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MSK 1 > Knee Examination/Testing > Flashcards

Knee Examination/Testing Flashcards

1
Q

What is a likely knee injury if a patient complains of traumatic injury with a posteriorly directed force to the tibia with the knee flexed?

A

-PCL injury (posterior cruciate)

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2
Q

Likely knee injury if a patient reports traumatic injury with varus or valgus force exerted on the knee?

A

-collateral ligament injury (LCL or MCL)

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3
Q

Possible injuries that could occur at the knee if the patient reports a traumatic onset of knee pain that occurred while jumping, twisting or changing directions with the foot planted?

A
  1. ligamentous injury (ACL)
  2. patella subluxation
  3. quadriceps rupture
  4. meniscal tear
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4
Q

Injuries at the knee that could occur if a patient reports anterior knee pain with jumping & full knee flexion?

A
  • patellar tendonitis

- patellofemoral pain syndrome

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5
Q

A patient reports swelling in the knee with occasional locking & clicking. What are possible injuries that could have occurred at the knee joint?

A
  • meniscal tear

- loose body within the knee joint

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6
Q

What is a possibly hypothesis for a knee injury if a patient reports pain with prolonged knee flexion, during squats & while going up & down stairs?

A

-patellofemoral pain syndrome

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7
Q

What is the likely hypothesis of injury if a patient reports pain & stiffness in the morning that diminishes after a few hours?

A

-OA

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8
Q

Ottawa Knee Rule for Radiography

A
  • highly sensitive for knee fractures in adults & children
  • if acute injury, if 1 out of the 5 variables are present, radiographs are required:
    1. age >/= 55 yrs
    2. isolated patellar tenderness w/o other bone tenderness
    3. tenderness of fibular head
    4. inability to flex knee to 90
    5. inability to bear weight immediately after injury & in the ED
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9
Q

Tibiofemoral angle

A

-angle between anatomical axis of femur & mechanical axis of the tibia

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10
Q

Genu valgum

A
  • “knock knees”

- angle less than 165

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11
Q

Genu varum

A
  • “bow legs”

- angle approaches or exceeds 180

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12
Q

Q-angle

A

-Patient standing with knee extended. Stationary arm of goniometer is aligned with ASIS, moving arm is aligned with tibial tuberosity, axis at midpoint of patella

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13
Q

What can a large Q-angle predispose someone to?

A

-patellar subluxation

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14
Q

Tibial Torsion

A
  • pt sitting with knee flexed to 90. Place thumb over prominence of one malleolus & index finger of same hand over prominence of other malleolus. Looking down over end of distal thigh, visualize axes of the knee and of the ankle. Lines should form 12-18 degree angle due to lateral tibial rotation.
  • increased tibial torsion increases Q-angle
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15
Q

Patella Alta

A

-positive if patellar tendon is longer by 15-20% or more of patellar height

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16
Q

Patella Baja

A

-positive if patellar tendon is shorter by 15-20% or more of the patellar height

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17
Q

If rapid edema (within 1 hour) occurs what injuries should you consider?

A
  • patellar dislocation
  • osteochondral fractures
  • ACL tears
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18
Q

If there is intermediate edema (6-12 hours) present, what injuries should you consider?

A
  • capsular tears
  • peripheral meniscus tears
  • ACL tears
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19
Q

Localized edema in the knee

A

-usually found in the prepatellar, infrapatellar, pes anserine, and/or popliteal fossa

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20
Q

Subpatellar edema

A

-with pt supine or long sitting & leg straight, look for a posterior tilt of the inferior patellar pole (tipping of the inferior patella into the tibia). This can irritate the fat pad

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21
Q

Ballottement Test statistics and is used as a tool to determine what?

A
  • tool for knee joint effusion
  • Sensitivity: .83
  • Specificity: .49
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22
Q

Ballottement Test protocol

A
  • pt. supine. Grasp pt’s thigh at the anterior aspect about 10 cm above patella. With the other hand, grasp pt’s lower leg about 5 cm distal to patella. Proximal hand exerts compression against anterior, lateral, & medial aspects of thigh & slides distally. Distal hand exerts compression in a similar way & slides proximally. Examiner quickly pushes the pt’s patella posteriorly toward femur with 2 or 3 fingers then lets up
  • positive: patella bounces off trochlea (rises again) with a distinct impact
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23
Q

“Milking” Test

A

-move/”milk” fluid to inferior from supra patellar area, then to medial area from lateral joint line - thus all fluid is inferior & medial. By gently tapping medial area, fluid will float back to lateral side of joint

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24
Q

Palpation of medial meniscus

A

-palpable on medial rotation of tibia, disappears on lateral rotation

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25
Q

Palpation of lateral meniscus

A

-palpable with knee in slight flexion, disappears with full extension

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26
Q

Joint Line Tenderness is a diagnostic tool for what? What are the statistics of this test?

A
  • diagnostic tool for meniscal tear
  • Sensitivity: .76
  • Specificity: .77
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27
Q

Protocol for Joint Line Tenderness Examination

A
  • palpable joint line with patient’s knee flexed to 90

- positive: reproduces pain

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28
Q

Palpation of Pes Anserine

A
  • insertion of sartorial, gracilis, semitendinosus

- medial & distal to tibial tuberosity, usually can’t feel anything unless pathology/bursitis

29
Q

Best position to palpate the lateral collateral ligament?

A

-pt’s ankle crossed over opposite knee

30
Q

Palpation of the tibial nerve

A

-firm, hard cord central to posterior knee area, approximately 1” superior to joint & lateral to popliteal artery

31
Q

Palpation of common peroneal nerve

A

-lateral to tibial nerve & medial to biceps femoris tendon

32
Q

Palpation of saphenous nerve

A

-medial knee joint between tendons of sartorius & gracilis

33
Q

Tibiofemoral joint close packed position

A

-full extension

34
Q

Proximal tibiofibular close packed position

A

-full DF of ankle

35
Q

Patellofemoral joint close packed position

A

-full flexion

36
Q

Tibiofemoral joint open packed position

A

-25 deg flexion

37
Q

Proximal tibiofibular joint open packed position

A

-neutral ankle, 25 degrees of knee flexion

38
Q

Patellofemoral joint open packed position

A

-0-5 deg flexion

39
Q

Tibiofemoral joint capsular pattern

A

flex > ext

40
Q

Extensor or Quadriceps Lag

A

-able to obtain full passive extension of the knee & lack of full active extension of the knee due to muscle atrophy, pain, effusion, or loss of mechanical advantage

41
Q

Tibial rotation (“screw home mechanism”)

A
  • with pt sitting with knee flexed to 90, palpate tibial tubercle & a point on the patella so the two points form a vertical line. Pt actively extends the knee. You should observe the tibia laterally rotating on the femur
  • in open packed position, tibia should passively rotate about 10 deg in each direction
42
Q

Resting position for testing resisted motion?

A

-about 25 deg of knee flexion, with the patient positioned supine or prone

43
Q

Lachman test is a diagnostic tool for what knee injury? Statistics of the Lachman test?

A
  • diagnostic tool for ACL tear
  • Sensitivity: .85
  • Specificity: .94
44
Q

Lachman Test protocol

A
  • pt supine & knee joint flexed between 10 & 20 deg., examiner stabilizes femur with one hand. With the other hand, examiner translates the tibia anteriorly
  • positive: lack of end point for tibial translation or subluxation
45
Q

Anterior Drawer test is a diagnostic tool for what knee injury? Statistics of the test?

A
  • diagnostic tool for ACL tear
  • Sensitivity: .55
  • Specificity: .92
46
Q

Anterior Drawer Test protocol

A
  • with patient’s knee flexed between 60 and 90 with foot on exam table, examiner draws tibia anteriorly
  • positive: anterior subluxation of > 5 cm
47
Q

(Anterolateral) Slocum Test is a diagnostic tool for what?

A

-rotary instability

48
Q

(Anterolateral) Slocum Test protocol

A
  • this is an extension of the anterior drawer test, which allows you to see if additional structures are damaged. (you probably wouldn’t do this, unless you had a positive ACL finding)
  • if ACL is positive, retest with tibia in max external rotation
  • positive: tibia moves forward as much in lateral rotation as it does in neutral rotation; likely anteromedial rotary instability (medial structures likely also torn)
  • if ACL test is positive, retest with the tibia in maximal internal rotation
  • positive: tibia moves forward as much in medial rotation as it does in neutral rotation; likely lateral &/or posterolateral structures also torn
49
Q

Pivot Shift Test is a diagnostic tool for what knee injury? Statistic of the test?

A
  • diagnostic tool for ACL tear
  • Sensitivity: .24
  • Specificity: .98
50
Q

Pivot Shift Test protocol

A
  • pt is supine. Lift heel of foot to flex hip to 45 deg keeping knee fully extended; grasp knee with other hand, placing thumb beneath head of fibula. Apply strong internal rotation to tibia & fibula at both knee & ankle while lifting the proximal fibula. Knee permitted to flex about 20 deg; examiner then pushes medially with proximal hand & pulls with distal hand to produce a valgus force at the knee.
  • positive: lateral tibial plateau subluxes anteriorly
51
Q

Posterior Drawer Test is a diagnostic tool for what knee injury? Statistics of the test?

A
  • diagnostic tool for PCL tear
  • Sensitivity: .90
  • Specificity: .99
52
Q

Posterior Drawer Test protocol

A
  • pt is supine, knee is flexed to 90. push the tibia posteriorly
  • positive: posterior subluxation of tibia
53
Q

Valgus Stress Test tests for what? Statistics of the test?

A
  • diagnostic tool for MCL tear
  • Sensitivity: .78-91
  • Specificity: .49-.67
54
Q

Valgus Stress Test protocol

A
  • place joint in maximum varus, then apply valgus stress at 5 deg flexion & again at 30 degrees of flexion
  • positive: pain & laxity with valgus stress at 5 and/or 30 degrees
55
Q

Varus Stress Test is a diagnostic tool for what knee pathology? Statistics of the test?

A
  • diagnostic tool for LCL tear

- Sensitivity .25

56
Q

Varus Stress test protocol

A
  • place joint in maximum valgus, then apply varus stress at 5 degrees of flexion (making ant & post fibers taut) & again at 30 degrees of flexion (focuses more on anterior fibers)
  • positive: pain & laxity with varus stress at 5 and/or 30
57
Q

McMurray’s test is a diagnostic tool for what knee pathologies? Statistics?

A
  • diagnostic tool for meniscal tear
  • Sensitivity: .16-.95
  • Specificity: .25-.98
  • diagnostic tool for OA
  • Sensitivity: .55-.71
  • Specificity: .71-.77
58
Q

McMurray’s test protocol

A
  • pt supine, grasp heel with one hand & stabilize the knee with the other. Knee is passively flexed until the heel approaches buttock, externally rotated, & axially loaded while brought into extension. Test is repeated in internal rotation of the tibia.
  • positive: palpable or audible click or pain during rotation
59
Q

Apley’s Test is a diagnostic tool for what knee injury? What are the statistics with the Apley’s test?

A
  • diagnostic tool for meniscus
  • Sensitivity: .22-.61
  • Specificity: .70-.88
60
Q

Apley’s Test protocol

A
  • pt is prone with knee flexed at 90. Examiner places downward pressure on foot, compressing knee, while internally & externally rotating tibia
  • positive: pain
61
Q

Thessaly test is a diagnostic tool for what? Statistics?

A
  • diagnostic tool for meniscal tear
  • Sensitivity: .89-.92
  • Specificity: .96-.98
62
Q

Thessaly test protocol

A
  • pt. stands on the symptomatic leg while holding the examiner’s hands. The pt rotates the body & leg internally & externally with the knee bent at 20 degrees of flexion
  • positive: pain and/or a click in the joint line
63
Q

Moving Patellar Apprehension Test

A
  • identifying patellar instability
  • sensitivity 1.0
  • specificity .88
64
Q

Moving patellar apprehension test protocol

A
  • with pt supine, knee extended & ankle off exam table, examiner flexes the knee to 90 & back to extension while holding the patella in a lateral position. The procedure is repeated with the patella held in a medial position
  • positive: pt exhibits apprehension and/or quadriceps contraction during lateral glide & no apprehension during medial glide
65
Q

Clarke’s Sign is diagnostic for what injury?

A

-diagnostic tool for retropatellar pain syndromes, especially chondromalacia patella

66
Q

Clarke’s Sign protocol

A
  • pt supine with knee extended. Add distal & posterior compression to patella while pt contracts quadriceps muscle
  • positive: pain (however, this may be positive for asymptomatic individuals)
67
Q

Rotary dysfunction

A
  • common movement disorder
  • lateral rotation of the tibia relative to the femur occurs during the final 15-30 degrees of extension; medial rotation of the tibia occurs during the initial 15-20 degrees of flexion from a fully extended position
68
Q

Anatomical considerations for the tibiofemoral joint

A

-femur is convex on the concave tibia. this joint is markedly incongruent in positions of flexion, but becomes progressively more congruent as the knee extends. Flexion is combine with tibial medial rotation and adduction; while ext is combined with lateral rotation (notably during terminal extension) and abduction

69
Q

Anatomical considerations for the patellofemoral joint

A

-the patella might not move as much laterally during mobilization, but functionally, the lateral glide of the patella is often hyperbole. As the knee extends, the patella moves 5-7 cm superiorly in the femoral groove

MSK 1 (15 decks)

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