Knee Functional/Special Tests Flashcards
Subjective Hx
-MOI
-pain/location/changes/time of day
-Swelling
-Noise
-Locking
-Giving out
-length of symptoms
Rule out Non-MSK
PAD: claudication, cook extremities, decrease filling time
DVT: pain, warmth, swelling
Compartment Syn: swelling, absent pulses, neuro
Septic Arthritis: pain, swelling, infection signs
Cellulitis: skin warmth, redness, rash
Ottawa Knee Decision Rule
- > 55
- Tenderness at head of fib
- Tenderness at Patella
- Inability to flex knee 90
- Inability to WB 4 steps
(+) 2/5= need imaging
Pittsburgh Knee Decision Rule
- Hx Trauma
- Inability to WB 4 steps
- <12 or >50
(+) 2/3: imaging
Knee Decision Rule of Bauer
- Inability to WB 4 steps
- Knee swelling
- Ecchymosis
(+) 1/3: imaging
Observations
-abrasion, bruising, atrophy, swelling
-LE rotation
-knee position
-flx or hyperextensionon
-tibial torsion
-foot position
Knee Joint ROM
-Flex (0-140) then Ext (0-15)
-AROM > Over > PROM
Knee MMT
-knee flx/ext
-Hip ROM
-Ankle DF and PF
Flexibility Tests
-Ober’s
-Modified Thomas
-Prone Rectus (ELy)
-Gastroc Length
-Hamstring Length
Joint Play/Mobilization: Knee Extension
Ext: ant roll AND glide (concave on concex)
- Pt supine (prone if dec ext)
- Towel under tibia
- Push femur posteriorly (push ant if in prone)
Mob:
-ad ER
Joint Play/Mobilization: Knee Flexion
Flex: Post roll and glide
- Pt supine (sitting if distracting or dec)
- Push tibia posteriorly
Mob:
-Ad IR
Joint Play/Mobilization: Patellar Sup/Inf Glide
Crab hand: tiny
Bear Claw: big
- Pt in supine, full ext
- Move patella up and down
Joint Play: Patellar Medial/Lateral Glide
Claw hand
- Pt in Supine, full ext
- Move patella side to side
Joint Play: Proximal Tibiofibular Joint
-use if lacking last bit of flexion and has pain at fib head
-or frequent ankle sprains
AP Glide:
1. Pt supine in hooklying
2. Push posteriorly
PA Glide: treat in this position
1. Pt in quadruped
2. Push anteriorly
Menisci Palpation
-open packed position
-find joint line
Patellar Tendon Palpation
-tib tub to patella
Collaterals Palpation
LCL:
-fib head in FABER position
MCL:
-medial knee
Plicae Palpation
-superiomedial corner of patella
Knee Exam Order
- Subjective Hx (MOI and pain description)
- Observation
- ROM (knee, hip, ankle)
- MMT (knee, hip, ankle)
- Joint Play
- Palpation
- Special Tests
Ligament Special Tests
ACL: Lachman, anterior drawer, pivot shift
PCL: Posterior Drawer, Posterior sag, valgus at 0
MCL: valgus stress test at 20
LCL: Varus stress test at 20
Instability Special Tests
AMRI: Anterior drawer + ER
ALRI: anterior drawer + IR, pivot shift
PMRI: Posterior drawer + IR
PLRI: Posterior drawer + ER, reverse pivot shift, dial test
Meniscus Special Tests
McMurray, Thessaly, Apley
Patellar Special Tests
Patellar Grind Test
Patellar Apprehension
Lachman Test
ACL
-less flx than Anterior drawer
- Pt supine, knee flexed slightly
- PT stabilizes femur and pulls tibia ant
- 1-2 reps
Anterior Drawer Test
ACL
-more flx ~ 60
- Pt supine with knee flexed 60
- PT sits on foot
- Pull tibia anteriorly
Pivot Shift
ACL, ALRI
- Pt supine
- PT flexes knee to 90 while IR tibia (check for lateral sublux
- PT slowly extends knee while maintaining IR (reduction at full extension)
Posterior Drawer
PCL
-more flx ~ 60
- Pt supine with knee flexed 60
- PT sits on foot
- Find norm of tibia
- Push tibia posteriorly
Posterior Sag Sign
PCL
- Pt supine
- PT flexes knee and hip ot 90 passively and looks for sag of tibia
Valgus Stress Test
PCL (0 deg) , MCL (20 deg)
- Pt supine w/ leg at 0 then 20 deg flexion
- PT outside of leg holding medial tibia and lateral thigh (take up slack)
- PT provides valgus stress
Varus Stress Test
Cruciates (0 deg), LCL (20 deg)
- Pt supine w/ leg at 0 then 20 deg flexion
- PT inside of leg holding lateral tibia and medial thigh (take up slack)
- PT provides varus stress
Anterior Medial Rotary Instability Special Test
Anterior Drawer w/ ER
Anterior Lateral Rotary Instability Special Test
anterior drawer + IR
Posterior Medial Rotary Instability Special Test
Posterior drawer + IR
Posterior Lateral Rotary Instability Special Test
Posterior drawer + ER
Posterorlateral Instability Reverse Pivot Shift
PLRI
- Pt supine
- PT flexes knee to 90 while ER tibia (check for medial sublux
- PT slowly extends knee while adding valgus stress (reduction at full extension)
McMurrays Test
-Meniscus
-NWB
-tells you which one is involved
-provocative
Medial:
1. Pt supine at 90/90
2. PT palpates or watches medial joint line
2. PT passively flexes knee
3. PT puts tibia into ER while extending knee
Lateral:
1. Pt supine at 90/90
2. PT palpates or watches lateral joint line
2. PT passively flexes knee
3. PT puts tibia into IR while extending knee
Apley’s Test
-Meniscus test
-NWB
Distraction:
1. Pt prone with knee bent
2. PT stabilizes femur with leg
3. PT ER then distracts, IR then distracts
Better: meniscus
Worse: Ligament
Compression:
1. Pt prone with knee bent
2. PT stabilizes femur with leg
3. PT ER then comrpesses, IR then compresses
Worse: Mensicus
Thessaly’s Test
-meniscus
-WB test
-5 deg of knee flx, then 20 deg
- Pt stands on one leg with leg bent 5/20 with PT support
- PT askes Pt to twist from side to side
(+): clock, pop, or reproduction of pain
Patellar Apprehension
-lateral patellar subluxation
- Pt supine with leg off of plinth slightly flexed ~15
- Pt foot on PT leg
- PT lateral mobs patella
(+): Pt feels apprehensive about it subluxing
Patellar Grind Test
-Chondromalacia, PF dysfunction
- Pt supine in full knee ext
- PT uses web space to push superir patella down
- Pt then contracts quad
(+): reproduction of patients pain
Altman’s Criteria for Knee OA
- Knee Pain
- > 50
- Knee Crepitus
- Palpable bony enlargement
- Bony tenderness
- Morning stiffness <30mins
- No warmth
Contraindications to Manual Therapy
-infection
-Fever
-Cancer
-Acute Circulatory Condition
-Open Wound
-Fracture
-Hematoma
-Advanced DM
-Hypersensitivity
-Abnormal Endfeel
-RA
-Cellulitis
-Constant, Severe pain
-Extensive radiation of pain
-Condition not evaluated
