Knee/Ankle/Foot tests Flashcards
Patellar Apprehension Test
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)
Resisted Knee Extension
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
Valgus stress test
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
Varus stress test
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
Anterior drawer test (knee)
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
Posterior drawer test (knee)
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
Lachman’s test
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
Lelli’s test
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
Joint Line Tenderness Palpation
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.
Ege’s Test
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
Thessaly’s Test
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
Anterior drawer test (ankle)
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
Posterior drawer test (ankle)
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
Kleiger’s Rotational Stress Test
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)
Talar Tilt test
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)
Thompson Test
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
Morton’s Foot Squeeze
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
Tinel’s Test
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
Ottawa Foot Rules
foot x-ray is highly recommended for patients with a foot injury if they have any of these findings:
- Pain in the midfoot (anterior to talus, posterior to phalanges) and any one of the following:
- Bone tenderness at the base of the fifth metatarsal (for foot injuries), OR
- Bone tenderness at the navicular bone (for foot injuries), OR
- An inability to bear weight for four steps.
Ottawa Knee Rues
knee x-ray is highly recommended for patients with a knee injury if they have any of these findings:
- age 55 or over
- isolated tenderness of the patella (no bone tenderness of the knee other than the patella)
- tenderness at the head of the fibula
- inability to flex to 90 degrees
- inability to bear weight both immediately and in office (4 steps - unable to transfer weight twice onto each lower limb regardless of limping).
Ottawa Ankle Rules
ankle x-ray is highly recommended for patients with an ankle injury if they have any of these findings:
- Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR
- Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR
- An inability to bear weight for four steps.
