NP INSIDERS
60-Second Knee Exam for New NPs (Checklist)
If your 15-minute visit turns into a 30-minute knee rabbit hole, you’re not alone.
New NPs tell me the same thing: “I’m not sure which tests really matter, so I overdo it or skip something important.”
This quick checklist trims the fat without missing the red flags.
Use it to triage knee pain fast, guide imaging, and decide whether to treat or refer. Keep this open during clinic today and if you want the full set of MSK quick wins, grab Ortho Quick Wins: 7 Fast Fixes for 15-Minute Visits (free). Get the quick wins.
The 60-Second Knee Flow
- Look (5 sec): swelling, deformity, atrophy, bruising, effusion
- Move (10–15 sec): AROM flex/extend; ask what hurts most.
- Point (5 sec): “Point to where it hurts most.” Patellofemoral vs joint line vs posterior.
- Load (10–15 sec): single-leg squat or step-down (function + pain).
- Key Tests (20 sec):
Meniscus: Thessaly or McMurray (choose one).
ACL (if trauma): Lachman (primary).
Patellofemoral: patellar grind/crepitus with quad set.
- Neurovasc (5 sec): distal pulses, sensation (if trauma/red flags).
Red Flags You Can’t Miss
- Locked knee, true giving way + acute swelling after pivot → consider ACL/meniscal tear.
- Fever, warmth, erythema, inability to bear weight → septic arthritis until proven otherwise.
- Suspected fracture, high-energy trauma, gross deformity → immobilize + X-ray now.
Imaging What/When (Knee)
X-ray first if traumatic pain, age >50 with persistent pain, or inability to bear weight; use Ottawa Knee Rules.
MRI for mechanical symptoms, suspected meniscus/ACL after acute phase, or persistent pain after conservative care (4–6 weeks).
No imaging for first-episode anterior knee pain without red flags; focus on rehab + activity mods.
Treat vs Refer (Fast Calls)
Treat now: RICE, NSAIDs/acetaminophen if appropriate, patella taping/bracing, quad + hip abductor strengthening, activity modification.
Refer now: suspected septic joint, unstable fracture/dislocation, complete ligament rupture suspicion, neuro deficits.
Refer later: failed 4–6 weeks of conservative care or MRI-confirmed surgical pathology.
Want the rest? imaging cheats? Grab Ortho Quick Wins: 7 Fast Fixes for 15-Minute Visits—free mini-guide + short videos. Get the quick wins.
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