Exam 1: Knee Evaluation Introduction Lecture Flashcards
List the order of which you perform a full examination of the knee
- History
- Observation
- Palpation
- ROM (AROM, PROM, overpressure, and end-feel)
- Strength testing
- Ligamentous/instability testing
- Special testing
When checking ROM during an examination of the knee, which motions are important to test
knee extension
knee flexion
tibial internal rotation
tibial external rotation
Is reliability for end feel good or bad
it is bad unless you use end feel categories consistently such as (soft, hard, empty)
When checking strength testing during an examination of the knee, what types of strength testing are important
isometric testing of knee extension and flexion
Dynamometry testing of knee flexion and extension
Functional testing
(Isometric/dynamometry) strength testing is better because it is more objective
dynamometry
When checking ligamentous/instability testing during an examination of the knee, which ligaments are important to test
ACL, PCL, MCL, LCL, and rotary instabilities
When performing special tests during an examination of the knee, what are two broad area of special test that are important to cover
meniscal pathologies and patellar instability
Yellow and red flags found on the medical screening form and during the history allow the PT to formulate an ______ _____
initial hypothesis
If a patient reports a traumatic onset of knee pain during jumping, twisting, or changing direction with the foot planted, what would your initial hypothesis be
Possible ACL injury, possible patellar subluxation, possible quadriceps rupture, possible meniscus tear
If a patient reports a traumatic injury from a posteriorly directed force to the tibia with the knee flexed, what would your initial hypothesis be
Possible PCL injury
If a patient reports a traumatic injury from a varus or valgus force exerted on the knee, what would your initial hypothesis be
Possible MCL or LCL injury
If a patient reports anterior pain with jumping and full knee flexion, what would your initial hypothesis be
possible patellar tendonitis, possible patellofemoral pain sydrome
If a patient reports swelling to the knee with occasional locking and clicking, what would your initial hypothesis be
possible meniscus tear, possible loose body in the knee joint
If a patient reports pain with prolonged knee flexion, during squats, and while going up and down steps, what would your initial hypothesis be
possible patellofemoral pain syndrome
If a patient reports pain and stiffness in the morning that diminishes after a few hours
Possible osteoarthritis
When does observation begin and end
It begins with the PT first sees the patient and ends as they leave the clinic
As you observe a patient, what are three things you may look at
Bony alignment, Q - angle, soft tissue symmetry and atrophy, and articular vs extra-articular swelling
Q-angle measurements have a (poor/good/excellent) reliability
poor
Patellar position has poor reliability especially in which four motions
medial/lateral position
medial/lateral tilt
anterior/posterior tilt
patellar rotation
True or False:
When palpating the knee, we are comparing our findings to a norm
False, we are comparing to the uninvolved side
When palpating the patella, what are four things you would feel for
- Size, shape, and position
- Superior and inferior poles
- Medial and lateral excursion
- Medial and lateral facets and borders
When palpating the femoral condyles, what are two things you would feel for
- lateral condyle more prominent anteriorly
2. Adductor tubercle
Where is Hunter’s canal located and why is it important
Hunter’s canal is made of the femoral condyles and adductor tubercle. This is important because the saphenous nerve and femoral vein and artery runs through the canal which later turns into the popliteal artery and vein
When palpating the proximal tibia, what structures would you be feeling for
- Pes anserine
- Tibial tubercle
- Lateral tibial tubercle (ITB attachment)
What is the pathology behind runner’s knee
A bursa under the ITB gets inflamed and causes pain when the ITB snaps over the bursa
Why would we palpate the pes anserine
because the semitendinosus tendon, gracilis tendon, and sartorius tendon attach there
Which two special test are performed to test effusion
Stroke test and blottman test
What is normal ROM for knee flexion
0-140
What are normal ROM for knee extension
0-15
What are normal ROM of internal rotation of the tibia on the femur
20 to 30
What are normal ROM of external rotation of the tibia on the femur
30 to 40
Check for ____ with overpressure
pain
What are the five movements a PT will perform to assess end feel of the knee.
- Flexion for approximation
- Extension for stretch
- Medial rotation of tibia on femur
- lateral rotation of tibia on femur
- Patellar movement
What are the 6 strength tests a PT would perform to assess the strength of the knee
- Knee flexion
- Knee extension
- Hip flexion
- Hip Extension
- Hip Abduction
- Glute medius
Assessing the strength of a patient’s hip flexion in sitting (is/is not) functional. Why or Why not?
This is not functional because in sitting, the hip flexors are already shortened which causes the muscle to be weaker with a shorter lever arm.
Testing hip flexion strength in sitting is not functional especially if the patient has ____ ____ pain due to the psoas attachment on the spine
low back
Which ligamentous test would a PT perform when testing anterior stability
Anterior Drawer and
Lachman’s Test
Which ligamentous test would a PT perform when testing posterior instability
Posterior Drawer test
Posterior Sag/Godfrey Sign
Quadricep Active Test
Which ligamentous test would a PT perform when testing medial instabilty
Valgus Stress test
Which ligamentous test would a PT perform when testing lateral instability
Varus Stress test
Which ligamentous test would a PT perform when testing rotary instabilities
Pivot Shift
What does composite testing mean and what is its significance
It is a test cluster which states the LR of two or more tests done together
What are the 6 tests to assess meniscal injuries
McMurray's Test Apley's Compression Test Thessaly's Test Ege's Test Steinmann's Sign Joint line tenderness
Which three outcome measurements are used while examining the knee
WOMAC
Timed 6 minute walk test
Lower Extremity Functional Scale (LEFS)
True or False:
The WOMAC, Timed 6 minute walk test, and Lower Extremity Functional Scale (LEFS) are all outcome measures that can be used for the hip, knee, and ankle
true
What does WOMAC stand for
Western Ontario and MacMasters Universities Index
The WOMAC outcome measure is found to be reliable, validated and responsive for ______ of the hip and knee and has been applied to (ACL/Meniscal) tears as well as general PT.
osteoarthritis; meniscal tears
Do you need permission to use the WOMAC outcome measure
yes and it is expensive
Explain what the timed 6 minute walk test is
A functional measure that times how far a patient can walk in 6 minutes. This should be compared to a baseline after a re-evaluation
True or False:
The LEFS is found to be reliable and valid compared to the SF-36
true
The LEFS has good (specificity/sensitivity) and is easy to administer and score. This (is/is not) useful for research and clinical decision making
Sensitivity; is useful for research
