Knee Ankle Foot Pain Flashcards
Valgus test
Pt supine with knee flexed to 30 degrees
Physician supports lower leg itch one hand and other hand placed on the lateral aspect of the pt’s knee
Apply a medial force to the proximal tibia while abducting the lower leg
(+) test: increased laxity, soft or absent endpoint, pain
Indication: medial collateral ligament disruption
If positive when knee fully extended, indicates more serious injury, probably joint capsule
Varus test
Pt supine with knee flexed to 30 degrees
Physician supports the lower leg with one hand and other hand placed on the medial aspect of the pt’s knee
Apply a lateral force to the proximal tibia while adducting the lower leg
(+) test: increased laxity, soft or absent endpoint, pain
Indication: lateral collateral L. Disruption
Anterior/posterior drawer test
Pt supine with knee flexed to 90 degrees
Physician sits on the pt’s foot and grasps the proximal tibia with both hands, pulling the tibia anteriorly/posteriorly
(+) test: excessive translation
Indicates: ACL/PCL injury
Lachman’s test
Pt supine
Physician places cephalad hand on the distal thigh, superior to patella
Caused hand grasps the proximal tibia
Flexing the knee to 10-30 degrees, the examiner uses his caudate hand to pull the tibia anteriorly while the cephalad hand stabilizes the hand
More sensitive test
(+) test: increased laxity, soft or absent end point
Indicates: ACL injury
Reverse Lachman’s test
Pt supine
Physician places cephalad hand on the distal thigh, superior to patella
Causal hand grasps the proximal tibia
Flexing the knee to 10-30 degrees; proximal hand stabilizes the femur while the distal hand pushes the tibia posterior
Mores sensitive test
(+) test: increased laxity, soft or absent end point
Indication: PCL injury
McMurray’s test
Pt supine, with hip and knee flexed; examiner uses caudad hand to control the ankle and cephalad hand placed on distal femur
Lateral meniscus: examiner rotates the tibia into IR and applies a varus stress, then continues the leg into extension
Medial meniscus: examiner rotates the tibia into ER and applies a valgus stress, then continues the leg into extension
(+) test: pain or palpable click during extension
Indication: medial or lateral meniscus tear
Apley’s Grind test-compression test
Pt prone with knee flexed to 90 degrees
Examiner uses downward force on that foot to provide a compressive force on the meniscus, while rotating the foot internally and externally
(+) test: pain with rotation and/or compression
Indication: possible meniscal injury, collateral ligament injury, or both
Apley’s grind test-distraction test
Pt is in same position for the compression
Examiner stabilizes the thigh then applies upward traction to the leg while rotating it
(+) test: pain with distraction and rotation, increased ligamentous strain; indication: possible collateral ligament damage
(+) test: relief of pain with distraction and rotation, reduced meniscal pressure; indication: possible meniscus injury
Patellar laxity and apprehension tests
Laxity test: one hand above and one hand below the joint; thumbs placed against the medial side of the patella; examiner pushes the patella laterally, assessing ROM
Apprehension test: when testing laxity to the point of restriction, ask the pt if the maneuver provokes any discomfort or sense of instability
(+) test: sense of apprehension or instability
Indication: possible previous patellar dislocation or severe instability
Patellar Compression (grind) test
Pt supine and knee extended
Provide compressive load to the patella with one hand while moving the patella medial and lateral
(+) test: pain with compression
Indication: possible inflammation, chondromalacia, or injury to the patellofemoral articular surfaces
Patella-femoral grinding test
Compress patella causally into trochlear groove and instruct pt to tighten quadriceps against resistance
(+) test: crepitus or pain
Indication: roughness of articulating surfaces (chondromalacia)
Patellar glide test
Pt sitting or supine will slowly extend and flex the knee, while physician notes quality of the articular motion
Pacing hand lightly over the patella can increase sensitivity of the test
(+) test: palpable or audible crepitus, pain, or catching of the patella
Indication: possible damage to the articular surface
Anterior drawer test (ankle/foot)
Grasp posterior calcaneus with one hand and distal tibia/fibula with the other hand, monitoring anteriorly at the anterior talus
Provide anterior force on calcaneus while stabilizing the distal tibia/fibula
Normal springing of calcaneus back to neutral should occur
(+) test: pain, no springing, excessive motion/laxity
Indication: ATF ligament pathology/tear
Talar tilt test
Grasp distal tibia/fibula with one hand and inferior calcaneus with the other, blocking motion of the calcaneus on the talus
Invert the talus to evaluate ROM
(+) test: laxity, increased ROM, or pain
Indication: calcneofibular L. Pathology/tear, also tests some ATF
Eversion test (foot/ankle)
Grasp distal tibia/fibula with one hand and plantar surface of the mid-foot with the other hand
Evert the foot to evaluate ROM
(+) test: laxity, increased ROM or pain
Indication: deltoid ligament pathology
Squeeze test
Wrap hands around leg proximal to the ankle, contacting distal tibia/fibula with both thenar eminences
Squeeze for 2-3 seconds, then rapidly release
(+) test: pain at syndesmosis
Indication: syndesmosis pathology (high ankle sprain)
Cross leg test
Pt crosses affected ankle over opposite knee
Apply pressure to distal fibula of affected eg
(+) test: pain at distal ankle
Indication: high ankle sprain
Thompson test
Pt prone with foot off the table
Squeeze the pt’s calf, observe for plantarflexion
(+) test: absence of plantar flexion
Indication: Achilles’ tendon rupture
Homan’s sign
Pt laying or seated with knee extended
Dorsiflexion the pt’s foot, can apply lateral compression to calf
(+) test: pain with dorsiflexion
Indication: thrombophlebitis or acute deep vein thrombosis (DVT)
Accompany signs of edema, erythema, and warmth of the lower leg
Would need to order a Venous Doppler to rule out clot
Moses sign
Pt seated or supine with knee slightly flexed or extended
Induce an anterior compression on the gastrocnemius muscle into the posterior aspect of the tibia (compresses the calf towards the tibia)
(+) test: pain with anterior compression
Indication: DVT
Inversion ankle sprain
Anterior talofibular L.
80-8% of all ankle sprains
Ankle inversion with plantar flexion
High ankle sprain
10% of all ankle sprains
Ankle eversion and rotation (some dorsiflexion)
Anterior inferior tibiofibular L.
Syndesmosis
Pain more common on medial aspect with minimal swelling, pain worse with weight bearing
Morton’s neuroma
Inflammation and thickening of tissue that surrounds the nerve between toes
Most commonly between 3rd and 4th toes
Pt reports feeling like they are walking on a marble
Palpable in web space, which will replicate burning pain
Can have radiation of pain and numbness of toes
Test: Mulder’s sign: clicking sensation upon palpating with one hand the third web space and other hand compressing the transverse arch together
Turf toe
Inflammation and pain at base of 1st MTP
Presents as pain and bruising at base of great toe
Caused by hyperextension of great toe causing damage to the joint capsule; severe cases can damage sesamoid and flexor tendon
Commonly associated with activities performed on hard surface
