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Knee Examination Flashcards

1
Q

What are the 3 joints of the knee complex

A
  1. Tibiofemoral
  2. Patellofemoral
  3. Proximal tibiofibula
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2
Q

True or False:

The LCL attaches to the fibular head

A

True

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3
Q

What is the normal range of knee flexion

A

10-0-135

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4
Q

What is the normal knee extension

A

10 hyperextension

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5
Q

What is the loose pack position of the tibiofemoral joint

A

25 flexion

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6
Q

What is the closed pack position of the tibiofemoral joint

A

Full extension and full tibial ER

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7
Q

What can pain in the back of the knee be (3)

A
  1. Baker’s cyst
  2. Sciatic nerve
  3. Arthritis
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8
Q

What can pain above the patella be (2)

A
  1. Quad tendon pathology

2. Swelling

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9
Q

What can pain on or behind the patella be (4)

A
  1. Chondromalacia patella
  2. Patellar tracking
  3. Bursitis
  4. Arthritis
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10
Q

What can pain below the patella be (2)

A
  1. Osgood schlatter disease

2. Patellar tendinitis

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11
Q

What can pain on the side of the knee be (3)

A
  1. Meniscal tears
  2. Collateral ligament tears
  3. Arthritis
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12
Q

What questionnaire is specific for OA

A

WOMAC

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13
Q

What questionnaire is specific for all LE conditions

A

LE functional scale

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14
Q

What questionnaire is specific for ligament and menisci

A

Lysholm knee scale

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15
Q

What questionnaire is specific for ligamen

A

International knee doc comm questionnaire

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16
Q

What 2 questionnaires are non specific

A
  1. Cincinnati knee rating system

2. Knee outcome survey

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17
Q

Where can L3-L4 refer

A

Anterior thigh

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18
Q

Where can S2-S3 refer

A

Posterior thigh

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19
Q

Where can the acetabulofemoral joint refer to

A

Anterior knee

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20
Q

True or False:

Older people have more frontal plane motion eliminating transverse plane motion resulting in waddling

A

True

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21
Q

What are the Ottawa knee rules (5)

A
  1. Older than 55
  2. Tenderness at the head of fibula
  3. Isolated tenderness of patella
  4. Inability to flex knee to 90 degrees
  5. Inability to walk 4 WB steps immediately after injury AND in the emergency room (ER)
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22
Q

What are the Pittsburgh decision rules (3)

A
  1. Blunt Trauma or a fall as MOI and either of the following
  2. Less than 12 or older tha 50
  3. Inability to walk 4 WB steps in the ER
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23
Q

What can clicking be indicative of (1)

A
  1. Meniscal tear
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24
Q

What can snapping be indicative of (2)

A
  1. Synovial plica

2. Tendon over bone

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25
What can grating be indicative of (3)
1. Chondromalacia 2. OA 3. Osteochondritis
26
What can tearing be indicative of (2)
1. Muscle | 2. Ligament
27
What can catching be indicative of (2)
1. Meniscal tear | 2. Subluxing patella
28
What can popping be indicative of (4)
1. Meniscal tear 2. ACL tear 3. Muscle 4. Ligament
29
What can tingling be indicative of (2)
1. Nerve | 2. Circulation
30
What can hyperesthesia be indicative of (1)
1. Nerve
31
What can warmth be indicative of (1)
Inflammation
32
What is hyperesthesia
Abnormally increased physical sensitivity particularly to touch sensations
33
What can pain at rest be indicative of (1)
1. Usually inflammatory process
34
What can pain with activity be indicative of (1)
1. Structural problem
35
What can pain after activity be indicative of (1)
1. Inflammatory
36
What can pain that is worse in the am be (2)
1. Arthritis | 2. Chronic inflammatin
37
What can pain that is worse going up stairs be (1)
1. Anterior horns of menisci
38
What can pain that is worse going down stairs be (1)
1. Posterior horns of menisci
39
What are the potential patellofemoral dysfunctions (4)
1. Chondromalacia 2. Patellar subluxation/dislocation 3. Patellar tendonitis 4. Pre-patellar bursitis
40
What are the MOI chondromalacia patella (5)
1. Repetitive trauma 2. Patella alta 3. Patella baja 4. Squinting patella 5. Frog eye patella
41
What are the symptoms of chondromalacia patella (2)
1. Retropatellar pain | 2. Pain with going up and down stairs, running, and squats
42
What are the MOI of patellar subluxation (2)
1. Normal function with poor alignment (lateral retinacular tightness) 2. Influence of Q angle
43
What are the MOI of patellar dislocation (2)
1. Repetitive trauma | 2. Acute trauma
44
What are the symptoms of patella subluxation/dislocation (2)
1. Apprehension | 2. Pain
45
What are the MOI of patellar tendonitis (3)
1. Repetitive trauma 2. Usually insidious onset 3. Sports involving large eccentric load to quads
46
What are the symptoms of patellar tendonitis (4)
1. Anterior knee pain 2. Pain with palpation at the inferior pole of patella 3. Pain with jumping or kneeling 4. Pain during and/or after activity
47
What are the MOI of prepatellar bursitis (3)
1. Repeated friction 2. Trauma 3. Repetitive trauma
48
What are the symptoms of pre patellar bursitis (4)
1. Redness 2. Effusion directly over patella 3. Difficulty with ambulation 4. Inability to kneel
49
What are the MOI of meniscal injuries (3)
1. Valgus or varus force applied to a flexed knee 2. Forced medial rotation 3. Force lateral rotation
50
Which meniscus is insulted with IR and ER
IR: lateral meniscus ER: medial meniscus
51
What are the symptoms of meniscal injuries (5)
1. Acute joint line pain with palpation 2. Effusion 3. Locking, click, snap 4. Catching 5. Giving way feeling
52
What are the MOI of ACL laxity (3)
1. Sudden cut or deceleration 2. Rotational motion combined with varus or valgus force 3. Hyperextension
53
What are the symptoms of ACL laxity (6)
1. Felt/heard pop 2. Persistent pain if partial tear no pain full tear 3. Swelling 4. Hemarthrosis 5. Loss of ROM 6. Giving way feeling
54
What are the MOI of PCL laxity (3)
1. Hyperflexion (dash board injury or soccer slide tackle) 2. Hyperextension 3. Rotational motion with varus or valgus force
55
What are the symptoms of PCL laxity (5)
1. Felt/heard pop 2. Diffuse posterior knee pain 3. Swelling 4. Hemarthrosis 5. Inability to WB
56
What are the MOI of MCL laxity (3)
1. Acute valgus force applied to the knee 2. Excessive lateral rottion 3. Overuse syndromes (swimmer during breast stroke)
57
What are the symptoms of MCL laxity (3)
1. Localized pain and stiffness 2. Ecchymosis may appear after several days 3. Swelling
58
What are the MOI of LCL laxity (2)
1. Acute varus force applied to the knee | 2. Excessive lateral rotation
59
What are the symptoms of LCL laxity (3)
1. Localized pain and stiffness 2. Ecchymosis may appear after several days 3. Swelling
60
What is the capsular pattern of the knee
Flexion greater than extension
61
What are the MOI of musculotendinous injury (4)
1. Poor foot wear 2. Tight musculature 3. Overuse 4. Muscle imbalance
62
What are the symptoms of musculotendinous injury (1)
1. Pain with active contraction of muscle and passive lengthening of muscle
63
What are the MOI of ITB syndrome (2)
1. Repetitive use | 2. Misalignment
64
What are the symptoms of ITB syndrome (3)
1. Pain at lateral aspect of knee 2. Worsens with activity 3. My report popping noise during walking or running
65
What are the 6 criteria for diagnosis of OA
1. Older than 50 2. Stiffness longer than 30 minutes 3. Crepitus 4. Bony tenderness 5. Bony enlargement 6. No palpable warmth
66
What are the symptoms of OA (1)
1. Pain and stiffness in the particularly in the morning or after periods of rest
67
What is the MOI of a Baker's cyst (2)
1. May be associated with OA, RA, JRA, and gout | 2. May be related to medial meniscal damage
68
What are the symptoms of a Baker's cyst (3)
1. Popliteal mass or swelling 2. Aching 3. Knee effusion
69
Diagnose: Traumatic onset of knee pain that occurred during jumping, twisting or changing directions with a planted foot (5)
1. ACL tear 2. MCL tear 3. Meniscal tear 4. Patella subluxation 5. Quadriceps tendon rupture
70
Diagnose: Traumatic injury that resulted in a posterior directed force to tibia with knee flexed (1)
1. PCL
71
Diagnose: Traumatic injury that resulted in a varus of valgus force exerted on the knee (2)
1. LCL | 2. MCL
72
Diagnose: Anterior knee pain with jumping and full knee flexion (2)
1. Patellar tendonitis | 2. Patellofemoral pain syndrome (PFPS)
73
Diagnose: Swelling in the knee with occasional locking and clicking (2)
1. Meniscal tear | 2. Loose body in joint
74
Diagnose: Pain with prolonged knee flexion, during deep squatting and while going up and down stairs (1)
1. Patellofemoral pain syndrome (PFPS)
75
Diagnose: Pain and stiffness in the morning that diminishes after a few hours (1)
1. OA
76
What is the certainty of meniscal tear if there are complaints of locking in the knee and sensation that the leg is going to give out
94%
77
What is swelling 30 minutes to 2 hours after injury indicative of
Hemarthrosis
78
What is swelling 6-24 hours after injury indicative of
Synovial origin
79
What is considered normal knee position slight varus or valgus
Slight valgus
80
What can patella baja be caused by (1)
1. Quadriceps tendon overload
81
What can patella alta be caused by (3)
1. Patellar ligament overload 2. Q angle less than 13 3. Camel sign
82
What is the camel sign
Double hump where the first hump is the patella and the second hump is the patella fat pad
83
What are the MOI of osgood schlatters (3)
1. Indirect trauma or repetitive stress to attachment of patellar ligament and tibial tuberosity 2. Sudden powerful contraction of quadriceps 3. Repeated knee flexion against tight quadriceps
84
What are the symptoms of osgood schlatters (5)
1. Ache and pain at tibial tuberosity 2. Enlarged tibial tuberosity 3. Swelling 4. Heat and tenderness over area 5. Pain increased by activity that increases tension to tibial tuberosity
85
What are the 6 things you should observe about a lesion site
1. Edema or effusion 2. Bruising 3. Scarring 4. Color 5. Deformity 6. Posture
86
True or False: | The last thing you want to do with a patient with osgood schlatters problems is stretching
True
87
What are the 5 reasons to perform a LQS
1. No history of trauma 2. Referred or radicular symptoms 3. Doubt about the location of pathology 4. Abnormal collection of symptoms 5. Altered sensation
88
What does the same ROM supine and prone mean at the knee
Good flexibility
89
What is considered normal hamstring length at 90/90
Equal to or less than 25 degrees
90
What can cause AROM insufficiency (10)
1. Weakness 2. Tensile load intolerance 3. Nerve involvement 4. Effusion/swelling 5. Active insufficiency 6. Guarding 7. Tight capsule 8. Muscle strain 9. Passive insufficiency 10. Loose body
91
What can cause PROM insufficiency (5)
1. Tight CT 2. Pasive insufficiency 3. Loose body 4. Guarding/apprehension 5. Pain
92
If you do not perform a LQS what muscle performance test should you do first
Resisted isometrics
93
Based on the results of the resisted isometrics what other muscle performance testing should be done (2)
1. FTPO (painful resisted isometrics) | 2. MMT (pain free resisted isometrics)
94
What is the ballotable patella/patellar tap test
Pt is in long sit and examiner places one hand above knee and the other hand pushes the patella in a posterior direction
95
What is a positive ballotable patella/patellar tap test
Patella floats back up not springs right back
96
What is considered major effusion
Ballotment of patella
97
What is considered mild effusion
The fluid can be milked down over time
98
What is considered extracapsular edema
Superficial fluid
99
What is considered intracapsular edema
Intracapsular fluid
100
What is the mediopatellar plica test
Pt supine with knee flexed to 10-20, palpate plica and push patella medially
101
What is a positive mediopatellar plica test
Pain on medial side of patella
102
What is Clark's sign/patellar grind test
Pt supine with knee supported in 0 neutral and PT uses web space to push patella down and then patient contracts quad
103
What is a positive Clark's sign/patellar grind test
Crepitus or pain the patient came in with
104
What is a positive Clark's sign/patellar grind test make you suspicious of
Chondromalacia patella
105
What are all of the test positions of the knee for Clark's sign/patellar grind test
0, 20, 45, 60, 90, 120
106
What is a normal Q angle for men and women
Men: 13 Women: 18
107
What does an increased Q angle put the patient at risk for
Lateral patellar tracking
108
What are the land marks for measuring the Q angle
ASIS, middle of patella, and tibial tuberosity
109
What are the 2 part of the patellofemoral joint apprehension test
1. Lateral patellar glide | 2. Medial patellar glide
110
What are the lateral and medial patellar glide tests
Patient is supine with knee in full extension and PT pushes the patella slowly medial and lateral and it is repeated at 20 and 45 degrees
111
What is a positive lateral patellar glide test
Patella glides laterally 1/2 the width of the patella
112
What is a positive medial patellar glide test
Patella glides 30-40% the width of the patella or more than 10mm
113
What is a risk of patellofemoral joint apprehension test
Dislocation
114
What is the figure 4 test
Pt is supine and places ankle over opposite knee and PT pushes knee into table while stabilizing contralateral ASIS
115
What is a positive figure 4 test
Pain over lateral joint line at popliteal hiatus indicative of lateral meniscus tear
116
What is Payr's sign
Pt sits with ankle over opposite knee and PT pushes down on knee
117
what is a positive Payr's sign
Pain over medial joint line indicative of a posterior horn lesion of the medial meniscus
118
What is the squat test/duck waddle/childress test
Pt is standing then squats and if no pain pt is asked to duck walk in the squat
119
What is a positive squat test/duck waddle/childress test
A block preventing full flexion or pain at end range flexion indicative of meniscal tear
120
What is the dynamic test
Pt supine with hip ABD 60 flexed 45 and ER knee flexed 90 and lateral border of foot on table and PT palpates lateral joint line then slowly ADD hip while maintaining knee at 90
121
What is a positive dynamic test
Sharp pain at the end of hip ADD or increased pain above what was elicited with only lateral joint line palpation
122
What is Thessaly test at 5
Pt stands facing PT and grabs PT's hand then just relaxes leg and IR and ER and repeat 3 times
123
What is a positive Thessaly test at 5
Joint line discomfort and sense of locking or catching indicates meniscal tear
124
What is Thessaly test at 20/disco test
Pt standing facing PT and grabs PT's hand then flexes knee 20 and IR and ER and repeat 3 times
125
What is a positive Thessaly test at 20/disco test
Joint line discomfort and sense of locking or catching indicates meniscal tear
126
What is McMurray click test
Pt supine PT stands on involved side grasps heal, flexes knee to end range and palpating medial and lateral joint line then ER and IR and extend knee
127
What does ER and extension of the knee assess
Medial meniscus
128
What does IR and extension of the knee assess
Lateral meniscus
129
What is a positive McMurray click test
Audible or palpable thud or click
130
What is Apley's test
Pt prone and PT puts knee on pt hamstring with knee flexed to 90 and PT distracts and rotates tibia then compresses knee joint and rotates tibia
131
What is a positive Apley's test during the distraction portion
Worse pain with rotation indicative of soft tissue rotation sprain
132
What is a positive Apley's test during the compression portion
Worse pain with compression than distraction indicative of meniscal tear
133
What is the valgus stress test
Pt supine with hip slightly ABD knee flexed to 30 and PT applies medially directed force at lateral joint line with tibia ER then repeat in extension
134
What is a positive valgus stress test at 30
Excessive medial opening and concordant pain when compared to uninvolved knee implicates MCL
135
What does a positive valgus stress test at 0
Then ACL/PCL and/or joint capsule is implicated
136
What is the varus stress test
Pt supine with hip slightly ABD knee flexed to 30 and PT applies laterally directed force at medial joint line with tibia IR then repeat in extension
137
What is a positive varus stress test at 30
Excessive lateral opening and concordant pain when compared to the uninvolved knee implicates LCL
138
What does a positive varus stress test at 0
Then ACL/PCL and/or joint capsule is implicated
139
What is Godfrey's test
Pt supine with hip and knee flexed to 90 and PT or chair supports under calf
140
What is a positive Godfrey's test
Posterior sagging of the tibia secondary to gravitational pull
141
What is the posterior sag sign
Hip 45 flexion knee 90 flexion
142
What is a positive posterior sag sign
Posterior tibial translation
143
What is the posterior drawer test
Pt supine with knee flexed to 90 hip flexed to 45 and neutral foot angle PT sits on pt foot then translates tibia posteriorly and repeat with foot IR and ER
144
What is a positive posterior drawer test
Dependent upon motion compared to uninvolved leg grade 1, 2, or 3
145
What is a grade 1 posterior drawer test
0-5mm motion
146
What is a grade 2 posterior drawer test
6-10mm motion
147
What is a grade 3 posterior drawer test
11 or more mm motion
148
What is the anterior drawer test
Pt supine knee flexed to 90 and foot flat on table PT sits on pt foot then translates tibia anteriorly with fingers palpating medial and lateral hamstring
149
What is a positive anterior drawer test
Greater anterior tibial displacement on affected side compared to unaffected side
150
What is Lachman's test
Pt supine with knee flexed to 15 and PT stabilized distal femur and applies and anterior tibial force to proximal tibial
151
How does the PT get the knee into 15 flexion
By putting their knee under the pt's knee
152
What is a positive Lachman's test
Greater anterior tibial displacement on affected side when compared to the unaffected side
153
What is the gold standard test for ACL testing
Lachman's test
154
What is Hughston's test
Pt hook lying knee flexed to 90 with IR/ER PT sits on pt's foot and applies posterior forces moving tibia on femur while palpating joint line
155
What is a positive Hughston's test
Excessive motion with IR or ER rotation
156
What does a positive Hughston's test with IR and ER mean
IR: Posteromedial rotary instability ER: Posterolateral rotary instability
157
What is Slocum test
Pt hook lying knee flexed to 90 with IR/ER PT sits on pt's foot and applies an anterior directed force of the tibia on the femur
158
What is a positive slocum test
Excessive motion with IR and ER
159
What does a positive slocum test with IR and ER mean
IR: Anterolateral rotary instability ER: Anteromedial rotary instability
160
What is the pivot shift test (Test of MacIntosh)
Pt assumes a supine position and PT positions pt's LE into 10-15 knee flexion and IR and applies a valgus force with hand then slowly flexes the knee beyond 30 degrees keeping IR
161
What is a positive pivot shift test (Test of MacIntosh)
Audible or palpable thud or click
162
What is the reverse pivot shift test (Jakob test)
Pt supine with knee flexed to 70-80 with ER gravity assists the knee into extension as PT slightly leans against the foot transmitting an axial load and valgus force to the knee
163
What can be felt and observed around 20 knee flexion during the reverse pivot shift test
Lateral tibial plateau moving anteriorly shifting from a posterior position of subluxation into neutral rotation
164
What is a positive reverse pivot shift test (Jakob test)
Reduction of the tibial head
165
What is Ober's test
Pt side lying hip and knee flexed PT extends and ABD upper leg passively allowing the leg to lower towards the table while stabilizing the pevis
166
True or False: | Ober's test is performed with the knee flexed and extended
True
167
What is a positive Ober's test
If leg remains ABD
168
What does the leg remaining ABD eman during Ober's test
A contracture is present
169
What is the nobel compression test
Pt supine with knee flexed to 90 and hip flexed, PT applies pressure over lateral femoral condyle or 1-2 cm proximal and then the pt extends the knee while PT maintains pressure
170
What is a positive nobel compression test
At approximately 30 flexion the pt complains of extreme pain over the lateral femoral condyle
171
What does a positive nobel compression test indicate
ITB friction syndrome
172
What are the special tests that address patellofemoral problems (5)
1. Ballotable patella/patellar tap test 2. Mediopatellar plica test 3. Clarks sign/patellar grind test 4. Measure Q angle 5. Patellofemoral joint apprehension test
173
What are the special tests that address meniscal problems (8)
1. Figure 4 test 2. Payr's sign 3. Squat test/duck waddle/childress test 4 Dynamic test 5. Thessaly test at 5 6. Thessaly test at 20/disco test 7. McMurray click test 8. Apley's test
174
What is the special test for MCL integrity
Valgus stress test
175
What is the special test for LCL integrity
Varus stress test
176
What are the special tests for PCL intergrity (2)
1. Posterior sag sign/godfrey's test 2. Posterior drawer test 3. Valgus stress test at 0 4. Varus stress test at 0
177
What are the special tests for ACL integrity (4)
1. Anterior drawer test 2. Lachman's test 3. Valgus stress test at 0 4. Varus stress test at 0
178
What are the special tests for ligamentous rotary instability (4)
1. Hughston's test 2. Slocum test 3. Pivot shift test/test of MacIntosh 4. Reverse pivot shift test/Jakob test
179
What are the special tests for the ITB (2)
1. Ober's test | 2. Nobel compression test

Musculo 2 (3 decks)

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