Knee/Ankle/Foot tests

Question 1

Patellar Apprehension Test

Answer 1

Positioning: patient supine; thumbs to medial patella

Instruction: n/a

Technique: apply lateral pressure to medial patella

Interpretation: look of fear on pt’s face indicates some patellar dysfunction (instability, subluxation, tracking)

Question 2

Resisted Knee Extension

Answer 2

Positioning: patient seated; one hand above knee, one hand at base of shin

Instruction: don’t let me push your leg back

Technique: resist active leg extension

Interpretation: positive is anterior knee pain - note if it is at/before/after the knee

Question 3

Valgus stress test

Answer 3

Positioning: patient supine; pull testing leg slightly off the table (knee on, shin off), stand inside the foot
V1: knee neutral
V2: knee flexed 30 degrees

Instruction: not looking for pain, but let me know if something feels weird

Technique: hold medial aspect of the ankle for stability, apply quick medial force to lateral aspect of the knee

Interpretation: positive would be no joint capsule feel - MCL damage

Question 4

Varus stress test

Answer 4

Positioning: patient supine; pull testing leg slightly off the table (knee on, shin off), stand inside the foot
V1: knee neutral
V2: knee flexed 30 degrees

Instruction: not looking for pain, but let me know if something feels weird

Technique: hold lateral aspect of the ankle for stability. apply quick lateral force to medial aspect of the knee

Interpretation: positive would be no joint capsule feel - LCL damage

Question 5

Anterior drawer test (knee)

Answer 5

Positioning: patient supine, knee flexed to 90 deg; sit gently on the toes to anchor the foot. thumbs to the shin and wrap fingers around the calf.

Instruction: let me know if there’s any pain

Technique: pull the tibia anteriorly

Interpretation: positive is pain or more than 5 mm of motion. indicates ACL damage

Question 6

Posterior drawer test (knee)

Answer 6

Positioning: patient supine, knee flexed to 90 deg; sit gently on the toes to anchor the foot. thumbs to the shin and wrap fingers around the calf.

Instruction: let me know if there’s any pain

Technique: push the tibia posteriorly

Interpretation: positive is pain or more than 5 mm of motion. indicates PCL damage

Question 7

Lachman’s test

Answer 7

Positioning: patient supine, knee flexed 30 deg; stand just outside the leg. one hand medially above the knee to stabilize femur, other hand around the upper calf (lateral side)

Instruction: let me know if anything feels weird

Technique:
anterior test: pull the tibia anteriorly
posterior test: push the tibia posteriorly

Interpretation: positive is pain or more than 5 mm of motion
anterior test: ACL damage
posterior test: PCL damage

Question 8

Lelli’s test

Answer 8

Positioning: patient supine; make a fist and place under the calf, 2-3 fingers past the tibial tuberosity

Instruction: relax your leg

Technique: press down on the patient’s quad

Interpretation: positive is the foot not moving. indicates ruptured ACL

Question 9

Joint Line Tenderness Palpation

Answer 9

Positioning: patient seated; kneel down in front of the leg

Instruction: let me know if anything feels not right

Technique: palpate the medial and lateral joint lines

Interpretation: positive is pain with palpation. indicates possible meniscal tear.

Question 10

Ege’s Test

Answer 10

Positioning:
V1: pt in maximal external rotation of the legs
V2: pt in maximal internal rotation of the legs

Instruction: squat as deep as you can

Technique: support pt as needed

Interpretation: pain/clicking/popping/pain anywhere on the way down or up.
V1: external rotation - medial meniscus
V2: internal rotation - lateral meniscus

Question 11

Thessaly’s Test

Answer 11

demo on good leg first, then test injured leg

Positioning: patient stands on bad leg, knee flexed 20 degress; hold both hands for pt stability

Instruction: rotate your hips fully from side to side three times

Technique: observe the patient’s movement while helping to hold them steady

Interpretation: meniscus test/ positive is patient reporting pain/catching/locking or refusal to perform

Question 12

Anterior drawer test (ankle)

Answer 12

Positioning: patient supine, knee bent; one hand on the anterior tibia and the other gripping the heel.

v1: neutral position
v2: plantar flexion 20 deg

Instruction: keep everything relaxed

Technique: pull the foot anteriorly

Interpretation: positive is excess movement or pain/popping. checking for ligament instability. most likely anterior talofibular

Question 13

Posterior drawer test (ankle)

Answer 13

Positioning: patient supine, knee bent, foot on the table. one hand on the top of the foot, other hand on posterior tibia just above the ankle

Instruction: keep everything relaxed

Technique: anchor the foot by pressing down on the dorsum of the foot. then pull the tibia anteriorly

Interpretation: positive is posterior talofibular ligament instability

Question 14

Kleiger’s Rotational Stress Test

Answer 14

Positioning: patient supine; thumbs down grip on the anterior shin for stabilization

Instruction: let me know if anything feels weird

Technique: rotate the foot like a doorknob shearing the tibia and fibula. use a good amount of force.

Interpretation: positive is excess movement or pain/popping. could indicate a high ankle sprain (ant/post tibiofibular ligaments)

Question 15

Talar Tilt test

Answer 15

Positioning: patient supine; thumbs down grip on the anterior shin for stabilization, other hand to lateral edge of foot

Instruction: keep everything relaxed, let me know if you feel anything

Technique: move the foot into eversion and inversion

Interpretation: posiive is pain on inversion or eversion.

inversion: lateral ankle sprain (1. anterior talofibular lig 2. calcaneofibular lig 3. posterior talofibular lig)
everion: medial ankle sprain (deltoid ligament)

Question 16

Thompson Test

Answer 16

Positioning: patient prone

Instruction: keep your leg relaxed

Technique: squeeze the widest part of the calf

Interpretation:
no plantar flexion: achilles tendon rupture
local pain: strain of gastroc or soleus

Question 17

Morton’s Foot Squeeze

Answer 17

Positioning: pt supine

Instruction: let me know if anything feels painful or weird

Technique: squeeze around all the metatarsal heads and observe any reaction of pain r discomfort

Interpretation: positive is pain…could be morton’s neuroma, stress fracture, fracture of metatarsal heads, metatarsal joint arthritis

Question 18

Tinel’s Test

Answer 18

Positioning: patient in any position, need access to medial ankle

Instruction: let me know if any weird feeling lingers

Technique: tap the nerve behind medial malleolus

Interpretation: positive is pain/shooting electricity - posterior tibial nerve damage

Question 19

Ottawa Foot Rules

Answer 19

foot x-ray is highly recommended for patients with a foot injury if they have any of these findings:

1. Pain in the midfoot (anterior to talus, posterior to phalanges) and any one of the following:
2. Bone tenderness at the base of the fifth metatarsal (for foot injuries), OR
3. Bone tenderness at the navicular bone (for foot injuries), OR
4. An inability to bear weight for four steps.

Question 20

Ottawa Knee Rues

Answer 20

knee x-ray is highly recommended for patients with a knee injury if they have any of these findings:

1. age 55 or over
2. isolated tenderness of the patella (no bone tenderness of the knee other than the patella)
3. tenderness at the head of the fibula
4. inability to flex to 90 degrees
5. inability to bear weight both immediately and in office (4 steps - unable to transfer weight twice onto each lower limb regardless of limping).

Question 21

Ottawa Ankle Rules

Answer 21

ankle x-ray is highly recommended for patients with an ankle injury if they have any of these findings:

1. Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR
2. Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR
3. An inability to bear weight for four steps.