Knee

Question 1

Slocum Drawer Test (IR)

Answer 1

Patient pos - Patient is supine with knee flexed to 90 and the hip flexed to 45 degrees. examiner will internally rotate the tibia 30 degrees.

Stabilization - the patient will be stabilized by the table. The clinician will stabilize the distal leg by sitting on the foot.

Force - Examiner uses both hands to grasp the lower leg while the thumbs palpate the anterior joint line. The clinician will then draw the tibia anteriorly.

Implication - Positve test is indicated by movement of the tibia primarily on the lateral side, may be indicitive of anterlateral rotary instability. The structure most affected by this is the ACL (also LCL, PC, posterior capsule, IT band, popliteus complex)

Question 2

Varus Stress Test

Answer 2

Patient pos - Patient lies supine on the table.

Stabilization - ATC’s fingers are placed over the joint line wile the distal femur is stabilized. A varus stress is then applied to the knee while one is holding the foot and ankle. With your fingers on the joint line assess the amount of gaping to the lateral compartment.

Force - The clinician applies a varus stress to the knee while the ankle is stabilized. the test is first done at full extension then at 30 degrees of knee flexion.

Positive Finding - positive test implies instability in the LCL ligament.

Question 3

Noble’s Compression Test

Answer 3

Patient pos - The patient lies supine on the table

Fixation - The clinician flexes the patient’s knee to 90 degrees, accompanied by hip flexion.

Test - The knee is passively extended while the clinician palpates the lateral aspect of the knee where the IT band inserts.

Positive Findings - At approximately 30 degrees of flexion the patient experiences severe pain ocer the lateral femoral condyle. Patient might experience snapping over the knee. indicative of snapping knee syndrome or IT band syndrome.

Question 4

Quadriceps Femoris MMT

Answer 4

Patient pos - Sitting, with the knees over the side of the table and holding on to the table

Fixation - The examiner may hold the thigh firmly down on the table and resisit knee extension with the other hand.

Test - Full extension of the knee joint without rotation of the thigh.

Question 4

Thessaly’s Test

Answer 4

Patient pos - Patient stands flat footed on one leg.

Stabilization - Examiner provides support with his or her hands

Force - The patient rotates his or her knee and body, internally and externally, three times, keeping the knee in slight flexion (5degrees). then lowers to 20 degrees flexion and repeats the proccess.

Positive findings - Patients with suspected meniscal tear experience medial or laterl joint line pain and discomfort. Any clicking catching or cepitus is also considered a positive finding.

Question 5

Lachman’s Test

Answer 5

Patient Pos - Patient lies supine with involved leg beside the examiner. Involved leg is passively flexed between 0 - 30 degrees of flexion. for better results the tibia may be slightly rotated laterally.

Stabilization - The patient’s femur is stabilized with the examiner’s hand just superior to the joint capsule around the lateral aspect of the thigh. The exaaminer’s opposite hand is placed around the proximal end of the tibia around the medial aspect of the leg.

Force - The examiner uses an anterior force to the tibia while using pressure to stabilize the femur.

Positive Findings - A “mushy or soft “ end feel during the anterior force, excessive anterior translation of the tibia on the femur when compared bilaterally . Indicative of a ACL injury.

Question 6

Stroke/Brush/Bulge Test

Answer 6

Patient pos - Patient is placed in long sitting

Force - The examiner commences just below the joint line on the medial side just below the patella, stroking proximally toward the patients hip as far as the suprapatellar pouch two or three times with the fingers. With the opposite hand, the examiner strokes down the lateral side of the patella.

Positive findings - Measuring the wave of fluid. the knee contains 1 - 7 ml of synovial fluid. this test shows as little as 4 to 8 ml of extra fluid within the knee.

Question 6

Patella Apprehension Test

Answer 6

Patient Pos - Patient is placed in supine position.

Force - One hand stabilizes the leg while the other applies a lateral translation force on the patella with the examiners thumbs.

Positive Findings - a positive test consists of orally expressed apprehension or a apprehension of the quad restricting the later translation.

Question 7

Posterior Drawer Test

Answer 7

Patient pos - Patient is supine with knee flexed at 90 degrees and the foot neutral.

Force - The clinician exerts force in a posterior direction at the proximal tibial platform.

Positive finding - Posterior translation of the tibia on femur is indicative of PCL damage. (be careful of doing this test before ACL due to false positives)

Question 9

Biceps Femoris MMT

Answer 9

Patient Pos - Prone laying, knee flexed 50-70 degrees, leg and thigh laterally rotated.

Fixation - Stabilization is provided by holding the thigh of the tested leg around the belly of the muscle so the leg does not come up off the table.

Pressure - Proximal to the ankle, apply force in the direction of extension.

Question 9

Wilson Test

Answer 9

Patient Pos - Patient sits at the end of the table with your legs dangling over the edge.

Force - bend the patient’s knee so that it is flexed at a 90 degree.

Test - Grasp the patient’s foot and bring the tibia into internal rotation. have the patient extend their leg.

Positive Findings - If the patient reports pain in the knee about 30 degrees from full extension this is a positive sign. This test is indicitive of osteochondritis dissecans.

Question 11

Valgus Stress Test

Answer 11

Patient Pos - Patient lies supine on the table

Stabilization - ATC’s fingers are placed on the joint line while the proximal femur is stabilized. A valgus stress is applied to the knee while one is holding the foot and ankle. One’s fingers can then assess the amount of gapping on the medial side.

Positive Findings - Positive test implies instability to the MCL

Question 12

Semitendonosis / semimembranosis MMT

Answer 12

Patient pos - Prone laying. knee flexed 50-70 degrees, leg and thigh medially rotated.

Stabilization - Stabilization is provided by holding the thigh of tested leg around the belly of the muscle so the leg doesnt come off the table.

Pressure - Proximal to the ankle, apply force in the direction of knee extension. do not apply force to the rotation element.

Question 13

McMurrays Test

Answer 13

Patient pos - Patient lies supine and passively flexes the involved knee and hip.

Stabilization - Stabilization is provided by the examiner’s hands, one on the knee and the other on the ankle.

Force - The examiner holds the tibia and medially rotates it while extending the knee and applying a varus stress. This can also be done with external rotation and and varus stress to accompany the extension. Note where in the movement pain occurs to signify injury.

Positive Findings - A snap or click in conjunction with pain

Question 14

Ege’s Test

Answer 14

Patient Pos - Patient is standing with feet 30 - 40 cm apart. Clinician tells patient to maximally medially rotate feet or laterally rotate depending on suspected injury (leteral meniscus or medial)

Force - The patient is then ordered to to squat and stand slowely. producing valgus forces with internal and Varus forces with external rotation.

Positive Findings - The test is positive with pain, clicking, or snapping in the knee.

Question 15

Solcum Drawer (ER)

Answer 15

Patient Pos - Patient is supine with the knee flexed to 90 and the hip flexed to 45 degrees. the examiner will take the lower leg into 15 degrees of external rotation.

Stabilization - The patient is stabilized by the table while the clinician will stabilize the affected leg by sitting on the foot.

Force - Examiner uses both hands to grasp the lower leg with the thumbs palpating the anterior joint line. The clinician then tries to translate the tibia anteriorly.

Implications - Positive test is indicated by movement of the tibia in the anterior direction primarily on the medial side, May be indicative of anteromedial rotary instability. The structure of most concern with a positive test would be the MCL. other sturctures involved could be (ACL, posterior oblique ligament, posterior capsule)

Question 16

Reverse Lachman’s

Answer 16

Patient pos - Patient is prone with the knees flexed to 30 degrees.

Stabilization - Examiner grasps the tibia with one hand while fixing the femur with the other. Ensure that the hamstrings are relaxed.

Force - The Examiner pulls the tibia superiorly while noting the amount of posterior translation of the tibia on the femur.

Caution - be aware of a false positive after a acl tear due to the forward translation of the tibia on the femur to begin with.

Question 17

Q angle

Answer 17

Patient pos - The patient is supine with the knees extended.

Stabilization/test - Goniometric measurement stationary arm folowing the tibial tuberocity or line of the tibia. Axis is locateds on the center of the patella. The moving arm will be aligned with the ASIS.

Positive Findings - Normal Q angle for men is around 13 degrees and 18 degrees for females.

Question 18

Plica Stutter Test

Answer 18

Patient pos - The patient is seated on the edge of the examining table with both knees flexed to 90 degrees.

Fixation - The examiner places a finger over one patella to palpate during movement.

Test - Patient will slowly extend the knee

Positive findings - If the Patella stutters or jumps somewhere between 60-45 degrees of the flexion.

Question 19

Sag Test (Godfrey’s Test)

Answer 19

Patient pos - Patient is supine on table with both knees and hips flexed to 90 degrees.

Stabilization - ATC holds patients ankles together distally over the malleoli, to keep the knee joints at 90 degrees.

Observation - Looking laterally on the injured side, the tibia will appear to sag posteriorly when compared to the opposite.

Positive Findings - If the tibia seems to sag this indicates injury to the PCL

Question 20

Anterior Drawer Test

Answer 20

Patient Pos - Patient is supine with the knee flexed to 90 degrees and the hip flexed to 45degrees.

Stabilization - Patient is stabilized by the table. the clinician will stabilize the affected leg by sitting on the foot.

Force - The clinician will use both hands to grasp behind the lower leg and thumbs to palpate the anterior joint line. The clinician will then pull the tibia forward and translate the tibial platform anteriorly.

Positive Findings - The tibial platform will translate forward indicating damage to the ACL

Question 21

Ballotable Patella Test

Answer 21

Patient pos - Patient is placed in supine.

Force - The examiner applies a slight tap or pressure to the patella.

Positive Findings - While tapping the patella a positive sign will feel like the patella is floating in fluid.

Question 23

Aply’s Compression/Distraction Test

Answer 23

Patient pos - Patient is prone with the affected knee flexed to 90 degrees.

Stabilization - Stabilization is provided by the table.

Force - The examiner loads the shaft of the tibia through the heel with a compression force while externally and latrerally rotating the tibia on the femur. The test is then repeated with a distraction force away from the femur.

Positive Findings - Any restrictions, excessive movement, snapping, snapping, clicking, or pain. Compression force pain consistant with meniscle tear. distraction force positive finding is laxity and joint gapping indicitive of ligamentous pathology.

Question 24

Pivot Shift Test

Answer 24

Patient pos - The patient is supine with the hip passively flexed to 30 degrees and abducted to 30 degrees.

Stabilization - The examiner stabilizes the distal leg near the ankle and internally rotates the tibia 20 degrees.

Force - The examiner applies a valgus force to the knee while slowly bringing the knee into extension.

Positive findings - A clunk or clicking occurs as the knee is flexed and anteriorly subluxes during extension. The patient may also gaurd and resist the subluxation giving a positive aprehension sign.

Interpretation - A positive finding may indicate injury to the ACL, the posterlateral capsule, LCL, or IT band

Question 25

Bounce Home Test

Answer 25

Patient pos - patient lies supine with legs extended

Stabilization - Stabilization is provided by the examiner holding the distal leg around the foot and calf.

Force - Examiner passively flexes the knee and then extends. Before reaching full extension the clinician will suddenly let go of the calf and let the knee fall into extension.

Positive Findings - If extension is not complete or has a rubbery stop end feel the test is considered posirtive. Also, if the patient feels sharp joint line pain or gaurds the knee from reaching extension this is considered a positve sign,

Question 26

Popliteus MMT

Answer 26

Patient pos - Sitting, with the knee flexed at a right angle and with the led in lateral rotation of the tibia on the femur.

Test - Medial rotation of the tibia on the femur

Question 27

Clarke’s Sign

Answer 27

Patient pos - Patient is placed supine on the table with the knee extended and relaxed.

Force - The examiner presses down slightly proximal to the upper pole or base of the patella with the web of the hand. The patient is then asked to contract the quad while the examiner pushes down.

Positive Findings - If the patient can complete and maintain the contraction without pain, the test is considered negative. If the test causes retropatellar pain and the patient cannot hold a contraction, the test is considered positive.