6 - Knee Flashcards
Anterior Drawer Sign…excessive motion indicates what?
-Anterior cruciate ligament tear.
Most common tear of the knee ligaments?
- Medial menisci…
- (2nd) Medial collateral…
- (3rd) Anterior cruciate
How do you stabilize for anterior drawer sign?
-Sit on patient’s anterior foot with your posterior thigh while patient’s knee is flexed.
No motion on anterior drawer (A-P) sign indicates what?
-Posterior tibia
Posterior Drawer sign
-Excessive (P-A) motion indicates
posterior cruciate ligament tear. Not as common as Anterior tears.
Lachman’s test
-Same procedure as Anterior draw sign except knee is bent only up to 30 degrees.
What is the orthopedic test of choice for anterior cruciate ligament?
–Lachman’s
What follow up test to Anterior Drawer verifies cruciate ligament damage and laxity?
–Lachman’s
What test would you run if you suspected a false negative on anterior drawer sign of the knee?
–Lachman’s
Why is Lachman’s preferred over anterior drawer for anterior cruciate ligament testing?
-The lower angle of flexion does not stretch the quadriceps as much, and the condyles are not as deeply seated into the menisci.
Tibia Posterior…what are some indications?
- Aching behind the knee,
- Loss of fluid motion on anterior drawer (pulling P-A)
- Full flexion ROM is lost (pulls anterior ligaments tight)
Apley’s Compression (menisci)
- Positive is pain
- Indicates Meniscal damage on side of pain finding when compressed
- Is a subjective test
If Apley’s compression causes a decrease in pain what test would you run next?
-Apley’s Distraction suspecting collateral ligament damage.
What would you do to verify pain on the medial side with Apley’s compression?
-McMurray’s test.
Apley’s Distraction Test Postive is what?
- Positive report is pain
- Indicates collateral ligament damage on side of pain
- It’s a subjective test
If pain were decreased on Apley’s distraction what test would you run?
-Apley’s compression suspecting a meniscal tear.
What if Apley’s distraction relieves the pain?
-It’s probably meniscal
What does Apley’s compression test indicate?
-Medial or lateral meniscal damage,….. pain helps determine the side.
McMurray’s test ..Describe the order of procedure.
. Pt. supine, knee bent, Dr. palpates medial joint.
-Externally rotate foot,…Varus medial stress,…extend leg while palpating the medial joint line.
What is a positive finding for McMurray’s?
-Palpable or audible click, with or without pain.
Positive McMurray’s indicates what?
-Tear in the medial meniscus, most likely a horizontal/bucket handle tear
Pain alone (no click) in McMurray’s may indicate what?
-Medial collateral ligament tear,….-medial meniscal tear,….-anterior cruciate tear,…-Tibia AM
What’s the most common cause of a joint mouse of the knee?
Medial meniscus tear.
What orthopedic tests should be run if McMurray’s has pain only?
- Valgus stress,…-Appley’s compression,…Appley’s distraction…
- Anterior drawer sign…-Lachman’s,…
Valgus stress (Pushing from lateral to medial) What is a positive?
-Excessive movement at the medial joint space.
What test would you run to verify a Valgus stress test?…
Apley’s distraction with medial side pai
The best way to check an Anterior-Medial Tibia for fluid motion?
-If there’s no motion on Valgus stress, it may be due to the tibia rotating anterior which in turn pulls the medial ligaments tight that attach to the femur. Thus restricting motion.
Is it normal to have a little bit of movement during valgus stress?
-Yes! (no motion=A-M tibia;……Excess motion=Ligament tear)
What other ligament(s) might be torn if the medial collateral is torn?
-Medial meniscus,…..-maybe anterior cruciate or (ligament crossing the joint space)
With Abduction/Valgus Stress:…-Excess motion indicates medial collateral ligament tear.
-If pain is exacerbated during this procedure it indicates a partial tear.
–If pain stays the same it indicates a complete tear.
Should you compare valgus to varus stress on the same knee?
- No, the two don’t always have the same laxity.
- Compare right knee valgus to the left knee valgus,……-and right knee varus to left knee varus.
What is the direction of pull for patella grind
S-I, try to not get A-P force….-A more humane way is to have supine patient lift foot off table which tightens quads & elevates patella superior
What is the positive for Patella Femoral Grinding Test
Pain or crep
What does a positive Patella Femoral Grinding Test indicate
Chondromalacia patella
What is positive patella femoral grinding most likely indicative of in an adult
DJD or plica.
Which direction is pressure applied for patellar apprehension test?
-M-L against the medial border of the patella…..-then L-M against the lateral border of the patella.
Patella Apprehension Test What is a positive?
-Patient has a look of apprehension indicating a propensity to dislocate. (Look at patient’s face.)
Most common direction of patellar dislocation?
?……-Superior & lateral because of quad muscle.
How would patient present for needing patellar traction?
-flexed knee,…-history of impact on kneecap causing pain. (Remember baseball video?)
What are the findings to indicate the need for patellar traction?……
1) Dislocation.
-(2) Patient is unable to extend knee because the quadriceps become flexors.
-(3) On visualization Patella is superior and lateral to knee joint
Name (4) Post checks for patellar traction.
-(1.) Visualization,….-(2.) Light palpation,….-(3.) Active ROM (extension)….-(4.) X-ray
What procedures would you not use for post checking patellar traction?
- Fluid motion (not on a hypermobile area),
- Patellar Apprehension,
- Patella femoral grinding test.
Is the tibial tuberosity medial or lateral compared to inferior tip of the patella
slightly lateral.
