Knee Flashcards
What does Clark’s test for
Chondromalacia patella, degen patfem Jt
Clark’s technique
Press patella inferiorly, pin in position
Ask Pt to contract quads slowly
+ve Clark’s
P on posterior surface of patella
-ve Clark’s
Pt can maintain contraction without pain
Control pressure carefully as false +ve can occur
Clarks clinical notes
Quad contraction compresses patella against femoral condyles
What does Ballotment’s test
Internal derangement, lig sprain/strain or rupture, vascular damage
Intra-articular knee swelling
Ballotments technique
Pillow under knee
Milk knee/quads
Movement top-bottom
Hold patella
Tap
+ve Ballotments
Rapid bounce, spongy feel, floating
Increased bulge over patella (fluid)
Ballotments clinical notes
Normally patella should move approx 1mm
With Jt swelling, ant to post motion will be increased as local edema raises the patella further of femur
Trauma is most common cause of effusion
What does Apley’s test
Comp- meniscal damage
Distract- capsule/ligament lesion/ CoLat lig sprain
Apley technique
Supine
Leg to 90
Place knee on hamstring
Distract- int/ext rot
Comp- int/ext rot
+ve Apley
Distract- relief
Comp- P, locking
Apley spec and sens
86-100
13-16
What does McMurray test for
Meniscal lesion
Tibial int rot- lat meniscus
Tibial ext rot- med meniscus
McMurray technique
Leg to 90
Dorsiflex foot, compress
Apply pressure into int/ext rot
+ve McMurray
P, locking, clicking, grinding
Potential cause of McMurray symptoms
Loose body of meniscus may cause snap/c
Signs of meniscal lesion
Knee Jt line P, crepitus with movement, locking of knee
McMurrays spec and sens
69-98
16-67
What does Age’s test
Meniscal lesion
Tibial int rot- lat meniscus
Tibial ext rot- med meniscus
Age’s technqiue
Test med meniscus – Lat rot each tibia maximally and squat, increasing distance between knees and lat rot
Lat meniscus – Both tibias med rot maximally, difficult even for a healthy Pt
+ve Ege’s
Pain or crepitus
Early flexion –anterior tears
Deep flexion – posterior horn tears
Eges spec and sens
81-90
64-67
What does Thessalys test
Meniscal lesion
Thessaly technique
Use pracs hands for balance
Stand on one leg, slightly flex
Roate round- x3, bring Pt back to mid point
+ve Thessaly
P, buckling, catching, clicking
Med/lat joint line discomfort
What does anterior drawer test
ACL sprain/rupture
Ant drawer technique
Same as acc movement, pull tibia anteriorly
+ve Ant drawer
P- ACL sprain
Excessive movement- ACL rupture
Degrees of knee instability
1- mild, <5mm of translation
2- moderate, 5-10mm
3- severe, >10mm
Ant drawer spec and sens
86-100
18-95
What does post drawer test
PCR sprain/rupture
Post drawer test
Same as acc, push posteriorly
What does Lachman test for
Considered gold standard
ACL, PCL
Lachman technqiue
Supine
Flex leg to 15-30 deg
Ant- stabilise femur, pull tibia ant
Post- stabilise femur, push tibia
+ve Lachman
P- sprain
Excessive movement- rupture
Mushy/soft end feel, disappearance of infrapatellar slope
Potential cause of false -ve Lachman
False -ve may occur if femur is not properly stabilised or if meniscus lesion blocks translation or if tibia is medially rot
Bounce home test
Pt supine and relaxed
Lift leg and bend knee to approx 20, by placing hand behind popliteal fossa
Remove support allowing it to drop into full extension
Bounce home interpretation
Jt line P- meniscal tear
Inability to full extend:
1. spongy end feel- swelling/edema
2. rubbery end feel/P- meniscal tear
3. hard- intra-articular fragment, osteochondritis dissecans
Bounce home clinical notes
Examiner should not fully remove hand from popliteal fossa, instead examiner should be there to support knee incase of P
Hughstons plica test
Pt supine leg straight
Flex and medially rotates leg while applying medial to lateral force on patella with heel of hand
Palpate medial condyle
Apply force to patella while flexing and extending the knee and observing patella popping or shutter
Plica test interpretation
Popping or shuttering- plica inflam
Medial patella plica test
Pt supine
Examiner passively flexes knee to 30 while applying lateral to medial force on patella with other hand
Attempting to move patella medially
Medial patella plica test interpretation
Medial knee P- plica inflammation osteochondritis dissecans
Medial patella plica test clinic notes
By flexing knee and moving the patella medially an inflamed plica may cause tension between the patella and medial femoral condyle, which may cause P or discomfort
Noble compression test
Pt supine or sidelying
Examiner applies lateral to medial pressure over the Pts lateral condyle with thumb and slowly flexes + extends leg (3-4 times)
Noble compression test interpretation
P over lateral femoral condyle or palpable tendon snapping- ITB syndrome
Noble compression clinical notes
Etiological factors of ITB
- pelvic tilt, running or cycling
- inc activity suddenly
- leg length discrepency
Posterior sag sign
Pt supine with knee flexed to 90
Hips flexed to 45
Examiner compares prominence of tibial tuberosities bilaterally
Post sag sing interpretation
Tibia ‘sags back’ or ‘drops back’ on femur= PCL tear
Post sag spec and sens
100
83-100
Varus/valgus stress test
Valgus- medial force at knee
Varus- lateral
Slightly flexed
Varus/valgus interpretation
P- M/LCL sprain
Inc motion/gapping- M/LCL rupture
Valgus clinical notes
Term valgus refers to distal bone moving laterally
MCL injury classification
Grade
1- 0-5mm of Jt p=opening, no instability
2- 5-10mm, mild instability
3- 10-15mm, moderate instability
4- >15mm, severe instability
