Knee: Examination 1 Flashcards
Joint effusion: grade 0
none
Joint effusion: grade “trace”
milk medially, sweep laterally
small amount back
Joint effusion: grade 1+
milk it out and does not return on its own
Joint effusion: grade 2+
milk it out and immediately returns to full pouch
Joint effusion: grade 3+
cannot milk it out
joint mobility end feels:
normal for knee flexion with hip flexed
soft (soft tissue approximation)
joint mobility end feels:
normal for flexion with hip extended
firm (quad tension)
joint mobility end feels:
abnormal - empty
unwillingness or inability to allow assessment
joint mobility end feels:
abnormal/empty endfeel might indicate
- serious pathology (fx)
- excessive laxity
joint mobility end feels:
normal for extension
firm
joint mobility end feels:
abnormal for extension
bony
joint mobility end feels:
abnormal bony endfeel implications
may require surgical intervention
MMT in strong patients has poor (2)
- reliability
- sensitivity
muscle strength: preferred method
use of handheld dynamometer if available
Ligament testing: grade 1+
3-5 mm
Ligament testing: grade 2+
5-10 mm
Ligament testing: grade 3+
> 10 mm
Collateral ligament testing: In this position, preferentially testing the collateral ligaments
20-30˚
Collateral ligament testing: varus/valgus testing at 0˚
which structures
both collateral and secondary restraints
Collateral ligament testing: secondary restraints
cruciate ligaments
Collateral ligament testing: higher sensitivity/specificity with (valgus/varus) stress testing
valgus
Collateral ligament testing: higher sensitivity or specificity for pain and laxity?
sensitivity
(+) Anterior drawer = (#) mm translation with endfeel
6 mm
Anterior drawer tests this bundle of ACL
anteromedial
ACL testing: Which test is better for chronic ACL tears?
Anterior drawer
ACL testing: Anterior drawer
sensitivity
55%
ACL testing: Anterior drawer
specificity
92%
ACL testing: Lachman
tests this bundle
posterolateral
ACL testing: gold standard for ACL
Lachman
ACL testing: Lachman
sensitivity
85%
ACL testing: Lachman
specificity
94%
ACL testing: This test may be limited d/t significant pt guarding clinically
pivot shift
ACL testing: pivot shift
specificity
98%
ACL testing: pivot shift
sensitivity
24% clinically
ACL testing: must beware of false (positives/negatives)
positives
ACL testing: If this structure is injured, the tibia may be posteriorly subluxed and cause a false (+) ACL
PCL
PCL testing: tibial (ER/IR) tightens the PCL
tibial ER
PCL testing: interpretation
If laxity increases with ER, consider…
posterolateral corner injury
PCL testing: posterior drawer
sensitivity
90%
PCL testing: posterior drawer
specificity
99%
PCL testing: posterior sag
sensitivity
79%
PCL testing: posterior sag
specificity
100%
Posterolateral corner: composed of these structures
- arcuate ligament
- LCL
- popliteal tendon
- lateral head of gastroc
Posterolateral corner: tests
- posterolateral drawer
- prone ER test (dial test)
- reverse pivot shift test
- ER recurvatum test