Knee Exam and Eval Flashcards
A lumbar scan is done in patients in whom you suspect which two pathologies?
OA and patella-femoral patients (overuse patients)
Which muscles are always tested in a knee patient? (these muscles all relate to gait and stability)
quads, hamstrings, gastroc soleus, hip abductors
Effusion tests
- patella ballottement
- fluctuation test for moderate effusion
- stroking
- tape measure
Effusion 2+
exercises not progressed
2+ effusion even after RICE
contact physician regarding NSAIDS or aspiration
effusion increasing more than 2 grades
decrease activity to level before the change in effusion occurred
trace or less effusion
consider high level activity for return to sport
MCL special tests
Valgus force at 0 and 10-30 degrees
O degree valgus force test assesses which structures?
medial knee structures: capsule, MCL, plica, ACL, PCL
30 degree valgus force assesses which structure?
MCL
SN/SP of MCL special tests
high sensitivity, low specificity
LCL special tests
varus force at 0 and 10-30 degrees
When assessing MCL/LCL, do you start with the knee at 0 or 30 degrees of flexion?
always start at 30 and work your way to 0!
zero degrees varus force test assesses which structures?
LCL, lateral capsule, ACL, PCL, arcuate-popliteus complex
30 degrees varus force test assesses which structure?
laxity of LCL
Lachman’s test
- 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
Grading of Lachman’s and anterior drawer tests
0 = no anterior displacement 1+ = - 5mm translation 2+ = - 5 - 10 mm 3+ = > - 10 mm translation
Anterior drawer test
- 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
Rotary instability - anterolateral pivot shift
- 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
Name the 3 major PCL tests
Godfrey’s, posterior drawer, reverse Lachman’s
Godfrey’s
- 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
Posterior Drawer test
- PCL test
- SN = .9
- SP = .99
Reverse Lachman’s
SN = .62
SP = . 89
PCL test
How do you test for a meniscal tear?
via joint line palpation
looking for tenderness
palpation better for detecting lateral vs medial meniscus tear
Most common meniscus test?
McMurrey’s
McMurrey’s Test
- 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
Apley’s compression test
for meniscal tears
apply pressure w/ pt in prone and knee flexed
Q angle
- 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
Patellafemoral articulating surfaces
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
Patella apprehension test
moving patella into sublux position (usually laterally)
goal is to reproduce pain
Patella mobility
medial/lateral translation should be 1/3 the surface of the patella
Joint mobility
patella femoral
tibia femoral
tibia fibula - proximal : LCL attaches here, check in patients with lateral knee pain, the joint can become hypermobile
Functional tests
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
WOMAC
used for knee arthritis and pre/post TKA
Lysholm knee scoring scale
commonly used as an evaluation method to assess post-surgical outcome results
also used in research and ACL pts
Pittsburgh knee rules
blunt trauma or fall
Age 50
can’t weightbear for 4 steps
Ottawa knee rules
- age > 50
- isolated tenderness of patella
- head of fibula tenderness
- cannot flex knee to 90
- cannot walk 4 steps
valgus force from trauma, think ____
ACL, MCL
varus force from trauma, think _____
PCL, LCL
