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Musculo 2 > Knee Examination > Flashcards

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
Q

What can grating be indicative of (3)

A
  1. Chondromalacia
  2. OA
  3. Osteochondritis
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26
Q

What can tearing be indicative of (2)

A
  1. Muscle

2. Ligament

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27
Q

What can catching be indicative of (2)

A
  1. Meniscal tear

2. Subluxing patella

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28
Q

What can popping be indicative of (4)

A
  1. Meniscal tear
  2. ACL tear
  3. Muscle
  4. Ligament
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29
Q

What can tingling be indicative of (2)

A
  1. Nerve

2. Circulation

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30
Q

What can hyperesthesia be indicative of (1)

A
  1. Nerve
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31
Q

What can warmth be indicative of (1)

A

Inflammation

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32
Q

What is hyperesthesia

A

Abnormally increased physical sensitivity particularly to touch sensations

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33
Q

What can pain at rest be indicative of (1)

A
  1. Usually inflammatory process
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34
Q

What can pain with activity be indicative of (1)

A
  1. Structural problem
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35
Q

What can pain after activity be indicative of (1)

A
  1. Inflammatory
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36
Q

What can pain that is worse in the am be (2)

A
  1. Arthritis

2. Chronic inflammatin

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37
Q

What can pain that is worse going up stairs be (1)

A
  1. Anterior horns of menisci
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38
Q

What can pain that is worse going down stairs be (1)

A
  1. Posterior horns of menisci
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39
Q

What are the potential patellofemoral dysfunctions (4)

A
  1. Chondromalacia
  2. Patellar subluxation/dislocation
  3. Patellar tendonitis
  4. Pre-patellar bursitis
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40
Q

What are the MOI chondromalacia patella (5)

A
  1. Repetitive trauma
  2. Patella alta
  3. Patella baja
  4. Squinting patella
  5. Frog eye patella
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41
Q

What are the symptoms of chondromalacia patella (2)

A
  1. Retropatellar pain

2. Pain with going up and down stairs, running, and squats

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42
Q

What are the MOI of patellar subluxation (2)

A
  1. Normal function with poor alignment (lateral retinacular tightness)
  2. Influence of Q angle
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43
Q

What are the MOI of patellar dislocation (2)

A
  1. Repetitive trauma

2. Acute trauma

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44
Q

What are the symptoms of patella subluxation/dislocation (2)

A
  1. Apprehension

2. Pain

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45
Q

What are the MOI of patellar tendonitis (3)

A
  1. Repetitive trauma
  2. Usually insidious onset
  3. Sports involving large eccentric load to quads
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46
Q

What are the symptoms of patellar tendonitis (4)

A
  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
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47
Q

What are the MOI of prepatellar bursitis (3)

A
  1. Repeated friction
  2. Trauma
  3. Repetitive trauma
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48
Q

What are the symptoms of pre patellar bursitis (4)

A
  1. Redness
  2. Effusion directly over patella
  3. Difficulty with ambulation
  4. Inability to kneel
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49
Q

What are the MOI of meniscal injuries (3)

A
  1. Valgus or varus force applied to a flexed knee
  2. Forced medial rotation
  3. Force lateral rotation
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50
Q

Which meniscus is insulted with IR and ER

A

IR: lateral meniscus
ER: medial meniscus

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51
Q

What are the symptoms of meniscal injuries (5)

A
  1. Acute joint line pain with palpation
  2. Effusion
  3. Locking, click, snap
  4. Catching
  5. Giving way feeling
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52
Q

What are the MOI of ACL laxity (3)

A
  1. Sudden cut or deceleration
  2. Rotational motion combined with varus or valgus force
  3. Hyperextension
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53
Q

What are the symptoms of ACL laxity (6)

A
  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
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54
Q

What are the MOI of PCL laxity (3)

A
  1. Hyperflexion (dash board injury or soccer slide tackle)
  2. Hyperextension
  3. Rotational motion with varus or valgus force
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55
Q

What are the symptoms of PCL laxity (5)

A
  1. Felt/heard pop
  2. Diffuse posterior knee pain
  3. Swelling
  4. Hemarthrosis
  5. Inability to WB
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56
Q

What are the MOI of MCL laxity (3)

A
  1. Acute valgus force applied to the knee
  2. Excessive lateral rottion
  3. Overuse syndromes (swimmer during breast stroke)
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57
Q

What are the symptoms of MCL laxity (3)

A
  1. Localized pain and stiffness
  2. Ecchymosis may appear after several days
  3. Swelling
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58
Q

What are the MOI of LCL laxity (2)

A
  1. Acute varus force applied to the knee

2. Excessive lateral rotation

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59
Q

What are the symptoms of LCL laxity (3)

A
  1. Localized pain and stiffness
  2. Ecchymosis may appear after several days
  3. Swelling
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60
Q

What is the capsular pattern of the knee

A

Flexion greater than extension

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61
Q

What are the MOI of musculotendinous injury (4)

A
  1. Poor foot wear
  2. Tight musculature
  3. Overuse
  4. Muscle imbalance
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62
Q

What are the symptoms of musculotendinous injury (1)

A
  1. Pain with active contraction of muscle and passive lengthening of muscle
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63
Q

What are the MOI of ITB syndrome (2)

A
  1. Repetitive use

2. Misalignment

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64
Q

What are the symptoms of ITB syndrome (3)

A
  1. Pain at lateral aspect of knee
  2. Worsens with activity
  3. My report popping noise during walking or running
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65
Q

What are the 6 criteria for diagnosis of OA

A
  1. Older than 50
  2. Stiffness longer than 30 minutes
  3. Crepitus
  4. Bony tenderness
  5. Bony enlargement
  6. No palpable warmth
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66
Q

What are the symptoms of OA (1)

A
  1. Pain and stiffness in the particularly in the morning or after periods of rest
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67
Q

What is the MOI of a Baker’s cyst (2)

A
  1. May be associated with OA, RA, JRA, and gout

2. May be related to medial meniscal damage

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68
Q

What are the symptoms of a Baker’s cyst (3)

A
  1. Popliteal mass or swelling
  2. Aching
  3. Knee effusion
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69
Q

Diagnose: Traumatic onset of knee pain that occurred during jumping, twisting or changing directions with a planted foot (5)

A
  1. ACL tear
  2. MCL tear
  3. Meniscal tear
  4. Patella subluxation
  5. Quadriceps tendon rupture
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70
Q

Diagnose: Traumatic injury that resulted in a posterior directed force to tibia with knee flexed (1)

A
  1. PCL
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71
Q

Diagnose: Traumatic injury that resulted in a varus of valgus force exerted on the knee (2)

A
  1. LCL

2. MCL

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72
Q

Diagnose: Anterior knee pain with jumping and full knee flexion (2)

A
  1. Patellar tendonitis

2. Patellofemoral pain syndrome (PFPS)

73
Q

Diagnose: Swelling in the knee with occasional locking and clicking (2)

A
  1. Meniscal tear

2. Loose body in joint

74
Q

Diagnose: Pain with prolonged knee flexion, during deep squatting and while going up and down stairs (1)

A
  1. Patellofemoral pain syndrome (PFPS)
75
Q

Diagnose: Pain and stiffness in the morning that diminishes after a few hours (1)

A
  1. OA
76
Q

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

A

94%

77
Q

What is swelling 30 minutes to 2 hours after injury indicative of

A

Hemarthrosis

78
Q

What is swelling 6-24 hours after injury indicative of

A

Synovial origin

79
Q

What is considered normal knee position slight varus or valgus

A

Slight valgus

80
Q

What can patella baja be caused by (1)

A
  1. Quadriceps tendon overload
81
Q

What can patella alta be caused by (3)

A
  1. Patellar ligament overload
  2. Q angle less than 13
  3. Camel sign
82
Q

What is the camel sign

A

Double hump where the first hump is the patella and the second hump is the patella fat pad

83
Q

What are the MOI of osgood schlatters (3)

A
  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
Q

What are the symptoms of osgood schlatters (5)

A
  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
Q

What are the 6 things you should observe about a lesion site

A
  1. Edema or effusion
  2. Bruising
  3. Scarring
  4. Color
  5. Deformity
  6. Posture
86
Q

True or False:

The last thing you want to do with a patient with osgood schlatters problems is stretching

A

True

87
Q

What are the 5 reasons to perform a LQS

A
  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
Q

What does the same ROM supine and prone mean at the knee

A

Good flexibility

89
Q

What is considered normal hamstring length at 90/90

A

Equal to or less than 25 degrees

90
Q

What can cause AROM insufficiency (10)

A
  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
Q

What can cause PROM insufficiency (5)

A
  1. Tight CT
  2. Pasive insufficiency
  3. Loose body
  4. Guarding/apprehension
  5. Pain
92
Q

If you do not perform a LQS what muscle performance test should you do first

A

Resisted isometrics

93
Q

Based on the results of the resisted isometrics what other muscle performance testing should be done (2)

A
  1. FTPO (painful resisted isometrics)

2. MMT (pain free resisted isometrics)

94
Q

What is the ballotable patella/patellar tap test

A

Pt is in long sit and examiner places one hand above knee and the other hand pushes the patella in a posterior direction

95
Q

What is a positive ballotable patella/patellar tap test

A

Patella floats back up not springs right back

96
Q

What is considered major effusion

A

Ballotment of patella

97
Q

What is considered mild effusion

A

The fluid can be milked down over time

98
Q

What is considered extracapsular edema

A

Superficial fluid

99
Q

What is considered intracapsular edema

A

Intracapsular fluid

100
Q

What is the mediopatellar plica test

A

Pt supine with knee flexed to 10-20, palpate plica and push patella medially

101
Q

What is a positive mediopatellar plica test

A

Pain on medial side of patella

102
Q

What is Clark’s sign/patellar grind test

A

Pt supine with knee supported in 0 neutral and PT uses web space to push patella down and then patient contracts quad

103
Q

What is a positive Clark’s sign/patellar grind test

A

Crepitus or pain the patient came in with

104
Q

What is a positive Clark’s sign/patellar grind test make you suspicious of

A

Chondromalacia patella

105
Q

What are all of the test positions of the knee for Clark’s sign/patellar grind test

A

0, 20, 45, 60, 90, 120

106
Q

What is a normal Q angle for men and women

A

Men: 13
Women: 18

107
Q

What does an increased Q angle put the patient at risk for

A

Lateral patellar tracking

108
Q

What are the land marks for measuring the Q angle

A

ASIS, middle of patella, and tibial tuberosity

109
Q

What are the 2 part of the patellofemoral joint apprehension test

A
  1. Lateral patellar glide

2. Medial patellar glide

110
Q

What are the lateral and medial patellar glide tests

A

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
Q

What is a positive lateral patellar glide test

A

Patella glides laterally 1/2 the width of the patella

112
Q

What is a positive medial patellar glide test

A

Patella glides 30-40% the width of the patella or more than 10mm

113
Q

What is a risk of patellofemoral joint apprehension test

A

Dislocation

114
Q

What is the figure 4 test

A

Pt is supine and places ankle over opposite knee and PT pushes knee into table while stabilizing contralateral ASIS

115
Q

What is a positive figure 4 test

A

Pain over lateral joint line at popliteal hiatus indicative of lateral meniscus tear

116
Q

What is Payr’s sign

A

Pt sits with ankle over opposite knee and PT pushes down on knee

117
Q

what is a positive Payr’s sign

A

Pain over medial joint line indicative of a posterior horn lesion of the medial meniscus

118
Q

What is the squat test/duck waddle/childress test

A

Pt is standing then squats and if no pain pt is asked to duck walk in the squat

119
Q

What is a positive squat test/duck waddle/childress test

A

A block preventing full flexion or pain at end range flexion indicative of meniscal tear

120
Q

What is the dynamic test

A

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
Q

What is a positive dynamic test

A

Sharp pain at the end of hip ADD or increased pain above what was elicited with only lateral joint line palpation

122
Q

What is Thessaly test at 5

A

Pt stands facing PT and grabs PT’s hand then just relaxes leg and IR and ER and repeat 3 times

123
Q

What is a positive Thessaly test at 5

A

Joint line discomfort and sense of locking or catching indicates meniscal tear

124
Q

What is Thessaly test at 20/disco test

A

Pt standing facing PT and grabs PT’s hand then flexes knee 20 and IR and ER and repeat 3 times

125
Q

What is a positive Thessaly test at 20/disco test

A

Joint line discomfort and sense of locking or catching indicates meniscal tear

126
Q

What is McMurray click test

A

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
Q

What does ER and extension of the knee assess

A

Medial meniscus

128
Q

What does IR and extension of the knee assess

A

Lateral meniscus

129
Q

What is a positive McMurray click test

A

Audible or palpable thud or click

130
Q

What is Apley’s test

A

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
Q

What is a positive Apley’s test during the distraction portion

A

Worse pain with rotation indicative of soft tissue rotation sprain

132
Q

What is a positive Apley’s test during the compression portion

A

Worse pain with compression than distraction indicative of meniscal tear

133
Q

What is the valgus stress test

A

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
Q

What is a positive valgus stress test at 30

A

Excessive medial opening and concordant pain when compared to uninvolved knee implicates MCL

135
Q

What does a positive valgus stress test at 0

A

Then ACL/PCL and/or joint capsule is implicated

136
Q

What is the varus stress test

A

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
Q

What is a positive varus stress test at 30

A

Excessive lateral opening and concordant pain when compared to the uninvolved knee implicates LCL

138
Q

What does a positive varus stress test at 0

A

Then ACL/PCL and/or joint capsule is implicated

139
Q

What is Godfrey’s test

A

Pt supine with hip and knee flexed to 90 and PT or chair supports under calf

140
Q

What is a positive Godfrey’s test

A

Posterior sagging of the tibia secondary to gravitational pull

141
Q

What is the posterior sag sign

A

Hip 45 flexion knee 90 flexion

142
Q

What is a positive posterior sag sign

A

Posterior tibial translation

143
Q

What is the posterior drawer test

A

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
Q

What is a positive posterior drawer test

A

Dependent upon motion compared to uninvolved leg grade 1, 2, or 3

145
Q

What is a grade 1 posterior drawer test

A

0-5mm motion

146
Q

What is a grade 2 posterior drawer test

A

6-10mm motion

147
Q

What is a grade 3 posterior drawer test

A

11 or more mm motion

148
Q

What is the anterior drawer test

A

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
Q

What is a positive anterior drawer test

A

Greater anterior tibial displacement on affected side compared to unaffected side

150
Q

What is Lachman’s test

A

Pt supine with knee flexed to 15 and PT stabilized distal femur and applies and anterior tibial force to proximal tibial

151
Q

How does the PT get the knee into 15 flexion

A

By putting their knee under the pt’s knee

152
Q

What is a positive Lachman’s test

A

Greater anterior tibial displacement on affected side when compared to the unaffected side

153
Q

What is the gold standard test for ACL testing

A

Lachman’s test

154
Q

What is Hughston’s test

A

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
Q

What is a positive Hughston’s test

A

Excessive motion with IR or ER rotation

156
Q

What does a positive Hughston’s test with IR and ER mean

A

IR: Posteromedial rotary instability
ER: Posterolateral rotary instability

157
Q

What is Slocum test

A

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
Q

What is a positive slocum test

A

Excessive motion with IR and ER

159
Q

What does a positive slocum test with IR and ER mean

A

IR: Anterolateral rotary instability
ER: Anteromedial rotary instability

160
Q

What is the pivot shift test (Test of MacIntosh)

A

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
Q

What is a positive pivot shift test (Test of MacIntosh)

A

Audible or palpable thud or click

162
Q

What is the reverse pivot shift test (Jakob test)

A

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
Q

What can be felt and observed around 20 knee flexion during the reverse pivot shift test

A

Lateral tibial plateau moving anteriorly shifting from a posterior position of subluxation into neutral rotation

164
Q

What is a positive reverse pivot shift test (Jakob test)

A

Reduction of the tibial head

165
Q

What is Ober’s test

A

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
Q

True or False:

Ober’s test is performed with the knee flexed and extended

A

True

167
Q

What is a positive Ober’s test

A

If leg remains ABD

168
Q

What does the leg remaining ABD eman during Ober’s test

A

A contracture is present

169
Q

What is the nobel compression test

A

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
Q

What is a positive nobel compression test

A

At approximately 30 flexion the pt complains of extreme pain over the lateral femoral condyle

171
Q

What does a positive nobel compression test indicate

A

ITB friction syndrome

172
Q

What are the special tests that address patellofemoral problems (5)

A
  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
Q

What are the special tests that address meniscal problems (8)

A
  1. Figure 4 test
  2. Payr’s sign
  3. Squat test/duck waddle/childress test
    4 Dynamic test
  4. Thessaly test at 5
  5. Thessaly test at 20/disco test
  6. McMurray click test
  7. Apley’s test
174
Q

What is the special test for MCL integrity

A

Valgus stress test

175
Q

What is the special test for LCL integrity

A

Varus stress test

176
Q

What are the special tests for PCL intergrity (2)

A
  1. Posterior sag sign/godfrey’s test
  2. Posterior drawer test
  3. Valgus stress test at 0
  4. Varus stress test at 0
177
Q

What are the special tests for ACL integrity (4)

A
  1. Anterior drawer test
  2. Lachman’s test
  3. Valgus stress test at 0
  4. Varus stress test at 0
178
Q

What are the special tests for ligamentous rotary instability (4)

A
  1. Hughston’s test
  2. Slocum test
  3. Pivot shift test/test of MacIntosh
  4. Reverse pivot shift test/Jakob test
179
Q

What are the special tests for the ITB (2)

A
  1. Ober’s test

2. Nobel compression test

Musculo 2 (3 decks)

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