Knee Assessment Flashcards
Tests for knee joint effusion
Patella tap test / patella ballotement test
Brush test / knee bulge sign
Patellar tap test / Patella ballotement test
Indication:
-Large amount of intra-articular synovial fluid
-knee joint effusion after injury
Procedure:
- supine with fully extended knees
- stroke down with one hand until reaching suprapatellar pouch
- stroke up with other hand until reaching the patellar tip
- with one finger, downward pressure onto patella against femur (check for ANTERIOR PATELLA REBOUNDING)
Positive sign:
- anterior floating
- rebounding of patella
NOTE:
Extra-articular swelling (ex: prepatellar bursitis/ patellar tendinitis) = NEGATIVE for this test
Brush test / knee bulge sign
Indication :
- lesser/ minor amount of synovial fluid
- knee joint effusion after injury
Procedure:
- supine with test leg extended
- brush over medial side (distal to proximal) 2-3x
- brushing over lateral side (proximal to distal) 2-3x
Positive :
- bulge/ wave of fluid floating to inferior medial border of patella
NOTE: usually done AFTER negative in patellar tap test
Tests for patellofemoral joint (PFJ) pathology
Q angle (Quadriceps angle)
Patellar grind test (clarke’s test)
Waldron’s test (squat test)
Patellar apprehension test
Q angle (quadriceps angle)
Indication:
Malalignment of the pelvic, leg, and foot = knee functional problem
Procedure:
- supine
- fulcrum: midpoint of patella
- stationary arm: midline of thigh pointing to ASIS
- moving arm: tibial tubercle
NORMAL Q ANGLE: 12-20 ° (men at lower end, women higher end)
Positive: Q > 20 ° = excessive due to either:
1. Biomechanical stress: repetitive knee activity with no smooth movement of patella in femoral groove
2. Muscle imbalance : VMO weak VML intact : wearing of underside patellar cartilage
3. Pronation of the foot: internal rotation of tibia = degenerative knee joint disease
Patellar grind test (Clarke’s test)
Indication :
- Chondromalacia patella
- Retro patellar cartilage integrity
Procedure:
- supine with extended knee
- place web space of thumb on superior boarder of patella
- apply downward pressure while asking patient to contract quadriceps (compresses the patella into trochlear groove)
Positive:
Pain with movement
Inability to complete the test
NOTE: this test is performed last because it is very painful
Waldron’s Test (squat test)
Indication :
Patella Femoral Pain Syndrome
PFJ pathology
Runner’s knee
Procedure 1 : NON-weight bearing test (phase 1)
- supine with slightly flexed knee
- press patella while patient actively flexes knee more
Procedure 2: WEIGHT-bearing test (phase 2)
- standing
- press patella while patient squat
Positive :
- pain
- crepitus
- poor patella tracking
Patellar Apprehension Test
Indication:
PFPS
Patella lateral instability
Patellar subluxation
Procedure:
- supine with 30 ° knee flexion (Common dislocation position)
- use thumb to passively translate patella laterally
Positive:
Pain
Discomfort
Patient stops movement with hand or extends knee
Tests for meniscal injuries
Mcmurray’s test
Apley’s grinding test
McMurray’s test
Indication:
Meniscal lesions
Procedure: MEDIAL MENISCUS
-Supine with knee fully flexed and hip 90 ° flexed
-Palpate for pain at medial joint line of flexed knee
- Valgus stress
- externally rotate tibia (toes outward)
- slowly extend knee while in valgus
Procedure: LATERAL MENISCUS
-Supine with knee fully flexed and hip 90 ° flexed
-Palpate for pain at lateral joint line of flexed knee
- Varus stress
- internally rotate tibia (toes inward)
- slowly extend knee while in varus
Positive:
Pain
Tenderness at joint line
Clicking
Locking
Apley’s grinding test
Indication:
Meniscal lesions
Procedure:
- prone with 90 ° flexed knee. Fix thigh
- compress the knee with downward pressure
- MEDIAL MENISCUS: medial tibial rotation
- LATERAL MENISCUS: lateral tibial rotation
Positive:
Pain
Decrease rotation compared to normal side associated with compression
Tests for ligament integrity
Apley’s distraction test
Valgus stress test
Varus stress test
Lachman’s test
Anterior drawer test
Posterior drawer test
Posterior sag test (step-off test)
Apley’s distraction test
Indication :
Knee joint stability - collateral ligament integrity
Procedure:
- prone position with knee flexed 90 ° and fix thigh
- distract the knee
- LCL: medial tibial rotation
- MCL: lateral tibial rotation
Positive:
Pain
Excessive rotation compared to normal side
Valgus stress test
Indication:
MCL integrity
Procedure:
- supine
Either: fully extended knee or 30 ° knee flexion
- fix ankle with one hand and knee with other
- medial pressure against knee + lateral pressure against ankle
Positive:
Pain
Gapping of the medial joint line
- fully extension : posterior medial capsule / cruciate/ MCL
- flexed knee : MCL
Varus stress test
Indication:
LCL integrity
Procedure:
- supine
Either: fully extended knee or 30 ° knee flexion
- fix ankle with one hand and knee with other
- lateral pressure against knee + medial pressure against ankle
Positive:
Pain
Gapping at lateral joint line
Knee extension: posterolateral capsule / cruciate/ LCL
30 ° knee flexion : LCL
Lachman’s test
Indication:
ACL integrity
Procedure:
- supine with 30 ° knee flexion
- fixate femur
- translate tibia anterior
Positive:
- translation anteriorly more than 3 mm compared to other side + soft mushy end feel
NOTE: make sure no PCL injury before applying test
