Knee

Question 1

Apley’s compression test

Answer 1

Knee
(Push sole x 3)
Pte lays face down, flex knee (90o). Examiner then grabs the sole with 2 hands, pushes down. Medial rotate -> push, laterally rotate -> push.
+ Pain in knee
! Pain in lateral rotation (lateral meniscal tear), pain in medial rotation (medial meniscal tear)

Question 2

Apley’s distraction test

Answer 2

Knee
(Pull sole x 3)
Same as Apley’s compression test but lift sole up instead of push down (examiner raise knee and place it on pte’s thigh to stabilize)
+ Pain in knee
! Pain in lateral rotation (LCL tear). Pain in medial rotation (MCL tear)

Question 3

Valgus Stress test of knee

Answer 3

Knee
(pushes knee medially) Pte lays face up. Examiner stand at end and hold ankle with one hand, then uses the other hand to push gently medially from lateral side. Repeat @ knee flexes slightly at 20-30o.
+ Excessive medial deviation of knee
! Medial instability of MCL

Question 4

Varus Stress test of knee

Answer 4

Knee
(pushes knee laterally) 
Same as Valgus but pushes knee laterally from medial side
\+ Excessive lateral deviation of knee
! Lateral instability of MCL

Question 5

Anterior drawer test

Answer 5

Knee
(Pull knee anteriorly)
Pte lays face up, with knee flexes at 90% (sole rest flat). Examiner sits on pte’s foot, and uses both hands to grab knee (with thumb on epicondyle of tibia), then lean back and pull tibia (anterior)
+ Tibia move anterior > 6mm
! ACL (anterior cruciate ligament) laxity

Question 6

Posterior drawer test

Answer 6

Knee
(Push knee posteriorly)
Same as ‘Anterior drawer test’ but examiner push tibia instead of pull
+ Tibia move posterior > 6mm
! PCL (posterior cruciate ligament) laxity

Question 7

Slocum test

Answer 7

Knee
(Slowly Coming to you - Medial rotate knee pull)
Similar to Drawer test but medially rotate pte’s foot before sits-in. Still pull pte’s knee but watches for one side moving forward more than the other side.
+ Excessive anterior movement of tibia on the medial or lateral side
! Anteriolateral rotary instability or Anteriormedial rotary instability

Question 8

Hughston’ test

Answer 8

Knee
(Going down to Houston - Medial rotate knee push)
Similar to Slocum but pushes knee instead of pull
+ Excessive posterior movement of the tibia on medial or lateral side
! Posteriorlateral or posteriormedial rotary instability

Question 9

McMurray’s test

Answer 9

Knee
(Straighten leg)
Pte lays faces up, raise leg to flex hip and knee. Examiner stands at corner of table, hold knee (below) and grab heel from end (using palm). Medial rotate foot, apply medial pressure to the knee from lateral, then straighten foot.  Repeat by lateral rotation (but still medial pressure)
\+ Audible or palpable popping sound
! Meniscal tear

Question 10

Bounce home test

Answer 10

Knee
(knee bounce)
Pte lays face up. Examiner stands at corner, grabbing knee (from below) and the ankle (wrap from under arm). Then slow straighten leg and see knee bounce
+ Knee remains in flexion (doesn’t bounce)
! Torn meniscus

Question 11

Clarke’s sign (patellar grind test)

Answer 11

Knee
(push patella and tap thigh)
Pte lays face up. Examiner uses superior hand (from top of patellar) to push it inferiorly, then ask Pte to contract thigh muscle and examiner push down the thigh muscle with the other hand.
\+ grinding or retropatellar pain
! Patello-femoral dysfunction

Question 12

Mediopatellar plica test

Answer 12

Knee
(move patella medially)
Pte lays face up.  Examiner places superior hand underneath the thigh, then uses the thumb to gently push proximal patella medially from lateral side
\+ Pain
! Medialpatella plica inflammation

Question 13

Fairbank’s apprehension test

Answer 13

Knee
(move patella laterally)
Similar to Plica test but uses index finger to push. Pte lays face up. Examiner places superior hand underneath the thigh, then uses the index finger to gently push patella laterally from medial side
+ Contract quadriceps and/or apprehension look
! Patellar dislocation

Question 14

Noble compression test

Answer 14

Knee
(Straighten leg side)
Pte lays face up, flex hip and knee.  Examiner stands at corner and grabs ankle and knee from lateral epicondyle of femur (do not grab, but only stabilize). Apply pressure to the lateral femoral condyle.  Straightens leg slowly
\+ Pain in lateral femoral condyle
! IT band compression

Question 15

Wilson test

Answer 15

Knee
(medial and lateral rotate foot)
Pte sits at the edge. Pte medially rotate foot and slowly extend foot. (any pain?), then while extended, laterally rotate foot and slow flex it back (any pain?)
+ Pain disappears with lateral rotation. Pain must be in medial femeral condyle.
! Osteocondritis dissecans (OCD)