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Orthopedics I: Knee > Assessing the Tibiofemoral Joint > Flashcards

Assessing the Tibiofemoral Joint Flashcards

1
Q

What 7 things should you look for in the history portion of a tibiofemoral joint exam for a traumatic knee injury?

A
  1. Mechanism of trauma
  2. Effusion
  3. Functional ability
  4. Weight bearing status
  5. Sounds (cracking, popping, tearing)
  6. Locking/unlocking
  7. Previous episodes
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2
Q

What 7 things should you look for in the history portion of a tibiofemoral joint exam for a non-traumatic knee injury?

A
  1. Onset (gradual or sudden)
  2. Previous episodes
  3. Previous trauma
  4. Other joint involvement
  5. Twinges
  6. Effusion
  7. Patellofemoral complaints
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3
Q

What 4 things should you look for in the observation portion of the tibiofemoral joint exam?

A
  1. Effusion (extent and position)
  2. Deformity (valgus, varus, recurvatum)
  3. Position (flexed, varus, valgus, recurvatum)
  4. Quad wasting
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4
Q

What are the 5 characteristics that you should for in the Ottawa Knee Decision Rule? What does the presence of any one of these characteristics indicate?

A
  1. Age ≥ 55 years
  2. Tenderness at head of fibula
  3. Isolated tenderness of the patella with no bone pain other than the patella
  4. Inability to flex the knee to at least 90 degrees
  5. Inability by the patient to w/b immediately and in the ER for 4 steps.
    Presence of any of these characteristics is an indication for referral for x-ray to confirm a fracture.
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5
Q

What 4 functional weight bearing tests should you do in a tibiofemoral exam? What 3 things are you looking for during them (besides the special test)?

A 
Double Squat
Single Squat
Step up/Step down Test
Thessaly Test
In all of these except the Thessaly, you are looking for symmetry, knees over toes, and loss of ROM in the hip, knee, or ankle.
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6
Q

How do you perform a Thessaly Test? What are you testing? What is a positive test?

A

Pt. stands on one or both legs facing examiner holding their hands, knees bent 20°, rotates from one side to the other 3 times. Testing for meniscus tear. Positive is joint line discomfort or possible sense of locking or catching.

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7
Q

What position would you test AROM of knee flexion? PROM of knee flexion?

A

AROM: sitting or prone
PROM: supine

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8
Q

What position would you test AROM of knee extension? PROM of knee extension?

A

AROM: sitting
PROM: supine

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9
Q 
How would you test the following muscles?
gracilis
sartorius
semitendinosus
quadriceps
hamstrings
poplitius
gastrocnemius
A

gracilis: hip adduction
sartorius: hip adduction, flexion and ER
semitendinosus: knee flexion and IR
quadriceps: knee extension, RF hip flex.
hamstrings: knee flexion. ST and SM in more IR of tibia and BF with ER.
poplitius: Open Chain medial rotation of tibia and flexion of knee
gastrocnemius: knee flexion; PF of ankle.

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10
Q

When doing the valgus stress test, what position of knee flexion (in degrees) will test the middle and posterior fibers of the MCL?

A

30 degrees

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11
Q

When doing the valgus stress test, what position of knee flexion (in degrees) will test the anterior fibers of the MCL?

A

90 degrees

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12
Q

When doing the valgus stress test, a positive test at 0 degrees suggests what problem?

A

superficial and deep fibers of the MCL are torn along with at least the ACL and possibly the PCL.

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13
Q

What two positions will you test for varus stability?

A

0 degrees and 20-30 degrees.

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14
Q

Explain how to perform a Lachman’s test. What are you testing?

A

Pt supine and relaxed, PT grasps femur and tibia, flexing knee to 15 degrees. A QUICK anterior draw of the tibia is performed. Easier with a bolster under knee. This is testing the patency of the ACL.

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15
Q

Why is the anterior drawer test not considered a good test of the ACL? What instance would it be a good test for the ACL?

A

In the acute knee, if the collaterals are intact, the test can be falsely negative. Only will be positive in an old ACL tear where the collaterals have slackened due to rotatory instability.

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16
Q

If the tibia is put in external rotation and then an anterior drawer is performed, what part of the knee are you testing for instability? What about if the tibia is put in internal rotation?

A

external rotation: antero-medial instability

internal rotation: antero-lateral instability

17
Q

If the tibia is put in external rotation and then an posterior drawer is performed, what part of the knee are you testing for instability? What about if the tibia is put in internal rotation?

A

external rotation: postero-lateral instability

internal rotation: postero-medial instability

18
Q
  1. What is the jerk test checking for?
  2. What starting position would you put a patient to perform a jerk test?
  3. How would you perform the jerk test?
  4. What is a positive test?
A
  1. anterolateral rotatory instability
  2. pt. supine, hip 45 degrees flexion, knee 90 degrees of flexion.
  3. Internally rotate the tibia with a hand on the foot/ankle and extend the knee as you perform a valgus stress at the knee.
  4. Positive is a loud clunk as the knee comes into full extension.
19
Q

What are the 3 tests for meniscal injury?

A

McMurray’s Test
Apley’s Test
Quadrant Tests

20
Q
  1. What starting position would you put a patient to perform a McMurray’s Test?
  2. How do you perform a McMurray’s Test?
  3. What is a positive test?
A
  1. pt. supine, knee flexed to 90 degrees.
  2. Compress tibia into the femur and IR the tibia as teh knee is extended and flexed then ER as the knee is extended and flexed again. (the “U Shape” test).
  3. Positive is a consistent click in the joint or a significant increase of pain in the joint.
21
Q
  1. How would you perform an Apley’s Test?

2. Positive test?

A
  1. pt. prone and tibia compressed into femur in IR and ER. Do in different degrees of knee flexion.
  2. Positive is clicking or pain.
22
Q
  1. What specifically are you testing for during quadrant testing of the knee?
  2. What is the position of the knee for the following motions?
    Inner Flexion
    Outer Flexion
    Inner Extension
    Outer Extension
A
  1. articular instability and less irritable meniscal tears.
  2. Inner Flexion: flexion, adduction, ER
    Outer Flexion: flexion, abduction, IR
    Inner Extension: extension, adduction, ER
    Outer Extension: extension, abduction, IR
23
Q

To gain flexion ROM, which position would you put the patient and how would you perform the mobilization?

A

patient in supine with knee flexed to appropriate amount with tibial IR.
Mob is combined motion of IR and posterior glide of the tibia.

24
Q

To gain extension ROM with more than 15 degrees of loss, which position would you put the patient and how would you perform the mobilization?

A

Patient prone with towel roll under femur with tibial ER. Mob is anterior glide of the tibia (hand placement is thumb and finger on opposite sides of the back of the knee).

25
Q

To gain extension ROM with 15 - 5 degrees of loss, which position would you put the patient and how would you perform the mobilization?

A

Patient supine with towel under tibia (NOT under knee joint) with tibia held in ER.
Mob is posterior glide and IR of the FEMUR which is an anterior glide and ER of the tibia. With muscle energy, have patient lift foot up, placing towels under foot as more extension is achieved.

26
Q

What component would you change from the 5-15 degrees of loss extension mob to achieve the last 5 degrees of extension?

A

place lower hand on heel to get more ER leverage on the tibia and emphasize the ER in both mob and muscle energy.

27
Q

What 2 exercises listed in the notes can you do to help gain flexion ROM?

A

Stair lunges

Flexion ROM on rolling stool (pt seated).

28
Q

What 2 passive exercises listed in the notes can you do to help gain extension ROM?

A 
Prone hangs (hang weight on foot to help).
Supine foot propping

Orthopedics I: Knee (3 decks)

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