Knee Special Tests
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| COLLATERAL LIGAMENT INSTABILITY TESTS (MEDIAL & LATERAL): a)tests for b)position/performed how?c)positive? | a)lig lax or restrictionb)1:pt supine; knee= 30 deg flexionc)place valgus force through knee to test MCL;place varus force to test PCLd)laxity is primary; pain may be noted also
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| LACHMAN’S: a)tests for b)position/performed how?c)positive? | a)ACL integrity b)supine; 20-30 deg flexionc)1: stabilize FEMUR2:passively glide tibia anteriorlyd)xs anterior glide
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| PIVOT SHIFT: a)tests for b)position/performed how?c)positive? | A)ACL integrity; anterolateral rotary instability b)supine; starting position: hip=flex&abd 30 degrees, slight IR;knee=extension;give knee: VALGUS force, while FLEXing c)tibia relocates indicating ligament laxity
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| Why does tibia relocate during pivot shift test? (PART 1/2) | It reproduces an event that occurs when knee gives way bc of loss of ACL - w/ an ACL tear, the knee will remain reduced in full ext, will subluxate (ANTERIORLY) in 20-30 deg of flex (w/ appropriate stress),and will then again reduce w/ further flexion
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| Tibia was subluxed anteriorly at beginning of test (knee extension; hip flex, abd, IR) It was then REDUCED by pull of IT band as knee was being flexed
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| POSTERIOR SAG TEST:a)tests for b)position/performed how?c)positive? | a)PCL integrity b)supine; hip=45 deg flexion, knee= 90 deg flexion c)Tibia sags posteriorly in this position relative to femur
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| POSTERIOR DRAWER TEST:a)tests for b)position/performed how?c)positive? | a)PCL integrity b)supine; hip=45 deg flex, knee=90 deg flex; glide tibia posteriorly d)xs posterior glide
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| REVERSE LACHMAN: a)tests for b)position/performed how?c)positive? | a)PCL integrity b)prone or supine (book says prone); knee=30 deg flexion; glide tibia posteriorly d)xs posterior glide
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| McMURRAY'S TEST: a)tests for b)position/performed how?c)positive? | a)meniscal tear b)supine; knee=max flexion; TO TEST LAT MENISCUS: palpate lat joint line; INTERNALLY ROTATE & EXTEND KNEE (not hip);TO TEST MEDIAL: palpate medial joint line ER & EXTEND KNEE; c)1: reproduces click 2:pain in knee joint
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| TESTS FOR MENISCUS TEARS are actually doing what to get positive result? | causing IMPINGEMENT by creating compression and/or shearing forces on the torn meniscus between the femoral and tibial surfaces.
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| APLEY TEST: a)tests for b)position/performed how?c)positive? | a)differentiates btwn meniscus tear & lig injury b)prone; knee= 90 deg flex;STEP 1:distract knee joint & IR/ER tibia; STEP 2:apply compressive force to knee & IR/ER tibia c)pain OR dec motion during step 1= lig; pain or dec motion during step 2= meniscal
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| HUGHSTON'S TEST:a)tests for b)position/performed how?c)positive? | a)plica dysfunction b)supine;starting pos: knee=FLEX & IR; palpate MEDIAL femoral condyle; glide patella medially; flex & extend knee c)1: pain 2: poppipng
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| PATELLAR APPREHENSION TEST: a)tests for b)position/performed how?c)positive? | a)LAT patellar dislocation/(hx of it) b)supine;knee=30 deg flexion (Magee;big book makes no reference); glide patella laterally c)pt does not like/allow (If pt feels patella is going to dislocate, pt will contract quads to bring patella back to line)
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| CLARK'S SIGN: a)tests for b)position/performed how?c)positive? | a)patellofemoral dysfunction/pain syndrome b)supine; knee=EXT; push POSTERIORLY on SUPERIOR POLE OF PATELLA; ask pt to perform active quad contraction c)pain reproduced
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| BALLOTABLE PATELLA:a)tests for b)position/performed how?c)positive? | a)infrapatellar effusion b)supine; knee=extension; softly tap over center of patella c)perception of patella floating ("dancing patella" sign)
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| BALLOTABLE PATELLA TEST is also called: | patellar tap test
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| FLUCTUATION TEST: a)tests for b)position/performed how?c)positive? | a)knee joint effusion b)supine;knee=extension; place one hand @ SUPRAPATELLAR POUCH,other @ ANT knee joint; alternate pushing down, one hand at a time c)fluctuation(movement) of fluid felt under hands
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| What is the suprapatellar pouch? | suprapatellar bursa
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| Q-ANGLE MEASUREMENT: a)tests for b)position/performed how?c)positive? | a)> btwn quads & patellar tendon; represents force of quads b)msr angle btwn:1)line from ASIS to mid-patella; 2)line from mid-patella to tibial tub c)normal=13 deg for men, 18 for women; < or > may indicate knee dysfunction or biomechanical dysfunction
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| Decreased Q-angle (less than 13 degrees) my be associated with: | 1)chondromalacia patallae 2)patella alta
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| Increased Q-angle (>18 degrees) is often associated with: | 1)chondromalacia patallae 2)subluxed patella ((laterally)) 3)inc femoral anteversion 4)genu valgum 5)lateral displacement of tibial tubercle/tuberosity 6)increased lateral tibial torsion
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| a)What 2 anatomical things lead to increased Q angle? b)What does increased Q angle lead to? | 1)Excess femoral anteversion ((is like femur IR's; see pic, Magee pg 729)) 2)External tibial torsion b)lateral tracking of patella
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| a)What 2 anatomical things lead to decreased Q angle? b)What does decreased Q angle lead to? | A: 1)Femoral neck retroversion((is like femur ER's; see pic, Magee pg 729)) 2)Internal tibial torsion b)(tends to centralize patellar tracking)
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| NOBLE COMPRESSION TEST: a)tests for b)position/performed how?c)positive? | a)distal IT band friction syndrome b)supine; hip=45 deg flexion, knee=90 deg flexion; apply pressure to lateral femoral EPIcondyle & extend knee c)Pain reproduced @ lateral femoral CONDYLE @ ~30 deg flexion
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| What is happening during the Noble Compression Test that makes it positive for IT band friction syndrome | As the patients' knee flexes to approximately 30 degrees, the IT band translates anteriorly under the area to which pressure is applied (lateral epicondyle of femur).
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| TINEL'S SIGN: a)tests for b)position/performed how?c)positive? | a)COMMON FIBULAR N. dysfunction((compression)) posterior to fibular head b)tap region where common fibular n. passes post to fibular head c)Reproduces tingling and/or paresthesia into leg following FIBULAR nerve distribution
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Created by:
tamasmit