Knee, ankle, foot tests

Question 1

valgus test (knee)
+
indicates

Answer 1

pt supine with knee flexed to 30. physician supports the lower leg with one and other hand placed on the lateral aspect of the patient’s knee. apply a medial force to the proximal tibia while abducting the lower leg.
30 degrees and 0 degrees
+ increased laxity, soft or absent endpoint, pain
indicates MCL disruption
0 + more serious (joint capsule)

Question 2

varus test (knee)
+
indicates

Answer 2

pt supine with knee flexed to 30. physician supports the lower leg with one and other hand placed on medial aspect of patint’s knee. apply a lateral force to proximal tibia while adducting lower leg.
30 and 0 degrees
+ increased laxity, soft or absent endpoint, pain
indicates LCL disruption
0 + more serious injury

Question 3

anterior drawer test
+
indicates

Answer 3

pt supine with knee flexed to 90. examiner sits on patient’s foot and grasps proximal tibia with both hands pulling tibia anteriorly.
+ excessive translation
indicates ACL insufficiency (tear/injury)

Question 4

Lachman’s test
+
indicates

Answer 4

pt supine. examiner places cephalad hand on the distal thigh, superior patella. caudad hand grasps the proximal tibia. flexing knee to 10-30 degrees, eexaminer uses his caudad hand to pull the tibia anteriorly while the cephalad hand stabilizes the thigh.
+ increased laxity, soft or absent end point
indicates ACL insufficiency (injury/tear)

Question 5

posterior drawer test
+
indicates

Answer 5

pt supine with knee flexed to 90. examiner sits on the patient’s foot and grasps the proximal tibia with both hands, translating tibia posteriorly.
+ excessive translation
indicates PCL insufficiency, posterior capsular injury or disruption (injury/tear)

Question 6

reverse lachman’s test
+
indicates

Answer 6

pt supine. examiner places cephalad hand on distal thigh, superior to patella. cuadad hand grasps the proximal tibia. flexing knee to 10-30 degrees. the proximal hand stabilizes the femur while the distal hand pushes the tibia posterior.
+ increased laxity, soft or absent end point
indicates PCL insufficiency/posterior capsule injury or disruption (injury/tear)

Question 7

McMurray’s test
+
indicates

Answer 7

pt is 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 tibia into internal rotation and applies varus stress.
medial meniscus - examiner rotates tibia into external rotation and applies valgus stress
continues into extension.
+ pain or palpable click during extension
indicates possible medial or lateral meniscus tear

Question 8

Apley’s grind test compression
+
indicates

Answer 8

pt prone with knee flexed to 90. examiner uses downward force on the foot to provide a compressive force on the meniscus, while rotating the foot internally and externally.
+ pain with rotation and/or compression
indicates possible meniscus injury, collateral ligament injury or both

Question 9

Apley’s grind test distraction
+
indicates

Answer 9

pt prone with knee flexed to 90. examiner uses downward force on the foot to provide upward traction to leg while rotating it.
+ pain with distraction and rotation
indicates possible collateral ligament damage
+ relief of pain with distraction and rotation
indicates possible meniscus injury

Question 10

patellar laxity and apprehension tests
+
indicates

Answer 10

laxity: one hand above and one hand below the joint. thumbs placed against the medial side of the patella. examiner pushes patella laterally, assessing ROM.
apprehension: when testing laxity to the point of restriction, ask pt if the maneuver provokes any discomfort or sense of instability.
+ sense of apprehension or instability
indicates possible previous patellar dislocation or severe instability

Question 11

patellar compression (grind) test
+
indicates

Answer 11

pt supine and knee extended. provide compressive load to the patella with one hand while moving the patella medial and lateral.
+ pain with compression
indicates possible inflammation, chondromalacia, or injury to the patellofemoral articular surfaces

Question 12

patella-femoral grinding
+
indicates

Answer 12

compress patella caudally into trochlear groove and instruct pt to tighten quadriceps against resistance
+ crepitus or pain
indicates roughness of articulating surfaces (chondromalacia)

Question 13

patellar glide test
+
indicates

Answer 13

pt sitting or supine will slowly extend and flex the knee while physician notes quality of the articular motion. placing hand lgihtly over the patella can increase sensitivity of the test.
+ palpable or audible crepitus, pain, or catching of the patella
indicates possible damage to the articular surface

Question 14

anterior drawer test (ankle)
+
indicates

Answer 14

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 spring of calcaneus back to neutral should occur.
+ pain, no springing, excessive motion/laxity
indicates ATF ligament pathology/tear (lateral ankle sprain)

Question 15

talar tilt test
+
indicates

Answer 15

grasp distal tibia/fibula with one hand and inferior calcaneus with other, blocking motion of the calcaneus on the talus. invert the talus to evaluate ROM
+ laxity, increased ROM, or pain
indicates calcaneofibular ligament pathology/tear , some ATF

Question 16

eversion test
+
indicates

Answer 16

grasp distal tibia/fibula with one hand and plantar surface of the midfoot with the other hand. evert the foot to evaluate ROM.
+ laxity increased ROM or pain
indicates deltoid ligament pathology

Question 17

squeeze test
+
indicates

Answer 17

wrap hands around leg proximal to ankle, contacting distal tibia/fibula with both thenar eminences. squeeze for 2-3 seconds, then rapidly release.
+ pain at syndesmosis
indicates syndesmosis pathology (high ankle sprain)

Question 18

cross leg test
+
indicates

Answer 18

pt crosses affected ankle over opposit knee. apply pressure to distal fibula of affected leg.
+ pain at distal ankle
indicates syndesmosis pathology (high ankle sprain)

Question 19

thompson test
+
indicates

Answer 19

pt prone with foot off table. squeeze patient’s calf. observe for plantarflexion.
+ absence of plantar flexion
indicates achilles tendon rupture

Question 20

homan’s sign
+
indicates

Answer 20

pt laying or seated with knee extended. dorsifelx the patient’s foot. can apply lateral compression to calf.
+ pain with dorsiflexion
indicates thrombophlebitis or acute DVT

Question 21

moses sign
+
indicates

Answer 21

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.
+ pain with anterior compression
indicates DVT of the posterior tibial veins

Question 22

turf toe

Answer 22

inflammation and pain at base of 1st MTP
pain and bruising at base of great toe
caused by hyperextension of great toe causing damage to joint capsule. can damage sesamoids and flexor tendon. associated with activities performed on a hard surface.