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Knee Special Tests
| Question | Answer |
|---|---|
| Collateral Ligament Instability tests - LCL and MCL : Purpose | Identify ligament laxity or restriction |
| Collateral Ligament Instability tests - LCL and MCL : description | Entire lower limb is supported and stabilized, knee is placed in 20-30 degrees of flexion. Valgus force placed to test MCL and Varus force checks LCL. |
| Collateral Ligament Instability tests - LCL and MCL : results | Primary finding is laxity but pain may be reproduced |
| Lachman's stress test purpose | indicates integrity of ACL |
| Lachman's stress test description | Pt lies supine with involved leg besides the examiner. Examiner holds pt's knee between full extension and 30 degree flexion. Pt's femur is stabilized while proximal aspect of tibia is moved forward |
| Lachman's stress test result | Positive: mushy or soft end feel when tibia is moved forward on femur (increased anterior translation with medial rotation of tibia) and disappearance of infrapatellar tendon slope |
| Pivot shift test purpose | Indicates ACL integrity |
| Pivot shift test description | Pt lies supine with clinician standing to side of pt's involved knee,. 2 main types of clinical tests to determine presence of pivot shift: reduction and subluxation test |
| Pivot shift test description - reduction test | Clinician stabilizes pt's lower leg and flexes the knee to 90 with 1 hand while using palm of other to medially rotate the tibia, effectively subluxing the lateral tibia plateau. Sudden reduction of ant subluxed lat tibial plateau: pivot shift |
| Pivot shift test description - subluxation test | Reverse of reduction test. Test beings with pt's knees flexed. Clinician IR patient's tibias & applies valgus stress to knee joint. Clincian slowly extends the knee, maintaining rotation. As knee reaches full extension, tibial plateau relocates |
| Posterior sag test purpose | indicates PCL injury |
| Posterior sag test description | pt lies supine with hip flexed to 45 and knee flexed to 90 |
| Posterior sag test results | Tibia drops back or sags back on femur because of gravity if PCL is torn |
| Slocum test purpose | assess anteromedial and anterolateral rotary instabilities |
| Slocum test description | Pt's knee if flexed 80-90 and hip flexed 45. Foot first placed in 30 degree IR. Examiner sits on pt's forefoot and hold the foot in position and draws tibia forward. If test positive: movement occurs primarily on lateral side of knee. Indicates ALRI |
| Slocum test description of 2nd part | Foot placed in 15 degrees of ER, and tibia drawn forward by the examiner. If test is positive, movement occurs primarily on medial side of the knee. This movement is excessive relative to the unaffected side & indicates anteriormedial rotary instability. |
| posterior drawer test purpose | Indicates integrity of PCL |
| posterior drawer test description | Pt supine with testing hip flexed to 45 degrees and knee flexed to 90 degrees. Passively glide tibia posteriorly following the joint plane |
| posterior drawer test results | excess posterior glide is positive findings |
| Reverse lachman test purpose | Test for PCL integrity |
| Reverse lachman test description | Pt prone with knee flexed 30 degrees, and examiner grasps tibia with 1 hand while fixing femur with the other hand. The examiner pulls tibia up/posteriorly, noting amount of movement and quality of end feel |
| McMurray's test purpose | identify meniscal tears |
| McMurray's test description | Pt lies in supine position with knee completely flexed (heel to buttock). Examiner medially rotates tibia and extends the knee to test lateral meniscus. Lateral rotation for medial meniscus |
| McMurray's test results | If there is a loose fragment of the meniscus, this action causes a snap or click often accompanied by pain. |
| Apley Test purpose | Help differentiate between meniscal tears and ligamentous lesion |
| Apley Test description | Pt lies prone with knee flexed 90. Pt thigth is anchored to examing table with examiner's knee. Examiner ER/IR tibia. combined first with distraction, while noting restriction, excessive mvmnt, or discomfort. Repeat with compression. |
| Apley Test result | Rotation + distraction more painful or shows increased rotation relative to normal side: lesion is ligamentous. If rotation + compression more painful or shows decreased rotation relative to normal, lesion is probably meniscal injury. |
| Bounce home test purpose | indicates meniscal lesion |
| Bounce home test description | Pt lies supine, and heel of pt's foot is cupped in examiner's hand. Pt's knee if completely flexd, and knee passively extends. If extention is not complete or has a rubbery end feel ("springy block"), there is something blocking full extension. |
| Bounce home test result | Most likely cause of block is torn meniscus |
| Thessaly Test purpose | Indicates meniscal lesion |
| Thessaly Test description | Pt stands flat foot on 1 leg while examiner provides hands for balance. Pt flexes knee to 5 degrees and rotates femur on tibia medially and laterally 3x while maintaining flexion. Test repeated with 20 degrees flexion |
| Thessaly Test result | Test is positive for meniscus tear if pt experiences joint line discomfort. Pt may have sense of locking or catching of the knee |
| Hughston's plica test purpose | Identify dysfunction of plica |
| Hughston's plica test description | pt lies supine, and examiner flexes the knee and IR tibia with 1 arm and hand while pressing the patella medially with the heel of the other hand and palpating the medial femoral condyle. |
| Hughston's plica test results | Pt's knee if passively flexed and extended while examiner feels for popping of plica band under the fingers. Popping: positive test |
| Patellar apprehension test purpose | Indicate past history of patella dysfunction |
| Patellar apprehension test description | Pt supine, with patella passively glided laterally |
| Patellar apprehension test result | pt doesn't allow patella to move in lateral direction |
| Clarke's sign purpose | Identify patellofemoral dysfunction |
| Clarke's sign description | Examiner presses down slightly proximal to base of patella with web of hand as pt lies relaxed with knee extended. Pt is then asked to contract the quads while examiner pushes down |
| Clarke's sign result | If pt can complete and maintain contraction without pain: test is negative. If test causes retropatellar pain and pt cannot hold contraction, test is positive |
| Ballotable patella/ patella tap test purpose | Indicates infrapatellar effusion |
| Ballotable patella/ patella tap test description | With pt's knee extended/flexed to discomfort, the examiner applies a slight tap or pressure over patella. |
| Ballotable patella/ patella tap test result | When this is done, a floating of patella should be felt. This is sometimes called the "dancing patella" sign |
| Fluctuation test purpose | Indicates knee effusion |
| Fluctuation test description | Examiner places the palm of hand over suprapatellar pouch and palm of other hand anterior to joint with thumb and index finger beyond margins of patella |
| Fluctuation test result | By pressing down with one hand and then the other, the examiner may feel the synovial fluid fluctuate under he hands and move from one hand to the other, indicated significant effusion |
| Q angle measurement | Angle obtained by first ensuring that the lower limbs are at a right angle to the light joining the ASISs. Line drawn from ASIS to midpoint of patella on same side and from the tibial tubercle to midpoint of patella. Angle formed by crossing of 2 lines |
| Normal Q angle measurement | 13 degrees for male and 18 degrees for females when the knee is straight |
| Noble Compression test purpose | Identifies distal IT band friction syndrome |
| Noble Compression test description | Pt lies supine and examiner flexes pt's knee to 90 with hip flexion. Pressure then applied to lateral femoral epicondyle, or 1-2 cm (0.4-0.8 in) proximal to it, with he thumb. While pressure is maintained, pt's knee is passively extended |
| Noble Compression test result | At approximately 30 degrees of flexion (0 degrees being straight leg), pat experiences severe pain over the lateral femoral epicondyle |
| Tinel's sign purpose | To identify dysfunction of common fibular nerve posterior to fibular head |
| Tinel's sign description | Tap region where common fibular nerve passes posterior to fibular head |
| Tinel's sign result | reproduces tingling sensation or paresthesia in leg |
Created by:
ecosio
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