Knee

Question 1

Ballotment Test

Answer 1

For: effusion in knee joint
How: supine, push palm downward on patella
+ = end feel soft and boggy
- = end feel hard

Question 2

Fluctuation Test

Answer 2

Tests: Edema/effusion in knee joint
How: supine. fingers medial and lateral, web on superior patella, apply pressure
+ = fingers spreading apart, patella moving inferiorly

Question 3

Tibiofemoral Posterior Glide

Answer 3

For: increase knee flexion
How: Supine, resting position ( flexion), stabilize femur from the posterior side, hand on proximal tibia, push posteriorly

Question 4

Tibiofemoral Anterior Glide (3)

Answer 4

For: increasing knee extension
How:
1. Supine, resting position, sit on foot, both hand grip proximal tibia from posterior side, pull anteriorly
2. Supine, resting position, stabilize hand posterior proximal tibia, apply posterior pressure on distal femur ( femur moving posteriorly to tibia is same as tibia moving anteriorly on femur)
3. Prone, resting position, stabilize distal femur from anterior side, apply pressure on proximal tibia on posterior side.

Question 5

Tibiofemoral Medial Glide

Answer 5

For: examine
How: Supine, resting position, sit between legs, stabilize distal femur on medial side, entire arm on fib/tib and hand at proximal tibia laterally apply pressure medially

Question 6

Tibiofemoral Lateral Glide

Answer 6

For: examine
How: Supine, resting position, sit next to pt, stabilize distal femur laterally, grip tibia with hand and forearm and move laterally.

Question 7

Tibiofemoral Medial Gap

Answer 7

For: examine, dec pain
How: Supine, resting position, stand next to pt, stabilize distal lower leg (ankle) with lower leg against body, push medially on lateral side of knee at jt line.

Question 8

Tibiofemoral Lateral Gap

Answer 8

For: examine, dec pain, incr ROM
How: Supine, resting position, sit between legs, stabilize distal lower leg (ankle) laterally, push laterally at medial joint line

Question 9

Apley’s Distraction Test

Answer 9

Tests: ligamentous laxity (problem)
How: prone, stabilize femur with knee flexed then distract and rotate
+ = pain

Question 10

Valgus Stress Test

Answer 10

Tests: Ligamentous strain of MCL
How: Supine, knee at 30 degrees of flexion push into valgus (medial gap). repeat at full extensions
+ = pain or increased excursion
grade 1 = pain no increased excursion
grade 2 = pain, increased excursion
grade 3 = very little pain, a lot of increased excusion

Question 11

Varus Stress Test

Answer 11

Tests: Ligamentous strain, LCL
How: Supine, knee at 30 flexion, push knee into varus (push laterally from medial side - Lateral gap) repeat with extended knee
+ = pain or increased excursion
grade 1 = pain, no increase excursion
grade 2 = pain and increased excursion
grade 3 = very little pain, a lot of increased excursion

Question 12

Anterior Draw Test

Answer 12

Tests: Ligamentous, ACL
How: supine, knees flexed to 90. pull tibia anteriorly with palpating jt space
+ = pain or increased excursion
grade 1,2,3

Question 13

Lachman’s Test

Answer 13

Tests: ACL - superior to anterior draw
How: Supine, knee 20-30 flexion pull tibia anteriorly with palpating tbiofemroal jt space creating counter pressure on femoral condyles
+ = pain or increased excursion
grade 1,2,3

Question 14

Slocum’s Test:

Answer 14

Tests: ligaments, ACL
How: Supine, knee flexed to 90, IR lower leg, pull proximal tib anteriorly. Medial plateau should move more
+ = pain or increased excursion
grade 1,2,3

Question 15

Lateral Pivot Shift Test

Answer 15

Tests: ligament sprain, ACL - ALRI
How: supine, knee extended, IR lower leg and push knee into valgus, then flex knee maintaining IR and medial pressure
+ = lower leg will ER against me

Question 16

Posterior Draw Test

Answer 16

Tests: ligament sprain, PCL
How: Supine, knee flex to 90. Stabilize lower leg, push posterior on distal femur
+ = pain or increased excursion
grade 1,2,3

Question 17

Posterior Sag Sign

Answer 17

Tests: Ligament sprain, PCL
How: Supine, bilateral 90/90, looking at anterior superior aspect of tibia on femur, comparing
+ = tibia on affect side is posterior in comparison to unaffected tibia
DO THIS BEFORE ANTERIOR DRAW OR LACHMANS - could give false +

Question 18

Anterior Reduction Test

Answer 18

Tests: Ligamentous laxity, PCL
How: supine, few degrees of flexion, tell pt to lift heel off table, look at anterior contour changes of tibiofemoral jt
+ = anterior aspect of tibiofemoral jt changes the affected doesn’t look like unaffected - presence of posterior sagging is eliminated
DO BEFORE ANTERIOR DRAW OR LACHMAN’S TESTS, PCL laxity can cause false +

Question 19

McMurray’s Test

Answer 19

Tests: Medial Meniscus tear
How: Supine, flex hip and knee to end range, IR lower leg. then extend to 90 degrees maintaining IR. repeat with ER of lower leg.
+ = palpable thud or click

Question 20

Apley Compression Test

Answer 20

Tests: Meniscal tear (both medial and lateral)
How: prone, knee flexed to 90, compress downward and rotate leg
+ = pain in knee
pain with IR/medial rotation = lateral meniscus tear
pain with ER/lateral rotation = medial meniscus tear

Question 21

Thessaly Test

Answer 21

Tests: Meniscal tear
How: SLS on affected. rotate knee and body IR and ER three times at 5 degrees of flexion, the 20 degrees.
+ = pt reports locking or catching

Question 22

Noble Compression Test

Answer 22

Tests: ITB irritation
How: supine, 90/90. apply pressure to lateral femoral condyle and tell pt to ext knee
+ = lateral lower thigh pain at 30 degrees of flexion

Question 23

Hughston’s Plica Test

Answer 23

Tests: Plica
How: seated, knee flexed to 90, IR tibia. Push patella medially. extend and flex knee
+ = popping

Question 24

Patellar Tendonopathy

Answer 24

(jumper’s knee)
anterior knee pain, increases with jumping and full extension
pain increases with isom knee ext and PROM knee flexion
-q angle, patella alta, leg length discrepancy, tight rectus femoris, tight hamstrings
TREATMENT - strengthen quads eccentrically

Question 25

ITB syndrome

Answer 25

-tibial vara, genu varum, subtalar carus, subtalar valgus, pronation, leg length discrepancy, excessively prominent lateral femoral condyle, tight ITB
TREATMENT - STM, strength, strengthen

Question 26

OA in knee

Answer 26

morning pain and stiffness (goes away within an hour - unlike RA)
exercise and weight reduction
acupunture, TENS, LASER