KNEE Flashcards
CLARKS
Pt supine
Push patella inferiorly
Pin in position
Ask pt to contract quads slowly
CLARKS - WHAT DOES IT TEST?
Chondromalacia patella
Degenerative patella femoral joint
CLARKS - POSITIVE TEST
Retropatella pain (Pain on posterior surface of patella)
BALLOTTMENTS/SWEEP
Pt supine
Pillow under knee
Milk knee/quads
Keeping pressure on femur, tap patella
BALLOTTMENTS - WHAT DOES IT TEST?
Internal derangement
Ligament sprain/strain or rupture
Vascular damage
BALLOTTMENTS - POSITIVE TEST
Increases bulge over patella
Rapid bounce back
Spongy feel
‘Floating” patella
APLEY’S COMPRESSION
Pt prone
Leg to 90
Dorsiflex foot and compress
Apply pressure into internal rotation (lateral meniscus)
Repeat while applying external rotation (medial meniscus)
APLEY’S COMPRESSION - WHAT DOES IT TEST?
Meniscal damage
External rotation = medial meniscus
Internal rotation = lateral meniscus
APLEY’S COMPRESSION - POSITIVE TEST
Pain on compression and external rotation = medial meniscus tear
Pain on compression and internal rotation = lateral meniscus tear
Locking of knee
APLEY’S DISTRACTION
Pt prone
Leg up to 90
Examiner place their knee on pt hamstring
Distract by holding around pt ankle and lifting leg
Internally and externally rotate foot
APLEY’S DISTRACTION - WHAT DOES IT TEST?
Capsule/ligament lesion
Colateral lateral ligament sprain
APLEY’S DISTRACTION - POSITIVE TEST
Pain on distraction (ligament lesion/colateral lateral ligament sprain)
Decrease pain (suggests meniscal lesion)
MCMURRAY
Pt supine
Knee fully flexed
One hand holding underneath pt foot
Other hand palpating knee joint line
Slowly extend the knee applying an internal rotation and varus force
Repeat again applying an external rotation and valgus force
MCMURRAY - WHAT DOES IT TEST?
Meniscal lesion
Tibial internal rotation - Lateral meniscus
Tibial external rotation - Medial meniscus
MCMURRAY - POSITIVE TEST
Pain
Crepitus
Locking
Clicking
Grinding
EGE’S (MEDIAL MENISCUS)
Pt standing
Laterally rotate each tibia maximally (feet turned out)
Pt squat
EGE’S (LATERAL MENISCUS)
Pt standing
Medially rotate each tibia maximally (feet turned in)
Pt squat
Difficult even for healthy pt
EGE’S - WHAT DOES IT TEST?
Meniscal lesion
Tibial internal rotation - Lateral meniscus
Tibial external rotation - Medial meniscus
EGE’S - POSITIVE TEST
Pain
Crepitus
Early flexion pain - anterior tears
Deep flexion pain - posterior horn tears
THESSALY’S
Pt standing
Use examiners hands for balance
Pt stand on one leg with knee flexed 5
Examiner walks round so pt trunk is following the examiner
Repeat with pt knee flexed 20
THESSALY’S - WHAT DOES IT TEST?
Meniscal lesion
THESSALY’S - POSITIVE TEST
Pain
Buckling of knee
Catching
Clicking
Medial/lateral joint line discomfort
ANTERIOR DRAW
Pt supine
Pt knee flexed
Examiner holds around top of tibia and fibula
Examiner pulls leg towards them
(same as accessory movement)
ANTERIOR DRAW - WHAT DOES IT TEST?
Anterior cruciate ligament sprain/rupture
ANTERIOR DRAW - POSITIVE TEST
Pain
Excessive movement (rupture)
POSTERIOR DRAW
Pt supine
Pt knee flexed
Examiner holds around top of tibia and fibula
Examiner pushes leg away from them
(same as accessory movement)
POSTERIOR DRAW - WHAT DOES IT TEST?
Posterior cruciate ligament sprain/rupture
POSTERIOR DRAW - POSITIVE TEST
Pain
Excessive movement (rupture)
LACHMAN
Pt supine
Examiner place knee under pt leg to flex leg 15-30
Anterior - Stabilise femur, pull tibia anteriorly
Posterior - Stabilise femur, push tibia posteriorly
LACHMAN - WHAT DOES IT TEST?
Anterior - ACL injury
Posterior - PCL injury
Considered gold standard
LACHMAN - POSITIVE TEST
Pain
Excessive movement (rupture)
Mushy/soft end feel
Disappearance of infra patella slope
PATELLA DECOMPRESSION
Pt supine
Leg straight
Pick up patella and move it
NOBLE COMPRESSION TEST
Pt supine
Flex knee to 90
Apply pressure with thumb to lateral femoral condyle
With thumb pressure maintained extend knee passively
NOBLE COMPRESSION TEST - POSITIVE TEST
Pain over lateral femoral condyle
NOBLE COMPRESSION TEST - WHAT DOES IT TEST?
ITB syndrome
STUTTER TEST
Pt seated on the edge of the couch
Both knees bent to 90
Place one finger over the patella
Pt extends knee slowly
STUTTER TEST - POSITIVE TEST
Patella stutters or jumps between 60-45 degrees of flexion
STUTTER TEST - WHAT DOES IT TEST?
Plica syndrome