knee and vascular LE orthopedic tests Flashcards
How is a Drawer test or sign performed?
Observe for sag sign on the symptomatic leg first
Patient is supine with the knee flexed and the examiner stabilizes the foot or ankle and firmly pulls the tibia forward and then pushes the tibia posteriorly
If a patient reports locking in the knee what should be immediately considered?
Meniscal lesion or joint mice
What ligament holds the menisci in the knee in place?
Coronary ligament
What is the action of articularis genu?
Contracts in knee extension to move the joint capsule out of the way
What is a positive result for a Drawer test or sign?
Excessive motion upon either translation as compared to the opposite side or pain in the central knee joint
A present sag sign is indicative of a(n) ____________________ injury?
PCL
What test should NOT be performed if a sag sign is present?
Drawer Test or Sign
What is indicated by a positive result for a Drawer Test?
Excessive anterior tibial motion = ACL damage
Excessive posterior tibial motion = PCL damage
A drawer test is performed on a patient and there is noted excessive anterior motion of the tibia compared to the opposite leg, how is this recorded and what is indicated?
Positive Drawer Test indicating an ACL injury
A drawer test is performed on a patient and there is noted excessive posterior motion of the tibia compared to the opposite leg, how is this recorded and what is indicated?
Positive Drawer Test indicating a PCL injury
How is a Lachman’s test performed?
The patient is supine with the knee flexed to 30 degrees
The examiner stabilizes the femur with one hand and exerts P to A stress on the tibia
What orthopedic tests for the knee can determine ACL damage?
Drawer Test/Sign
Lachman’s Test
What orthopedic test is specific to ACL damage?
Lachman’s test
What is a positive finding for a Lachman’s test?
Excessive anterior translation of the tibia and or pain in the central knee
What is indicated by a positive fining for a Lachman’s test?
ACL damage
How is an ABduction or Valgus stress test for the knee performed?
Lower leg ABducted with lower femur stabilized opening up the medial knee joint
Perform test in full extension and repeat in slight flexion on the well side first
What is a positive finding for an ABduction or Valgus stress test for the knee?
Pain or excessive motion at the medial knee
What is indicated by a positive finding for an ABduction or Valgus stress test for the knee?
MCL damage
An ABduction or Valgus stress test is testing the integrity of the _____________?
MCL
An ADduction or Varus stress test is testing the integrity of the ______________?
LCL
How is an ADduction or Varus stress test performed for the knee?
Lower leg is ADducted while the lower femur is stabilized opening up the lateral knee joint
Perform test in full extension then repeat in slight flexion on the well side first
What is a positive result for an ADduction or Varus stress test on the knee?
Pain or excessive motion at the lateral knee
What is indicated by a positive result for an ADduction or Varus stress test on the knee?
LCL damage
If a patient has lateral knee pain what can be on your DDx list? What test can be performed for each?
LCL = Varus/ADduction stress test
Lateral meniscus = Apley’s Compression/Grind Test OR McMurray’s Test (INT Rotation)
IT Band = Noble’s Test
Common Peroneal Nerve = MRS over fibular head
Fibular head
How is Noble’s test performed?
Patient in a supine position, the doctor places a thumb over the lateral femoral epicondyle as the patient repeatedly flexes and extends the knee. Pain symptoms are usually most prominent with the knee at 30 degrees of flexion
What is a positive finding for Noble’s test?
Reproduction of pain in the iliotibial band
What is indicated by a positive finding for Noble’s test?
Iliotibial band tendonitis
What orthopedic test is used for determining IT band TENDONITIS?
Nobles test
What motion leads to lateral knee pain and IT tendonitis?
Repetitive knee flexion in runners and cyclists
How is Apley’s Compression/Grinding Test performed?
Patient prone with knee flexed to 90 degrees. Compress the tibia firmly down into the examining table while rotating the tibia internally. Repeat with external rotation
What is a positive result for Apley’s Compression/Grinding Test?
Any report of pain or clicking at the medial or lateral meniscus
What is indicated by a positive result for an Apley’s Compression/Grinding Test?
Pain or click in external rotation = Damage to posterior horn of medial meniscus
Pain or click in internal rotation = Damage to posterior horn of lateral meniscus
An Apley’s Compression/Grinding Test is performed and the patient notes clicking during external rotation of the tibia. How is this recorded and what does it indicate?
Positive Apley’s indicating a medial meniscus injury
An Apley’s Compression/Grinding Test is performed and the patient notes pain during internal rotation of the tibia. How is this recorded and what is indicated?
Positive Apley’s indicating a lateral meniscus injury
How is McMurray’s test performed?
Flex patients knee to 90 degrees
Look at the meniscus tested
Press on the meniscus tested
Point the patients heel toward the meniscus tested
What is a positive finding for McMurray’s test?
Audible or palpable click or snap in the joint or report of pain at the medial or lateral meniscus
What is indicated by a positive finding for McMurray’s test?
Pain or click in external rotation = Damage to posterior horn of medial meniscus
Pain or click in internal rotation = Damage to posterior horn of lateral meniscus
A McMurray’s test is performed and the patient reports clicking in external rotation of the leg. How is this recorded and what does it indicate?
Positive McMurray’s test indicating a medial meniscus injury
A McMurray’s test is performed and the patient reports pain during internal rotation of the leg. How is this recorded and what does it indicate?
Positive McMurray’s test indicating a lateral meniscus injury
What two LE orthopedic tests can be used to determine a meniscal injury in the knee?
Apley’s Compression/Grinding Test
McMurray’s test
How is a Patellar Scrape/Grinding Test/Clarke’s Sign performed?
Gently hold down the patients patella and have the patient contract the quadriceps
The patella most commonly dislocated (Medially/Laterally)?
Laterally
What is a positive finding for a Patellar Scrape/Grinding Test/Clarke’s sign?
Any grinding or pain upon movement deep to the patella
What is indicated by a positive finding for a Patellar Scrape/Grinding Test/Clarke’s sign?
Chondromalacia patella or retropatellar arthritis
What test is an alternative to the Patellar Scrape/Grinding Test/Clarke’s sign?
Fouchet’s Sign
How is Fouchet’s sign performed?
Compression or transverse friction of the patella against the femoral condyles with the flat of the hand elicits pain
What is a present finding for Fouchet’s sign?
Any grinding or pain upon movement deep to the patella
What is indicated by a present finding for Fouchet’s sign?
Chondromalacia patella or retropatellar arthritis
What two orthopedic tests for the knee can indicate chrondromalacia patella if present or positive?
Patellar Scrape/Grinding Test/Clarke’s sign
Fouchet’s sign
What LE orthopedic test can be used to determine a patellar fracture or suprapatellar tendon rupture?
Dreyer’s sign
How is Dreyer’s sign performed?
Patient is supine and is asked to raise the affected leg off the table. If the patient is unable to perform this, the examiner then firmly encircles the lower thigh with his hands. Then the patient attempts to raise the leg
What is a present finding for Dreyer’s sign?
The ability to flex the hip with stabilization
What is indicated by a present finding for Dreyer’s sign?
Patellar fracture or suprapatellar tendon rupture
How is a patellar apprehension test performed?
Patient seated or supine with knee slightly flexed. Doctor manually displaces the patella laterally and observes for apprehension, withdrawal, or quad contraction
What is a positive finding for a patellar apprehension test?
Patient apprehension, withdrawal of the knee, or voluntary contraction of the quadriceps
What is indicated by a positive finding for a patellar apprehension test?
Recurrent patellar dislocation
What LE orthopedic test can be used to determine a tendency toward patellar dislocation or instability?
Patellar apprehension test
What is the pain pattern of a patient with vascular claudication?
Dull achy pain worse with physical demand and relieved by rest with possible changes in temperature or color
How will an arterial block look in a patient with vascular claudication?
White, cramping, dull ache
How will a venous block look in a patient with vascular claudication?
Red, edema, pain if inflammation present
What is the pain pattern of a patient with neurogenic claudication?
Worse with certain positions
Relieved with hip or lumbar forward flexion
Lateral canal stenosis will occur (Unilaterally/Bilaterally)?
Unilaterally
Cauda equina syndrome will occur (Unilaterally/Bilaterally)?
Bilaterally
What are signs or symptoms of Cauda Equina Syndrome?
Inability to initiate urination
Saddle anesthesia
Bilateral LE pain
What LE vascular orthopedic test is analogous to Roos test in the UE?
Buerger’s Test
Patient presents with lower leg and foot pain with swelling and heat. He just returned from a vacation in England and had a long flight. What condition do you suspect and what is the BEST diagnostic protocol?
DVT; Doppler ultrasound
How is Buerger’s Test performed?
Have patient dorsiflex and plantarflex the elevated foot for 1-2 minutes. Observe for blanching. The leg is then lowered off the table and the foot is observed for color changes and refilling or collapse of superficial veins
What is a positive finding for Buerger’s Test?
Blanching of the foot or venous collapse with the foot elevated or failure to complete the test due to fatigue or cramping of he muscles
OR a delay in filling longer than one minute after lowering the leg
What is indicated by a positive finding for Buerger’s Test?
Arterial insufficiency into the foot
What are signs and symptoms of a DVT?
Swelling of the calf with heat
Edema below the lesion
Recent history of prolonged sitting or bed rest
What is a positive result for Homan’s test?
Acute calf pain
What is indicated by a positive result for Homan’s test?
Thrombophlebitis (DVT)
What LE orthopedic test(s) can determine a deep vein thrombosis or thrombophlebitis in the LE?
Homan’s test
Moses test
For a Homan’s test the doctor will ________________ the foot with the knee extended to compress deep leg veins?
Dorsiflex
For a Moses test the patient is prone with the knee flexed. The doctor ___________________ the calf of the affected leg?
Compresses
What is a positive result for a Moses test?
Acute calf pain
What is indicated by a positive result for a Moses test?
Thrombophlebitis (DVT)
If a patient reports locking in the knee what should be immediately considered?
Meniscal lesion or joint mice
What ligament holds the menisci in the knee in place?
Coronary ligament
What is the action of articularis genu?
Contracts in knee extension to move the joint capsule out of the way
If a patient has lateral knee pain what can be on your DDx list? What test can be performed for each?
LCL = Varus/ADduction stress test
Lateral meniscus = Apley’s Compression/Grind Test OR McMurray’s Test (INT Rotation)
IT Band = Noble’s Test
Common Peroneal Nerve = MRS over fibular head
Fibular head
The patella most commonly dislocated (Medially/Laterally)?
Laterally
Patient presents with lower leg and foot pain with swelling and heat. He just returned from a vacation in England and had a long flight. What condition do you suspect and what is the BEST diagnostic protocol?
DVT; Doppler ultrasound
