Knee exam and eval lab Flashcards
Checking for tibial torsion
patient sitting, palpate femoral condyles and then position them so that they are parallel to the edge of the table
One thumb on ant aspect of lateral malleolus and one thumb at mid point of medial malleolus - thumbs should be parallel to edge of table
Strength - always test
quads
hams
plantarflexion
hip abductors
Palpate semitendinosis
large tendon with knee flexion and IR
Palpate gracilis
medial to the semitendinosis
Semimembranosis palpation
lateral mm of the semitend
Palpate pes anserine - what inserts here
Sartorius
Semitendinosis
Gracilis
Palpate plica -
anterior aspect of medial femoral condyle
Palpate meniscus
medial joint space with tibia ER
Gerdys tubercle - palpation
palpate with knee flexed to 90 degrees just under the lateral aspect of the tibial plateau and lateral to the tibial tub
Adductor tubercle - palpate
just superior to the medial epicondyle, patella retinaculum attaches and medial patellofemoral ligament and adductor magnus
Patella Ballottement
Tap two fingers on the knee cap and see if it moves?
Fluctuation test
Pace hand above the patella and sweep down - edema will be noticeable
Sweep test
Sweep along medial joint space to superior to patella - not colelction of fluid at alteral patella and sweep along lateral joint space to superior patella and note collection of fluid at medial patella
J stroke
Circumferential measurements
Place tape measure around superior border of patella, mid patells, and patella tendon on R and L leg
You would only use this one when comparing two legs or when comparing against itself over different treatments sessions
Special Test to LCL
Varus 0 and 30
Varus 0 and 30
testing lateral structures
Place thigh over your on table to get 30 degrees of flexion - stabilize at the joint line and apply force at proximal tibia in varus direction
Same in extension
Special test to MCL
Valgus 0 and 30
Valgus 0 and 30
Testing medial structures
Place thigh over your leg on the table to get 30 degrees of flexion - stabilize the joint line and apply force at proximal tibia in valgus direction
Same in extension
Lachmans
testing the ACL
place your leg on table again with their thigh over
Palpate the joint line and keep thumb on tibial tuberosity
Cup other hand under the leg and apply a quick jerk with the shoulder to feel the ant translation of the tibia
Anterior drawer
Testing the ACL
flex their knee up - apply pressure onto their foot to prevent it from moving
Put your thumbs on their tibial plateau, pick up slack from behind and make sure the hamstrings are relaxed
Keep your arms and forearms in the direction you want the force to go and pull quickly towards you
Looking at how much motion you have R to L
Godfreys
PCL
Bring leg up into 90 degrees of knee flexion
Look for the tibial tuberosity - it wont be there if there is a PCL tear because it will drop down
Posterior Drawer
Like the anterior drawer but opp direction
PCL
Reverse Lachmans
PCL
Same as lachmans but in the other direction
Need to compare R to L
Pivot shift
Testing anterior rotary instability
You are subluxing the tibia and relocating it
Place hand under fibula and push in an ant med direction with your other hand at the heel - hold these forces and then quickly flex the knee
Positive if there is slippage with the flexion
McMurrays
Meniscus
Need to put it with other tests
Take knee into hyperflexion - ER the tibia (gets the post/medial meniscus) and add varus force then quickly extend the knee
Take knee into hyperflexion - IR of the tibia (gets the post/lateral meniscus) and add valgus force then quickly extend the knee
Positive is clicking, pain, catching the meniscus
Q angle
Axis = mid patella
ASIS
Tibial tuberosity
Patella apprehension
Screening for patellafemoral pain
Apply force down pushing the patella into the femur and then ask for a contraction of the quad
Apprehension positive if pain
Flexibility
Gastroc 90/90 Elis Obers Others..
Functional Tests
Measurement for distance (about 10m) - patient starts at one end and have to hop while being timed
Look at ratio of injured to noninjured side
Usually for return to sport
