knee - ligamentous/capsular stress tests Flashcards
lachman (lachman-ritchey) test
▪ Positions patient supine, with the knee flexed between 20 and 30 degrees
▪ Places one hand on the lateral aspect of the distal thigh
▪ Places the other hand on the medial aspect of the proximal tibia (just distal to the tibial tuberosity)
▪ Stabilizes the femur and applies an anterior force to the tibia
▪ A positive test is indicated increased anterior translation of the tibia
▪ Tests for an anterior cruciate ligament (ACL) tear
prone lachman test
▪ Positions patient prone with lower leg hanging off the table, and the knee flexed between 20 and 25 degrees
▪ Places one hand on the posterior aspect of the proximal lower leg
▪ Places the other hand on the anterior aspect of the distal lower leg
▪ Applies a downward force on the proximal portion of the posterior tibia
▪ A positive test is indicated increased anterior translation of the tibia
▪ Tests for an anterior cruciate ligament (ACL) tear
anterior drawer test
▪ Positions patient supine, with hip flexed to 45 degrees, knee flexed to 90 degrees, and foot in a neutral position
▪ Places both hands around proximal tibia, thumbs below the knee joint lines, fingers over the hamstring tendons, and
sitting on the foot for stabilization
▪ Applies an anterior force to the tibia
▪ A positive test is indicated increased anterior translation of the tibia
▪ Tests for an anterior cruciate ligament (ACL) tear
pivot shift (lateral pivot shift, mcintosh, galaway, or losse) test
▪ Positions patient supine, hip flexed 30 degrees, and knee fully extended and internally rotated 20 degrees
▪ Places hand on the lateral aspect of the proximal lower leg
▪ Places other hand around the distal lower leg/ankle
▪ With the tibia internally rotated, slowly flexes the knee and applies a valgus force
▪ A positive test is indicated by a palpable “clunk” as the tibia posteriorly translates in the range of 30 – 40 degrees of knee
flexion
▪ Tests for anterolateral rotary instability, secondary to a torn ACL and/or posterolateral capsule damage, or lateral collateral ligament damage`
jerk test
▪ Positions patient supine, hip flexed 45 degrees, and knee flexed to 90 degrees, and internally rotated 20 degrees
▪ Places hand on the lateral aspect of the proximal lower leg
▪ Places other hand around the distal lower leg/ankle
▪ With the tibia internally rotated, slowly extends the knee and applies a valgus force
▪ A positive test is indicated by a palpable “clunk” as the tibia anteriorly translates in the range of 30 – 40 degrees of knee
flexion
▪ Tests for anterolateral rotary instability, secondary to a torn ACL and/or posterolateral capsule damage, or lateral collateral ligament damage
slocum drawer with external tibial rotation
▪ Positions patient supine, with the hip flexed to 45 degrees, knee flexed to 90 degrees, and tibia internally rotated 30
degrees
▪ Places both hands around proximal tibia, thumbs below the knee joint lines, fingers over the hamstring tendons, and
sitting on the foot for stabilization
▪ Applies an anterior force to the lateral tibia
▪ A positive test is indicated increased anterior translation of the tibia
▪ Tests for anterolateral rotary instability secondary to an ACL tear, posterolateral capsule damage, and/or lateral collateral ligament tear
slocum drawer test with internal tibial rotation
▪ Positions patient supine, with the hip flexed to 45 degrees, knee flexed to 90 degrees, and tibia externally rotated 15 to 20
degrees
▪ Places both hands around proximal tibia, thumbs below the knee joint lines, fingers over the hamstring tendons, and
sitting on the foot for stabilization
▪ Applies an anterior force to the medial tibia
▪ A positive test is indicated increased anterior translation of the tibia
▪ Tests for anteromedial rotary instability secondary to an ACL tear, posteromedial capsule damage, and/or medial collateral ligament tear
flexion-rotation drawer test
▪ Positions patient supine
▪ Tucks the patients leg between the arm and torso
▪ Places both hands around the proximal lower leg
▪ Flexes the knee to 25 degrees
▪ Posteriorly translate the tibia on the femur
▪ A positive test is indicated by an anterior and internal rotation reduction of the femur on the tibia
▪ Tests for damage to the anterior cruciate ligament, lateral collateral ligament, anterolateral capsule, arcuate ligament complex, and/or biceps femoris tendon
external rotation recurvatum test
▪ Positions patient supine
▪ Stabilizes the distal femur with one hand
▪ Other hand grasps the great toe/medial aspect of foot
▪ Passively extends the knee while maintaining stabilization of the femur
▪ A positive test is indicated by a marked difference in hyperextension, external femoral rotation, and varus alignment
▪ Tests for anterior cruciate ligament pathology and/or posterolaterally rotary instability
posterior drawer test
▪ Positions patient supine, with hip flexed 45 degrees, knee flexed 90 degrees, and the foot in a neutral position
▪ Places both hands around proximal tibia, thumbs below the knee joint lines, and sitting on the foot for stabilization
▪ Applies a posterior force to the tibia
▪ A positive test is indicated increased posterior translation of the tibia
▪ Tests for a posterior cruciate ligament (PCL) tear
godfrey 90-90 test
▪ Positions patient supine, with hip flexed 90 degrees and the knee flexed 90 degrees
▪ Places one arm underneath both distal lower legs
▪ Observes the location of the tibia
▪ A positive test is indicated by posteriorly displacement of the tibia
▪ Tests for torn posterior cruciate ligament (PCL) tear
quadricep’s active test
▪ Positions patient supine, with hip flexed 45 degrees and the knee flexed 90 degrees
▪ Stabilizes the distal tibia with one hand
▪ Stabilizes the distal femur with the other hand
▪ Instructs patient to slide the foot forward by contracting the quadriceps muscle group
▪ Applies resistance at the tibia
▪ Observes for anterior translation of the tibia on the femur
▪ Tests for torn posterior cruciate ligament (PCL) tear
posterior sag (gravity drawer) test
▪ Positions patient supine, with hip flexed 45 degrees and the knee flexed 90 degrees
▪ Observes the location of the tibia
▪ A positive test is indicated by posteriorly displacement of the tibia
▪ Tests for torn posterior cruciate ligament (PCL) tear
dynamic posterior shift test
▪ Positions patient supine
▪ Holds the foot with one hand, and places thumb and index finger over the medial and lateral joint lines of the knee
▪ Passively flex the patient’s hip and knee to 90 degrees
▪ A positive test is indicated by a “clunk” or “jerk” sensation as the knee approaches full extension
▪ Tests for posterolateral instability of the knee
valgus stress test
▪ Positions patient supine, with the leg extended
▪ Holds the ankle firmly with one hand while placing the other over the head of the fibula
▪ Places a valgus force to the knee in an attempt to open the medial side of the knee
▪ Attempts this test while the knee is at 0 and 20 to 30 degrees of knee flexion
▪ Performs bilaterally
▪ A positive test is indicated by medial knee pain and/or increased valgus movement with diminished or absent endpoint
▪ Tests for a torn MCL, PCL, and/or posteromedial capsule
