Knee

Question 1

What are the procedures for Valgus (abduction) and Varus (adduction) Stress Tests?

Answer 1

Valgus: Pt supine, Doc stabilizes medial ankle and pushes lateral to medial at knee.

Varus: Pt supine, Doc stabilizes lateral ankle and pushes medial to lateral at the knee

Question 2

What anatomy are we testing during Valgus? Varus?

Answer 2

Valgus = MCL strain or rupture
Varus = LCL strain or rupture

Question 3

How do we perform Apley’s Compression Test?

Answer 3

Patient is prone. Doctor rotates foot either medially or laterally, flexes knee to 90 degrees, then pushes down.

Be sure to rotate foot before flexing knee!!

Question 4

What is the purpose/findings for Apley’s Compression Test?

Answer 4

Looking for meniscus tears
+ Findings = pain or crepitus with compression

Internal rotation = lateral meniscus (heel will be pointing laterally)

External Rotation = medial meniscus (heel will be pointing medially)

Question 5

What is the purpose of Patella Ballottement Test?

Answer 5

Checking for retropatellar effusion or intraarticular knee swelling

Question 6

How do we perform Patella Ballottement Test?

Answer 6

Patient is supine with leg straight. Doctor pushes down on patella and moves it laterally and medially, palpating for motion. LOOKING FOR BOGGY SENSATION.

Question 7

What are positive findings for Patella Ballottement Test?

Answer 7

Patella feels spongy
Patella is slow to return to resting position
There is increased patella movement

Question 8

How do we perform the Bounce Home Test?

Answer 8

Patient is supine. Doctor lifts the leg and bends the knee to 20 degrees. Doctor then allows the knee to drop into full extension.

Question 9

What is the purpose/findings of Bounce Home Test?

Answer 9

Checking for meniscal tear

+ findings: possible pain in joint; inability to fully extend knee

Question 10

What is the purpose of Clarke’s Sign?

Answer 10

Checking for chondromalacia patella or Degeneration of the patellofemoral joint

Question 11

How do we perform Clarke’s sign?

Answer 11

Patient is supine and doctor applies S-I pressure on the top of the patella. Patient then contracts quadriceps.

IF NO PAIN: Bend knee to 30 degrees and repeat while holding the foot down. If no pain after that, bend to 60 degrees and repeat.

Question 12

What are positive findings of Clarke’s sign?

Answer 12

Retropatellar pain (grinding)
Patient can't hold the contraction

Question 13

What are two s/s of a torn meniscus?

Answer 13

Lack of springy end feel on extension

Tenderness in joint line

Question 14

Which test is considered the gold standard for meniscal tears?

Answer 14

McMurray Sign

Question 15

What is the procedure for McMurray Sign?

Answer 15

Patient is supine with hip and knee flexed to 90. Doctor stabilizes knee and grips the heel with the other hand. The doctor then rotates the tibia externally while applying varus stress while extending the leg. This is repeated with valgus stress applied.

Question 16

What is the purpose of McMurray Sign?

Answer 16

Looking for lateral meniscus tear while internally rotating with valgus stress.

Looking for medial meniscus tear while externally rotating and varus stress.

Question 17

What are positive findings for McMurray Sign?

Answer 17

Pain, crepitus, or clicking sound

Question 18

What is the procedure for Lateral Pivot Shift Maneuver?

Answer 18

Patient is supine with hip and knee flexed to 5 degrees. Doctor applies internal rotation, valgus stress, and flexes the knee.

Question 19

What is the purpose of Lateral Pivot Shift Maneuver?

Answer 19

Checking for ACL tear

Question 20

What’s another name for Lateral Pivot Shift Maneuver?

Answer 20

Test of McIntosh

Question 21

What are positive findings of LPSM?

Answer 21

Patient feels like knee is going to pop out (due to dropping of tibia under the femur)

Question 22

What is the most sensitive test for ACL tear?

Answer 22

Lachman Test

Question 23

How do we perform Lachman Test?

Answer 23

Patient supine, Knee is flexed to 25-30 degrees, doctor holds femur down as they lift tibia

Question 24

What’s the purpose of Lachman Test?

Answer 24

Looking for sprain or rupture of ACL

Pain with normal translation = Grade 1 sprain
Pain with increased translation = Rupture, Grade 2-3

Question 25

What is considered normal movement when performing the Drawer or Lachman tests?

Answer 25

6mm translation

Question 26

What is the procedure for Drawer Test?

Answer 26

Patient is supine, knees flexed to 90. Doctor sits on patient’s foot, then pulls tibia anteriorly and posteriorly, looking for excess motion.

Question 27

What is the purpose of Drawer Test?

Answer 27

Looking for sprain or rupture of ACL and PCL
Pain with normal translation = Sprain
Pain with increased translation = Rupture

Question 28

How do we perform Q-Angle Test?

Answer 28

Patient is standing. Doctor draws a line from ASIS through midpoint of patella, then another line from tibial tuberosity through the midpoint of the patella. Measure the angle between the two lines.

Question 29

What are possible findings of the Q-Angle Test?

Answer 29

Angle less than 13 suggests patellofemoral dysfunction or patella alta (high-riding patella)

Angle greater than 18 suggests patellofemoral dysfunction or patella valgum (knock-knee).