knee special tests

Question 1

collateral lig instability test (LCL and MCL)

Answer 1

purpose: id ligament laxity or restriction
description: knee in 20-30deg of flexion. valgus force to test mcl and varus force to test lcl
result: laxity and possible pain

Question 2

lachman’s stress test

Answer 2

purpose: integrity of ACL
description: supine. hold knee btw full ext and 30deg of flexion. stabilize femur with outside hand. move proximal tibia forward with inside hand
result: positive - mushy/soft end feel when tibia is moved forward on femur (increased ant translation with IR of tibia)

Question 3

pivot shift test

Answer 3

purpose: ACL integrity
description: supine. PT stands to side of involved knee.
reduction test - stabilize lower leg and flex knee to 90deg. use other hand to IR tibia.
result: sudden reduction of ant subluxed lateral tibia plateau seen as pivot shift
subluxation test - begin with pt one flexed. PT IR tibia and apply valgus stress test to knee with other hand. PT slowly extends knee, maintaining full knee ext.
result: tib plateau will be felt to relocate

Question 4

posterior sag sign

Answer 4

purpose: PCL integrity
description: supine. hip flexed to 45deg, and knee flexed to 90deg
result: tibia drops back/sags because of gravity if pcl is torn

Question 5

sclocum test

Answer 5

purpose: assess anteromedial and anterolateral instability
description: supine with hips in 45deg, knee flexed to 80-90deg.
ALRI (rotaty instability) - place foot in 30deg IR. PT sits on foot and draws tibia forward.
result: positive - movement occurs mostly on lat side of knee, excessive relative to unaffected side and indicated ALRI
AMRI - place foot in 15deg of ER and draw tibia forward.
results: if excessive movement them it occurs primarily on medial side of knee=AMRI

Question 6

posterior drawer test

Answer 6

purpose: integrity of PCL
description: supine. hip flexed to 45deg and knee flexed to 90deg. passively glide tib posteriorly
result:excess post glide is pos finding

Question 7

reverse lachman test

Answer 7

purpose: test pcl integrity
description: prone. knee flexed to 30deg. stabilize femur with one hand and pull tibia upward with other
result: excess posterior glide

Question 8

McMurray’s test

Answer 8

purpose: id meniscal tears
description: supine with knee completely flexed.
lateral meniscus: PT IR tibia and extends knee
medial meniscus: PT ER tibia and extends knee
result: cause snap/click that is often accompanied by pain if there is loose fragment

Question 9

apley test

Answer 9

purpose: differentiate btw meniscal tears and ligamentous lesion
description: prone. knee flexed to 90deg. anchor thigh to table with PT knee. First IR and ER tibia while distracting tib from femur. IR and ER tibia while compressing tibia.
result:
ligamentous - if rotation +distraction is more painful or shows increased ritation
meniscus - if rotation+compression is more painful or shows decreased rotation relative to normal side

Question 10

bounce home test

Answer 10

purpose: meniscal lesion
description: supine with knee fully flexed. cup patients heel. passively allow knee to fully ext.
result: if extension isnt complete or has springy block then torn meniscus can be blocking full extension

Question 11

thessaly test

Answer 11

purpose: meniscal lesion
description: stand flat on one leg while PT gives hands for balance. pt flex knee to 5deg and rotates femur on tib 3x IR and 3x ER. Repeat at 20deg flexion
result: + for meniscal tear if pt has med/lat joint line discomfort. can also have lock/catch

Question 12

hughston’s plica test

Answer 12

purpose: plica dysfunction
description: supine. PT flex and IR tibia with 1 arm. with other arm, press patlla medially with heel of hand and palpate medial femoral condyle with same fingers. passively flex/ext.
result: + if feel popping at medial femoral condyle

Question 13

patellar apprehension test

Answer 13

purpose: hx of patella dysfunction
description: supine. patella passively glided laterally
result: pt doesnt allow patella to move laterally

Question 14

clarke’s sign

Answer 14

purpose: id patellofemoral dysfunction
description: pt supine with knee ext. press down slightly proximal to base of patella with web of hand. ask pt to contract quads while pushing down.
result: positive if causes retropatellar knee pain and cant hold contraction

Question 15

ballotable patella/ patella tap test

Answer 15

purpose: id infrapatellar effusion
description: push down from top and bottom of patella toward it to push any fluid there. with one finger, push down on patella lightly
result: if positive, there will be floating patella aka dancing patella sign

Question 16

fluctuation test

Answer 16

purpose: knee joint effusion
description: place 1 hand over suprapatellar pouch, and 1 hand ant to joint with thumb and index fingers just beyond margins of patella
result: press down with 1 hand and then the other, examiner may feel synovial fluid fluctuate under hands and move from 1 hand to another

Question 17

Q angle measurement

Answer 17

purpose:
description: draw line from asis to midpoint of patella. and line from tibial tubercle to midpoint of patella. angle formed is called q-angle
result: normally q-angle is 13deg for males and 18deg for females
increased q angle=femoral neck anteversion, external tibial torsion, flat feet
decreased q angle=femoral neck retroversion, internal tibial torsion

Question 18

noble compression test

Answer 18

purpose: id distal IT band friction syndrome
description: supine. PT flex pt knee to 90, accompanied by hip flexion. Apply pressure to lateral femoral epicondyle or 1-2cm prox to it with thumb. Maintain pressure and passively extend knee
result: positive if at 30deg of flexion pt experiences severe pain over lateral femoral condyle

Question 19

tinel’s sign

Answer 19

purpose: id dysfunction of common fibular nerve posterior to fibular head
description: tap region where common fibular nerve passes posterior to fibular head
result: pos= tingling/paresthesia in leg