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Semester 2 PM Exam 8 > Knee Exam and Eval > Flashcards

Knee Exam and Eval Flashcards

1
Q

A lumbar scan is done in patients in whom you suspect which two pathologies?

A

OA and patella-femoral patients (overuse patients)

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2
Q

Which muscles are always tested in a knee patient? (these muscles all relate to gait and stability)

A

quads, hamstrings, gastroc soleus, hip abductors

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3
Q

Effusion tests

A
  1. patella ballottement
  2. fluctuation test for moderate effusion
  3. stroking
  4. tape measure
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4
Q

Effusion 2+

A

exercises not progressed

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5
Q

2+ effusion even after RICE

A

contact physician regarding NSAIDS or aspiration

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6
Q

effusion increasing more than 2 grades

A

decrease activity to level before the change in effusion occurred

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7
Q

trace or less effusion

A

consider high level activity for return to sport

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8
Q

MCL special tests

A

Valgus force at 0 and 10-30 degrees

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9
Q

O degree valgus force test assesses which structures?

A

medial knee structures: capsule, MCL, plica, ACL, PCL

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10
Q

30 degree valgus force assesses which structure?

A

MCL

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11
Q

SN/SP of MCL special tests

A

high sensitivity, low specificity

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12
Q

LCL special tests

A

varus force at 0 and 10-30 degrees

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13
Q

When assessing MCL/LCL, do you start with the knee at 0 or 30 degrees of flexion?

A

always start at 30 and work your way to 0!

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14
Q

zero degrees varus force test assesses which structures?

A

LCL, lateral capsule, ACL, PCL, arcuate-popliteus complex

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15
Q

30 degrees varus force test assesses which structure?

A

laxity of LCL

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16
Q

Lachman’s test

A
  • very high SN and SP
  • graded 0 - 3+
  • test for ACL tears
  • key: hamstrings must be relaxed or you may get a false negative
  • pull tibia anteriorly to assess motion of tibia on femur
17
Q

Grading of Lachman’s and anterior drawer tests

A 
0 = no anterior displacement
1+ = - 5mm translation
2+ = - 5 - 10 mm
3+ = > - 10 mm translation
18
Q

Anterior drawer test

A
  • ACL test
  • lower SN/SP than Lachman’s but specificity is high enough that if it is a positive test you know they have an ACL tear
  • hamstrings play a big role in false negatives!
  • same grading as Lachman’s
19
Q

Rotary instability - anterolateral pivot shift

A
  • highly SN/SP
  • determining how stretched out the capsule is
  • rotation and forward glide of the tibia on the femur
  • push tibia up and flex knee; looking for clunk/pop from ITB pulling tibia back into place during knee flexion
20
Q

Name the 3 major PCL tests

A

Godfrey’s, posterior drawer, reverse Lachman’s

21
Q

Godfrey’s

A
  • PCL test
  • SP = 1 !!!
  • great at detecting chronic PCL tears, bad for acute tears
  • hip and knee flexed at 90, looking for lack of tibial tuberosity presence. It slips posteriorly after chronic PCL tear
22
Q

Posterior Drawer test

A
  • PCL test
  • SN = .9
  • SP = .99
23
Q

Reverse Lachman’s

A

SN = .62
SP = . 89
PCL test

24
Q

How do you test for a meniscal tear?

A

via joint line palpation
looking for tenderness
palpation better for detecting lateral vs medial meniscus tear

25
Q

Most common meniscus test?

A

McMurrey’s

26
Q

McMurrey’s Test

A
  • SP = .94 for lateral meniscus tears
  • trying to pinch meniscus and get pop/click/pain by combining mvmts
  • start with knee hyperflexed and move it into extension
  • Medial meniscus test = ER thru tibia and varus force at the knee
  • lateral meniscus test - IR thru tibia and valgus force at knee
27
Q

Apley’s compression test

A

for meniscal tears

apply pressure w/ pt in prone and knee flexed

28
Q

Q angle

A
  • normal = 15 degrees
  • more than 20 = abnormal
  • lines from ASIS to patella and tibial tuberosity to patella
  • > 20 changes alignment of quad on patella, putting the patella at a disadvantage and potentially causing pain
29
Q

Patellafemoral articulating surfaces

A

contract quad while pushing patella into femur
looking for pain, but could also hurt a “normal” person without patella issues
goal is to force articulating surfaces together

30
Q

Patella apprehension test

A

moving patella into sublux position (usually laterally)

goal is to reproduce pain

31
Q

Patella mobility

A

medial/lateral translation should be 1/3 the surface of the patella

32
Q

Joint mobility

A

patella femoral
tibia femoral
tibia fibula - proximal : LCL attaches here, check in patients with lateral knee pain, the joint can become hypermobile

33
Q

Functional tests

A

hop tests and running tests

pt needs to have 80% of strength in affected vs unaffected leg to return to sport. 90% for high-level athlete

34
Q

WOMAC

A

used for knee arthritis and pre/post TKA

35
Q

Lysholm knee scoring scale

A

commonly used as an evaluation method to assess post-surgical outcome results
also used in research and ACL pts

36
Q

Pittsburgh knee rules

A

blunt trauma or fall
Age 50
can’t weightbear for 4 steps

37
Q

Ottawa knee rules

A
  • age > 50
  • isolated tenderness of patella
  • head of fibula tenderness
  • cannot flex knee to 90
  • cannot walk 4 steps
38
Q

valgus force from trauma, think ____

A

ACL, MCL

39
Q

varus force from trauma, think _____

A

PCL, LCL

Semester 2 PM Exam 8 (2 decks)

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