Hip and knee special tests: Flashcards
1
Q
Ottawa knee rule
A
if any 1 of these is positive, this individual should be imaged!
- Over 65 should be imaged
- Tenderness over patella with acute injury
- Tender over fibular head
- Can’t flex knee beyond 90 degrees
- Can’t weight bear for 4 steps after injury
2
Q
Patella tap test (Ballottement)
A
Patella floats on swelling if there is a significant amount of swelling
- tap the patella
3
Q
Fluctuation (milking)
A
- C grip with thumb and index and start at mid thigh and milk and encourage any fluid to be pushed inferiorly
- Other hand Palpate on the side of infrapatellar tendon
- Should feel like you’re squeezing a water balloon (pressing down with one hand and then the other
4
Q
Sweep test
A
- Start inferiorly and sweep inferior to superior (medially)
- Push swelling to superior recess of capsule
- Then sweep superiorly to inferiorly (laterally)
- If you see small wave of fluid come back = +1
- Sweep it out and comes back = +2
- Unable to sweep it out = +3
5
Q
Ege’s
A
- testing for meniscal injury/tear
- Weight-bearing, standing ER (duck toed) and squats
- Stress post horn medial
- Stress Ant horn lateral
- Pigeon toed: and stresses the opposite structures
6
Q
McMurray’s
A
- Meniscal tests:
- Patient in supine
- Take a slightly flexed knee and externally rotate the tibia
- Take pt into flexion and extension while ER tibia
- Apply slight valgus force (optional)
- Stresses posterior horn of medial meniscus, anterior horn of lateral meniscus
- Can reverse it, go into internal rotation with the tibia and do the same thing
7
Q
Apley’s compression/distraction
A
- Patient prone with knee flexed to 90
- anchor knee with your knee
- ER/IR tibia with compression and then with distracion
- postive: if distraction is more painful + increased motion = ligamentous if compression is more painful + decreased motion = mensicus
8
Q
Thessaly
A
- meniscal test
- stand on one leg, can offer support
- Slightly flex knee (can go through different flexion ranges)
- Have pt rotate medially and laterally (closed chain)
9
Q
Bounce home
A
- meniscal test
- Patient Supine
- heel is cupped by examiners hand
- patients knee is flexed and allowed to passively extend
- Postive: if extension is not complete or has a rubery end feel
10
Q
Lateral pull test
A
- Patellafemoral
- Patient lies supine with the leg extended
- patient contracts the quad while examiner watches patella movement
- if lateral movement is excessive = positive
11
Q
Apprehension test (knee)
A
- patient lies supine with muscles relaxed
- examiner pushes the patella laterally
- positive: quad contraction due to the patient feeling like the patella will dislocate
- PFS
12
Q
Patellar grind test
A
- patient sits on the edge of the table with knee flexed to 90
- examiner feels for patellofemoral joint crepitis while the patient extends their knee
13
Q
McConnells test
A
- Open chain
- Pt sitting on edge of table
- Actively extend knee, therapist repositioning patella medially while moving
- While pushing medially do resisted isometrics at different points in the range
- Less pain = positive McConnells test/sign
- This person would likely be helped by taping
14
Q
Knee
squat test
A
- Closed chain McConnells test also does a squat portion
- Just have the patient squat
- Is there pain
- Did the patella go laterally (excessively)
- Squat until they have the pain while positioning the patella medial
- does that feel better (applying McConnell to them)
15
Q
Step down test (knee)
A
- Have patient step off a ledge (can be any size but depends on how much pain they are in)
- Looking for a valgus collapse
- Closed chain McConnell’s test has a part of this
- Test both legs fo comparison
- On involved: probably more instability of the patella
- More valgus collapse if weakness of hip musculature is present
- Reposition the side tracking laterally and see if the symptoms are better (applying McConnell to them)
16
Q
Mediopatellar plica test
A
- patient lies in supine position with affected knee flexed to 30 resting on examiners arm
- examiner pushses the patella medially with the thumb
- if the patient complains of pain or clicking it indicates a positive test (for a plica)
should be done with meniscal tests
17
Q
Hughston’s plica test
A
- patient in supine
- examiner flexes knee and mediall rotates the tibia with one arm and hand while pressing the patella medially with the heal of the other hand and palpating the medial femoral condyle
- patients knee is passive flexed and extended while the examiner feels for popping of the plica under fingers = postive test
18
Q
LCL special test
knee
A
- patient in supine
- knee fully extened with varus force applied (joint capsule and other structures)
- Knee flexed to 30 with varus force should have more motion
grading scale: (knee extended * i think)
- Less than 5 mm = +1
- 5-10 mm = +2
- Over 10 mm = +3
19
Q
MCL special test
A
- Patient in supine
- First 0º of extension and valgus stress applied
~ Closed pack position - less motion
~ Testing joint capsule and the other structures - Second 30º of knee flexion should have more motion
- Influence of MCL
- Looking for degree of translation or laxity in the ligament but also end feel - hard or soft
- Should be a firm end feel - extension
20
Q
Anterior Drawer test
A
- Patient in Supine
- 80º of knee flexion with neutral rotation
- Step back and look at leg from side – how is the tibia in line with the femur
- No Positive sag sign – looking at the tibia should not look like the tibia is sitting posterior (PCL prevents this – Will give you a false positive)
- ACL will be intact with firm end feel
- Stablize foot by sitting on it
- Try not to let hamstrings contract = false negative
- Glide anterior - assess translation and end feel - Normal = 4mm
21
Q
Posterior sag sign
A
- patient lies supine with hip flexed to 45ºand knee flexed to 90º
- if the tibia drops back or sags on the femur due to gravity = positive
- PCL is torn with positive sign
22
Q
Slocum test
A
- tests both anterior and rotary instabilities
- knee flexed to 80-90ºand hip is flexed to 45
- the foot is first in 30ºIR and anterior drawer test is preformed
- if there is excessive movement related to unaffected side this indicates ALRI
- these structures may have been injuried: ACL, posterolateral capsule, Arcuate-popliteus complex, LCL, PCL, IT band
23
Q
Slocums test with ER
A
- same as before but foot is in 15 ER and anterior drawer is done
- if test is postive = movement on medial side
- indicates these structures may be injured: MCL, Posterior oblique ligament. posteriomedial capsule, ACL
24
Q
Lachman’s
A
- Tests ACL
- Minimizes the anterior capsule involvement
- Stabilize femur
- 30º of knee flexion and draw tibia anteriorly
Variations: in megee text
1. Stable Lachman’s
- Therapists knee supports patients knee in 30 degrees of flexion
- Draw tibia anteriorly
2. Mod Two
- Pt sitting on edge of table, femur supported on edge
- Involved leg resting on examiners thigh
- Pull anteriorly
3. Drop Leg
- Pt supine
- Thigh supported on table
- Pt leg clamped between therapists legs
4. Mod 4
- Pt supine, hope flexed to 45 degrees
- Leg between therapists arm and trunk
5. Prone
- Thigh supported on table
- Apply force posterior to anterior
25
Lelli:
- Put hand under calf and press down on the femur
- Three inches distal to tib tub
- Hard to see unless person is under anesthesia - Once all slack is taken up in the ACL the knee will extend
- When the ACL is torn there is no slack to take up and therefore will not get extension
26
Posterior Drawer Test
- Posterior drawer
- Same as anterior, but pushing posteriorly
- Normal = 4 mm
- pay attention to end feel
27
Anterior Lateral pivot shift test
- May be positive if torn ACL
- R posterior lateral laxity in joint capsule
- Patient lay in Supine with knee extend IR tibia
- If there is laxity → passive sublux the tibia on femur if its lax
- Take him from the extended to flexion
- As you flex the knee around 30º → reduce if it was lax
- Has to do with passive tension developed in IT band
- IR tibia and sublux you move the IT band anterior to the medial lateral axis of knee
- As you flex the knee with valgus stress
- IT band goes from anterior to posterior of the medial lateral aspect pulling the tibia back into place.
28
Review muscule length testss
- hamstring: SLR, knee extension
- Quad: Thomas, Elys
- IT band Obers
29
Sign of the buttock
- Bring leg up with knee straight
- Note limitation in hip flexion
- If knee is bent and hip flexion is the same
- Either have a tight hip joint/capsule
OR
- Tight glute Max
OR
- Mass in But-tock that’s limiting motion
30
FABERS
- Flexion ABduction ER
- Let leg fall down
- Tests ROM of joint particular anterior capsule
- Tightness of IRs, adductors, hip extensors
- *if a force is applied it is testing hip flexors*
| can also be used for OA
31
FAIRs
- Flexion Adduction IR
- Tests piriformis
- Can test in supine with flexion below 90
- Above 90 flexion the line of pull of piriformis changes
- So that it becomes an IR so you would stretch it with ER
- Piriformis stretch with a towel so you flex beyond 90º
32
Leg length tests
| TESTS**
1) Long femur or tibia
- Supine with knee flexed to 90º
- If the tibia is going anterior then there is a longer femur on that side
- If its a tibia is longer you will see a higher or lower of the knee itself
2) Or in prone
- Look at medial malleoli to isolate the tibia with knees flexed to 90º
3) Kneeling on a chair and take the tibia out
- Isolates the femur
33
Craigs test
- 15 degrees of anteversion normal (measure with goniometer)
- Palpate greater trochanter (ER and IR) - parallel to the table
- Take measurement from the knee
- Greater than 15 degrees - start to see some compensations
- Walking with toes in to seat femoral head more posterior
- Anteverted the femoral head is more anterior in the acetabulum
34
Log roll test
- Start with patient in supine
- OA first signs is lacking IR (lose IR first)
- Log roll into IR - should be limited for + sign
- Log roll out = laxity if they go too far out
35
Trendelenburg sign
- Stand on one leg and see if they lean or hip drop
- normally the pelvis on the opposite side should rise
36
Joint assessment for the hip
Long axis distraction:
- Supine and pull with hands on the malleoli
- Compare to other side
- If they have a bad knee prop leg on shoulder and pull up (can also be used for flexion beyond 70º)
Lateral distraction
- Use a belt
- So you aren’t working hard
- Capsular stretching can be used!
37
Compression test of the hip
- Supine
- Hip flexed and abducted and press through the knee
- (+) = pain
- testing for OA
38
# hip
Distraction test
- If compression painful, do distraction
- Pt supine, leg ext, pull ankle out
39
Scour test
- (+) test is hip or groin pain
- Pt supine - axial load applied and moved in circumduction
- Can be positive for OA or labrum*
- textbook: examiner flexes adducts patients hip and then with resistance maintained take hip into abduction while maintaining flexion
- a pinch may indicate a labrum
40
Test to stress anterior labrum
- Flex abduct and ER
- Take into ext, adduction, and IR
- Looking for catching, pain
41
Posterior labral tear test
- Hip in extension abduction and ER - Take into flexion adduction and IR
- positive = groin pain apprehension or reproduction of symtpoms
- *check text book slightly differen*
42
Femoral acetabuluar impingement sign
- Start with hip at 90 degrees, ER and abducted
- keep hip at 90º and IR and adduct
- Does that create a pinch or pain in the groin
- Especially when someone has a retroverted head
- CAM impingement and PINCER impingement can predispose to a labral tear
43
Nobles compression test
- Identify IT band, compress about 2 cm above lateral femoral condyle
- Passively take the knee into extension
- If a person has runners knee, they will have pain past 30 degrees of extension
