Knee: Examination 2 Flashcards
Meniscal testing: McMurray
higher sensitivity or specificity
specificity (low to mod sensitivity)
Meniscal testing: McMurray
Higher specificity for medial or lateral?
lateral
Meniscal testing: McMurray (lateral)
specificity
94%
Meniscal testing: McMurray
specificity - medial
77%
Meniscal testing: What are the main special tests
- McMurray
- Apley compression
- JL tenderness
- Thessaly
JL tenderness: more sensitive or specific?
sensitivity > specificity
Meniscal testing: JL tenderness
sensitivity - medial
83%
Meniscal testing: JL tenderness
sensitivity - lateral
68%
Meniscal testing: Thessaly
sensitivity/specificity
- sens: 64%
- spec: 53%
What is the meniscal cluster?
- hx catching or locking
- JL tenderness
- pain with flexion OP
- pain with ext OP
- pain or audible click with McMurray
Meniscal Cluster: with 5/5 variables, get high specificity of
99%
Meniscal Cluster: 4+ variables
specificity
96%
Meniscal Cluster: high specificity, (high/low) sensitivity
low
PFPS is a diagnosis of
exclusion
PFPS: what to assess
- resisted knee ext through ROM
- step down test
- patellar mobility - apprehension test
- patellar compression
- posteromedial and lateral borders of patella
- strength testing
functional testing: higher level
L to R comparisons should be within (%) for return to sport
80-85%
functional testing: higher level
Commonly used tests
- Noyes hop tests
- Star excursion balance test
- Y balance
functional testing: higher level
Noyes Hop Tests
- single hop for distance
- triple hop for distance
- timed 6m hop test
- cross over hop for distance
functional testing: higher level
Y balance
Different > (#) cm in anterior direction = higher risk of injury
> 4 cm difference
functional testing: higher level
Y balance
Difference in > 4 cm in anterior direction = (#)x risk of injury
2.5x risk of injury
functional testing: lower level (list)
- timed stair climbing test
- 6MWT
- TUG
- 5x STS
- self-selected walking speed
functional testing: lower level
What does the 6MWT measure?
submaximal aerobic capacity
Red flags:
With normal knee exam or unexplained pain onset, consider:
- referral from lumbar, SIJ, hip
- lumbar radiculopathy
- SCFE
- OCD
- Legg-Calve-Perthes disease
joint mobility: for flexion
(anterior/posterior) glide of tibia on femur
posterior
joint mobility: for flexion
Superior/inferior patellar glide
inferior
joint mobility: for extension
(anterior/posterior) glide of tibia on femur
anterior
joint mobility: for extension
(superior/inferior) patellar glide
superior
Flexibility: things to look at with the knee
- hip IR/ER
- hip flexors/extensors
- quads
- HS
- ankle DF (gastroc/soleus)
Strength: quad deficits of ≥ (%) L to R indicate using NMES
15-20%
Strength: be sure to incorporate these types of exercises
single leg
eccentrics
Strength: increased injury risk with imbalances between
quadriceps to hamstring strength ratio
Strength: for return to sport, males should have > (%) quad to ham ratio
> 66%
Strength: for return to sport, females should have > (%) quad to ham ratio
> 75%
Motor control: use these
- balance
- dynamic joint stability training
- perturbation exercises
- plyometrics
- agility and coordination training
- sport specific exercises
