Chapter 12: Knee Flashcards
What are the active ranges of motion of the knee?
- Flexion: 0-135 degrees
- Extension: 0-15 degrees
- Medial rotation: 20-30 degrees
- Internal rotation: 30-40 degrees
What are the end feels for passive range of motion of the knee?
- Flexion: tissue approximation
- Extension: tissue stretch
- Medial and lateral rotation: tissue stretch
What is the Valgus stress test?
Tests the medial collateral ligament.
With the patient lying supine the examiner pushes on the lateral aspect of the knee. Done both fully extended and in 20-30 degrees of flexion.
The test is positive if there is any laxity.
What is the Varus Stress test?
Tests the lateral collateral ligament.
With the patient lying supine the examiner pushes on the medial aspect of the knee. Done both fully extended and in 20-30 degrees of flexion.
The test is positive if there is any laxity.
What is the Drawer sign?
Test for anterior and posterior instability.
With the patient supine and their knee flexed to 90 degrees and their hip to about 45 degrees, hold their foot down by sitting on it. Wrap your hands around the tibia with your thumbs over the tibial plateau. Draw the tibia towards (anterior) yourself and the push the tibia away (posterior).
The test is positive if there is any excessive movement.
What is the Lachman test?
Tests anterior cruciate ligament, mainly the posterolateral band.
With the patient laying on their back have them hang their lag over the side of the table. While sitting on a chair place their lower leg between yours with the knee at about 30 degrees of flexion. Stabilize the femur with one hand while the tibia is pulled forward with the other hand.
The test is positive if there is any excessive movement.
What is the Godfrey test?
Tests for posterior instability.
With the patient supine, the examiner hold both legs while flexing the hips and knees at 90 degrees.
The test is positive if there is any posterior sag of the tibia.
What is the Posterior sag sign?
Tests for posterior instability.
With the patient lying supine have them bend their knees to 90 degrees and their hips to 45 degrees.
The test is positive if there is any posterior sag of the tibia.
What is the Pivot shift test?
Tests for anteriolateral rotary instability of the knee (anterior cruciate ligament rupture).
The patient lies supine with the hip both flexed abducted 30 degrees and relaxed in slight medial rotation (20 degrees). The examiner holds their foot with one hand while the other is placed at the knee. Apply a slight valgus force and move the knee into flexion.
The test is positive if the tibia drops backwards at around 30-40 degrees of flexion or if the patient has a look of apprehension.
What is the Apley’s test?
Test for Collateral ligament injury (during distraction) and meniscal injury (during compression).
The patient lies prone with their knee flexed at 90 degrees. Anchor their thigh to the table with your knee. The examiner medially and laterally rotates the tibia, first with distraction (pulling up) and then with compression (pushing down).
The test is positive if there is any pain, catching or grinding.
What is the McMurray’s test?
Tests for meniscal injury.
With the patient supine the examiner passively medially rotates (lateral meniscus) the tibia while flexing and extending the knee. And then do the same with lateral rotation (medial meniscus).
The test is positive if there is any pain, clicking, or grinding.
What is the Brush/stroke/wipe test?
Tests for swelling.
With the patient supine the examiner brushes up the medial side of the knee 2-3 times then over and down the lateral side of the knee.
The test is positive if fluid passes back to the medial side.
What is the Fluctuation test?
Tests for swelling.
With the patient supine the examiner places one hand above the patella and the other below it. Press down with one hand and then the other.
The test is positive if there is any synovial fluid moving back and forth between the hands.
What is the Patellar tap test?
Tests for swelling.
With the patient supine and their leg extended or flexed to discomfort. The examiner applies a tap or pressure over the patella.
The test is positive if a ‘dancing’/ floating patella is felt.
What is the Clarke’s sign?
Tests for a problem with the articulation between the articular surface of the patella and the articular surfaces of the femoral condyles.
With the patient supine the examiner presses down lightly proximal to the upper pole of the patella while the patients leg is extended. Ask the patient to slowly contract their quadriceps.
The test is positive if there is any pain and the patient cannot hold the contraction.
