2. Knee Tests & Disorders Flashcards
Medial mensiscus palpation
Palpable in IR; Pain with ER if injured
Lateral Collateral Ligament Palpation
Palpable in Tailor’s position
(Common) Peroneal/Fibular Nerve
Behind fibular head; posterior & lateral branches
Valgus Stress Test of Knee
Tests for instability of MCL; tests for sprain of MCL. Apply Valgus pressure (try to force leg into knock-kneed position)
Varus Stress Test of Knee
Tests for instability of LCL. Apply Varus pressure (try to force leg into bow-legged position)
Anterior Drawer Test
Tests ACL instability by pulling tibia anteriorly; if tibia can be pulled forward, ACL is not intact
Posterior Drawer Test
Tests PCL instability by pushing tibia posteriorly; if tibia can be pushed back, PCL is not intact
Lachman Test
Tests ACL instability by pulling tibia anteriorly; if tibia can be pulled forward, ACL is not intact
Modifid Lachman Test
Hang lower leg off table; Use table to stabilize upper leg. Tests ACL instability by pulling tibia anteriorly; if tibia can be pulled forward, ACL is not intact
Pivot Shift Test
Tests ACL instability; Valgus stress with IR; Perform in ext and at 30; Difficult test used by orthopaedists
Apply’s Compression (Grind test)
Tests meniscal tears; Place downward pressure on the ankle and IR/ER; Pain w/ IR = Lat mensiscus tear; Pain w/ ER = Med meniscus tear; Also painful with injured capsule & ligaments
Apply’s Distraction
Tests capsule and ligament sprains; Pull ankle upward and IR/ER; Pressure taken off meniscus; Pain w/ IR = lat side; pain w/ ER = med side
McMurray’s Test
PRIMARY MENISCUS TEST!!! Passively flex hip & knee and ER, then passively extend hip and knee in IR & pull knee lat; CLICKING & PAIN INDICATIVE OF MENISCUS TEAR
Patella Crunch Test (Clarke’s)
Tests for Patellofemoral Syndrome; 1) Patient contracts quad; 2) Patient contracts quad while provider applies slight pressure; 3) Patient contracts quad while provider applies more distal pressure
Apprehension Test of Knee
Attempt to displace patella laterally; Positive = pain & fear of dislocation
Knee Effusion Test
Milk edema to one side and release
Ballotable Test
Push down on patella and watch it float up; incative of edema
Bounce Home Test
AWEFUL TEST!!! DON’T EVER DO THIS!!! Place patient leg into 30 flex; as s/he relaxes, drop leg into extension and watch for it to bounce back
Quadricep Muscle Contusion - Mechanism
Mechanism = Direct blows
Quadricep Muscle Contusion - S/Sx
S/Sx = pain, edema, ecchymosis, decreased knee ext
Quadricep Muscle Contusion - Complication
Complication = Myositis Ossificans
Myositis Ossificans
Development of bone in muscle due to calcification during inflam. process; Develops from blood pooling close to bone; Start massaging quickly to push blood away from area of injury
Quadricep Muscle Strain - Mechanism
Mechanism = Forceful overstretch or contraction
Quadricep Muscle Strain - S/Sx
S/Sx = point tender; edema; spasm; pain on extreme flex & resistive ext
MCL Sprain - Mechanism
Mechanism = DIRECT BLOW TO LAT SIDE OF LEG; QUICK CHANGE OF DIRECTION; IR of femur; ER of tibia;
MCL Sprain - S/Sx
S/Sx = Pain at MCL; hemarthrosis; decreased RoM; (+) Valgus stress test; Med meniscus and capsule may also be injured
LCL Sprain - Mechanism
Mechanism = IMPROPER LANDING from a jump; DIRECT BLOW TO MEDIAL SIDE OF LEG; IR of tibia; ER of femur;
LCL Sprain - S/Sx
S/Sx = Pain at LCL; minimal edema because it is outside of the capsule; (+) Varus stress test
ACL Sprain - Mechanism
Mechanism = RAPID DECELERATION COMBINED WITH IR; Hyperextension; POSTERIOR BLOW TO TIBIA (such as at dog parks); Anterior blow to femur;
ACL Sprain - S/Sx
S/Sx = Sharp pain, audible pop, then fall; Sensation that “whole knee just moved”; (+) Anterior drawer test; (+) Lachman’s test
PCL Sprain - Mechanism
Less common than ACL sprains; Mechanism = MVAs; POSTERIOR BLOW TO FEMUR; Anterior blow to tibia; HYPERFLEXION; Severe Hyperextension (ACL then PCL);
PCL Sprain - S/Sx
S/Sx = Sharp pain, audible pop, then fall; (+) Posterior drawer test
Patellar Tendon Rupture - Mechanism
Mechanism = Forceful contraction of quads (knee extension); Jumping up
Patellar Tendon Rupture - S/Sx
S/Sx = Indentation below patella where tendon was; bruising; tenderness; cramping; Patella alta; inability to straighten knee; difficulty walking due to knee buckling or giving way
Patellar Tendonitis - Mechanism
Inflammation of patellar tendon; Mechanism = overuse
Patellar Tendonitis - S/Sx
S/Sx = Pain, edema, crepitus; tender at inf. Pole of patella
Meniscus Sprain - Mechanism
Medial more common than lateral; Mechanism = weight-bearing with rotational stress
Meniscus Sprain - S/Sx
S/Sx = Joint line pain, snapping following injury; posterior pain possible; clicking; locking of knee; mild edema day after injury
Medial Meniscus Sprain - Mechanism
Mechanism = Weight-bearing with external rotation stress
Lateral Mensiscus Sprain - Mechanism
Mechanism = Weight-bearing with internal rotation stress
Unhappy Triad
ACL sprain, MCL sprain, & Medial Meniscus Sprain
Unhappy Triad - Mechanism
Mechanism = Valgus stress with ER; Direct blow during rotational movement; CUTTING WHILE RUNNING
Patellar Fracture - Mechanism
Mechanism = Direct trauma, fall
Patellar Fracture - S/Sx
S/Sx = Pain, edema, radiating pain, indirect tenderness; HARD TO DIAGNOSE on Xray
Pes Anserine Bursitis
Chronic inflammation of bursa; Gracilis - add; Sartorius - Ext; Semitendinosis - fles
Pes Anserine Bursitis - Mechanism
Mechanism = Cyclist’s Knee; overuse
Osgood Schlatter’s Disease - Mechanism
Mechanism = Direct trauma to tibial tuberosity & then over use; COMMON IN TEENAGERS ACTIVE IN SPORTS
Osgood Schlatter’s Disease - S/Sx
S/Sx = Large bump on tibial tuberosity; tender to palpation; No pain w/ activity
Osgood Schlatter’s Disease - Complication
Complication = Avulsion (rupture) of tendon from bone; usually happens with rapid growth spurts
Osgood Schlatter’s Disease - Tx Recommendation
Treatement Recommendation = Should be removed from activity to prevent further damage
Patello-femoral Syndrome
Chondromalacia - softening of underneath surface of patella & anterior surface of femur
Patello-femoral Syndrome - Mechanism
Mechanism = Overuse
Patello-femoral Syndrome - S/Sx
S/Sx = lateral tracking of patella in fossa; Abnormal Q angle - more common in women; pain w/activity, edema, crepitus; stiffness w/ extended sitting (Movie goers knee); AM stiffness; pain with palpation along medial border of knee
Osteoarthritis
Chronic disorder; narrowing of joint space
Osteoarthritis - S/Sx
S/Sx = Medial pain; stiffness; decreased RoM; Edema
Prepatellar Bursitis - Mechanism
Housewife’s Knee; Mechanism = extended kneeling; direct blow to knee; overuse
Prepatellar Bursitis - S/Sx
S/Sx = Marked local edema; pain on extreme flexion due to pressure on bursa
Popliteal Bursitis
Baker’s Cyst; affects medial hamstring tendons due to irritation
Popliteal Bursitis - Mechanism
Mechanism = overuse
Patellar Dislocation - Mechanism
Mechanism = Sudden change of direction while weight-bearing; direct trauma
Patellar Dislocation - S/Sx
S/Sx = Pain, edema, deformity; Will often sublux and return to original position
