When assessing a patient with a swollen knee after a skiing injury, which assessment should be conducted first?

When a patient presents with a swollen knee following a skiing injury, the initial assessment should be focused on evaluating the stability and mobility of the knee joint. Conducting a tibiofemoral joint play assessment first is crucial because it allows the practitioner to assess the integrity of the knee structures, including ligaments and other soft tissues around the joint.

This assessment can help identify any mechanical issues, such as joint effusion or abnormal movement patterns, which are critical in determining the extent of the injury. The findings from this physical examination will guide further assessments and interventions. It can also help determine whether immediate imaging or other diagnostic tests, like X-rays, are needed to rule out fractures or other severe injuries.

Other tests, while important, are typically not prioritized over the tibiofemoral joint play in this context. Range of motion tests, for example, are more effective when the initial joint stability and integrity have been assessed. The patellar reflex test could offer insights into neurological function but is not specific to joint injury assessment. X-ray imaging is valuable for getting a clear picture of bone integrity but should follow a clinical assessment that directly evaluates the knee joint structure and function.