. Quadriceps/Hamstring/Calf muscles 4. Medial and lateral joint lines. 5. Femur and Tibia 6. Tibial tuberosity


Ballotment (helpful if the effusion is large) 1. Slightly flex the knee which is to be examined.
2. Place one hand on the supra-pateallar pouch, which is above the patella and communicates with the joint space. Gently push down and towards the patella, forcing any fluid to accumulate in the central part of the joint.
3. Gently push down on the patella with your thumb.
4. If there is a sizable effusion, the patella will feel as if it's floating and "bounce" back up when pushed down.

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