Knee Flashcards
Perform knee flexion APR
Test A/P Knee flexion ROM
Resisted extension
Perform knee extension APR
Test A/P knee extension ROM
Resisted flexion
Circumferential measurements of the knee
Tests effusion
Objective measure for maximally effused knee
Ballotment test
Patient is supine or long seated position with knees extended
Milk fluid from suprapatellar pouch by stroking superiorly to inferiorly above patella 2-3x
Gently compress pouch by pressing at against femur
Hold that position while tapping the patella against trochlea of femur with index finger of other hand
(+) Sensation that patella is floating
Very little diagnostic value
Test requires more swelling to be present
Knee Passive physiological Motion - Tibial IR/ER
Pt supine, knee flexed to approx 90 deg
Passively internally rotate tibia
Repeat for external rotation
Knee PPM flex/add
flex +heel toward midline/groin
Knee PPM flex/abd
flex + heel toward greater troch
Knee PPM ext/add
ext + heel toward midline
Knee PPM ext/abd
ext + heel toward greater troch
Special Tests for Posterolateral Corner
Reverse Pivot shift - Pt supine, knee flexed 70-80 deg and ER of tibia applied
Knee is passively straightened as examiner applies slight valgus stress at knee
At ~20deg flexion lateral tibial plateau shifts anterior: Positive test
Posterior Drawer with ER - ER tibia and apply posterior force
If normal at 90 but excess at 30 suspect PLC injury
Positive if tibia rotates excessively compared to other side
If rotates and subluxes posteriorly or excess motion at 30 and 90 suspect PCL injury
ER Recurvatum Test - Pt supine in a relaxed position
Pick up pt’s leg by great toe
Watch for hyperextension and tibial ER compared to other side
Prone ER - Pt prone, clinician grasps distal leg, flexes knee and ER tibia
+ if ER exceeds 10 deg of other leg
+ at 30 but not at 90= isolated PLC injury
+ at both = concomitant PCL
Patellafemoral Joint Mobility tests - glide direction/motion
Superior/Inferior
Pt supine, knee in open packed position
Take up slack
Place apex of patella in interthenar eminence
Align forearm with shaft of femur
Apply inferior glide of patella - For FLEXION
Repeat for superior glide - EXTENSION
Medial/Lateral
Pt supine, knee in open packed position
Stand on lateral side of knee
Grasp patella and move in a lateral direction
Repeat for medial glide - FLEXION
Caution with lateral glide (if hypermobile) - for EXTENSION
Tilt Pt supine, knee in open packed position Stand on lateral side of knee Hands wrapped around patella Thumbs used to tilt patella medially and laterally Compare to contralateral side
Tibiofemoral joint distraction
Supine, open packed position, 20 deg flexion
Stabilize distal femur
Distraction force with lumbrical grip along proximal tibia/fibula
Tibiofemoral medial glide of Tibia
*for IR
Pt supine, knee flexed 10-20 deg on bolster
Medial (Tibial IR)
Grasp medial aspect of distal femur and lateral aspect of proximal tibia
Stabilize femur while applying medially directed movement of tibia on femur
Tibiofemoral Lateral glide of tibia
*for ER
Pt supine, knee flexed 10-20 deg on bolster
Lateral (Tibial ER)
Grasp lateral aspect of distal femur and medial aspect of proximal tibia
Stabilize femur while applying laterally directed movement of tibia on femur
PA glide Tibia (tibiofemoral PAM)
*Extension
Pt supine, knee flexed to 60-80 deg of flexion
Grasp around proximal tibia with thumbs on tibial tubercle while sitting on foot to stabilize
Move tibia in anterior direction on femur
AP glide Tibia (tibiofemoral PAM)
*flexion
Pt supine, knee in open packed position on a bolster
Place both thumbs on tibial tubercle and wrap hands around proximal tibia
Direct force posteriorly moving tibia on femur
Prox. Tibiofibular Joint Mobility - AP Glide
Pt sidelying with involved side up, knees bent and pillow between knees
Stand behind pt and place thumbs on posterior aspect of head of the fibula
Produce posterior to anterior movement of fibula on tibia
Move to in front of pt, repeat by placing thumbs on anterior aspect of head of fibula and produce anterior to posterior movement
ACL Special Tests
PIVOT SHIFT- *Rules IN
Pt supine with knee extended
One hand holds ankle, other hand applies medial rotation force at tibia
Slowly flex knee maintaining rotation
As reach about 20 deg flexion the tibial plateau will relocate
Positive test is a thud or clunk of lateral tibia posteriorly
LACHMAN’S - *Rules OUT
Pt supine with knee flexed to 15 deg
Stabilize at distal femur with one hand, grasp behind proximal tibia with other hand
Apply anterior tibial force to prox tibia
Positive if greater anterior displacement of tibia compared to other side or empty end feel
Test uninvolved side 1st
End Feel is KEY
“Clunk” is negative
Soft/mushy is positive
Beware False (+) if PCL injury
ANTERIOR DRAWER - *Rules IN
Pt supine, knee flexed to approx 90 deg with foot flat
PT sits on pt’s foot, grasp behind prox tibia with thumbs palpating at tibial tuberosities
Apply anterior tibial force
Positive if greater anterior translation compared to other side or empty end feel
Beware of False (+) due to PCL injury
PCL Special Tests
QUADRICEPS ACTIVE TEST - *Rules IN
Pt supine with knee flexed to 90
Position of posterior sag of tibia
Pt’s thigh should be relaxed, PT stabilizing foot
Have pt “straighten our your leg” to initiate quadriceps
Will see anterior displacement of tibia
Reduction of posteriorly subluxed tibia
POSTERIOR DRAWER - *Rules IN
Pt supine, knee flexed to approx 90deg with foot flat
PT sits on pt’s foot, grasp behind prox tibia with thumbs palpating at tibial tuberosities
Apply posterior tibial force
Positive if greater posterior translation compared to other side
POSTERIOR SAG SIGN - *Rules IN
Pt supine with knee flexed to 90deg and hip flexed to 90deg
Make sure pt is relaxed in the position
Positive if tibia is positioned posterior
MCL Special Test
Valgus (lateral-> medial force)
LCL Special Test
Varus (medial->lateral force)
Meniscus Special Test
McMURRAY'S TEST- *Rules IN Pt supine, knee flexed passively to end range Rotate tibia into ER and slowly extend knee For medial meniscus Rotate tibia into IR and slowly extend knee For lateral meniscus Positive if pain, clicking or popping provoked
DYNAMIC TEST - *Rules OUT
For lateral meniscus
Pt supine, hip abducted to 60 deg, flexed and ER 45deg, lateral border of foot resting on examination table
Examiner palpates lateral joint line
Slowly adducts hip while maintaining knee flexion
Positive Test
Increase in pain greater than elicited by palpation or sharp pain at end of adduction
THESSALY’S - *Rules IN and OUT
Pt standing in single limb stance with knee flexed approximately 5 and 20 deg
Twist each direction
Positive if provocative for pain, locking or catching
EGE’S TEST - *Rules IN
Have pt stand, full ER and squat-For medial meniscus
Repeat in full IR-For lateral meniscus
Positive if provocative for pain, locking or catching
Patellar Dislocation Tests
PATELLAR APPREHENSION (Fairbanks) -
Patient positioned supine, knee flexed to 30 deg over the side of the table, foot resting on the examiner
Press both thumbs on the medial aspect of the patella to exert a lateral force
+ test: Patient shows signs of apprehension or pain is reproduced.
MOVING PATELLAR APPREHENSION -
- Lateral glide of patella in extension
- Move to 90 deg of flex (maintain glide - leg off edge of table)
- Repeat with Medial glide
PFPS/PF Joint Pathology cluster/signs/symptoms
- Pain during functional activity
- Resisted knee extension
- Eccentric step test
- Patellar compression
- Clarke’s Sign/Patellar Grind
Patellafemoral Joint Special Tests
RESISTED KNEE EXTENSION - Specific- *Rules IN
Patient is seated with feet off ground and knee flexed
Examiner resists knee ext (at which degree should knee be in for resistance???)
Positive test is indicated by reproduction of pain
PATELLAR COMPRESSION - evidence does not support efficacy of test to R/I or R/O just part of cluster
Patient positioned supine or long seated with knee extended
Examiner pushes patella directly in to the trochlea
Positive test indicated by reproduction of pain
Can vary amount of flexion if needed
CLARKE’S SIGN/PATELLAR GRIND - low quality studies - more research needed to say R/I or R/O
Patient is positioned supine with knees supported
Examiner places one hand on superior border of patella and presses it distally/inferiorly
Patient asked to contract quads
Positive finding is reproduction of pain/symptoms
Many false (+)
Pain in up to 85% of patients
Not testing what want to test
ITB Special Test
NOBLE’S COMPRESSION -
Flex knee and compress ITB at a point 1-2 cm proximal to the lateral femoral condyle
Actively or passively extend the knee while maintaining pressure on the ITB
(+) = significant, localized pain at the point of compression when the knee is extended to 30 deg of flexion
Indicative of ITB Friction Syndrome
However, no studies have validated this test
TibFem Joint Distraction
Open Packed Position
Bolster under pt’s knee
PT’s hands on tibia - distract,
OR
Hands distally (PT’s nose toward pt’s nose) - using forearms as leverage to distract
*good catch all/OA
Treatment of flexion on tibia
AP glide
In OPP
At 90
Or at end range
Unicondylar glide (Conjunct rotation) at end range *Medial for flexion
Medial tibia glide (stabilize med fem - push lateral tibia medially)
Flexion - what distraction/what glide?
TF Distraction with AP glide - use belt around ankle, with “gas pedal” - push down to distract TF - perform AP glide
Patellar Meidal glide Treatment
*For improving flexion
Supine or Sidelying (with knee over table)
Medial patellar tilt
*for flexion
Sidelying knee off table
Inferior patellar glide treatment
*For flexion
Bolster under knee
take up slack
inferior glide
