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PHTH 7232 Ortho > Knee Special Tests > Flashcards

Knee Special Tests Flashcards

1
Q

How to perform

Anterior drawer

A

Pt supine, Flex knee to

  • place hands in starting reference position
  • You know from the previous test if the tibia has not sagged back,
  • Keeping elbows straight, pull body straight forward (just rock body), feel for hamstring guarding
  • If it subluxates toward you, you know it’s a PCL tear
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2
Q

implications

Passive Tracking

A

Noncontractile tissue, patellar groove

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3
Q

indications

Medial/Lateral patellar glides

A

all patients

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4
Q

How to perform

Flexion Rotation Drawer (FRD)

A

pt in supine, knee flexed 0-60 degrees * Hug ankle under arm and grab proximal tibia with both hands - Good test because 2 planar and doesn’t hurt them * Valgus and compressive force-trying to take patella to contralateral ASIS - Go fly fishing - Normal knee will see nice smooth motion - Abnormal knee gives wiggle/wabble - Like pivot shift but less aggressive, positive test is subluxation of femur on fixed tibia

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5
Q

response

Anterior drawer

A

If tibia subluxates forwards, you know it’s an ACL tear

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6
Q

How to perform

Recurvatum

A

Pt. supine, stabilized the distal femur with one hand, grab ankle with other hand Pull up on ankle, trying to hyperextend knee 3 times 10 degrees is normal amount of recurvatum

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7
Q

indications

Apley’s Compression and Dynamic Compression (DDV)

A
  1. *History of macrotrauma 2. *Twisting MOI 3. *Delayed effusion (over 12 hours) 4. *Reproducible click/clunk 5. *Pseudo locking 6. *Joint line pain
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8
Q

What test is for meniscus and PCL?

A

Recurvatum (Laxity -> PCL/posterior capsule; palpate over joint [prob reprod of symptoms] -> anterior horns of meniscus).

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9
Q

How to perform

Recurvatum for Meniscus

A

Pt. supine, stabilized the distal femur with one hand and PALPATE JOINT, grab ankle with other hand Pull up on ankle, trying to hyperextend knee-3 times 10 degrees is normal amount of recurvatum Same as PCL recurvatum test except palpate joint line

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10
Q

implications

PMRI

A

Post 1/3 med. Cap., PMOL (some say this can’t happen with PCL intact) PCL must be intact to perform the test

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11
Q

response

Recurvatum

A

10_ is normal amount of recurvatum

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12
Q

response

Active Tracking OKC

A

Patella should move through a C (right) or reverse C shape (left). Not good if it goes laterally at top especilly

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13
Q

test category

Medial/Lateral patellar glides

A

Patello-Femoral

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14
Q

response

Lachman’s Test

A

Positive test is > 3mm translation and an empty end feel or lack of capsular end feel o Normally you feel a clunk where the ACL stops the tibia from moving

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15
Q

test category

fluid wave test

A

Effusion (intra-articular swelling)

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16
Q

response

Flexion Rotation Drawer (FRD)

A

Normal knee will see nice smooth motion - Abnormal knee gives wiggle/wabble - Like pivot shift but less aggressive - positive Test is subluxation of femur on fixed tibia

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17
Q

How to perform

Moving Patellar Apprehension test.

A

Two parts (first part must be + to move to part 2): pt supine, leg off table. 1) Use thumb to Manually glide patella laterally with knee Extended and passivly Flex to 90 degrees with Patella. Check for pt apprehension and pain. + Test: oral apprehension or quad apprehensive activation 2) Repeat with medial glide. + is No apprehension allowin full ROM

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18
Q

How to perform

ALRI

A

pt supine: knee flexed < 90 degrees (80-70 good) Same as Anterior drawer, except tibia is IR

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19
Q

indications

Medial/Lateral tilts

A

all patients

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20
Q

test category

Recurvatum

A

PCL

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21
Q

How to perform

Pivot shift

A

pt supine, knee 0-80 degrees * Grab under heel and flex hip * Thumb under fibular head, fingers to ceiling, palm on lateral joint line - 2 planar instability: tibia moves anteriorly and internally rotates * give valgus force and flex knee in one quick motion - move to about 60 degrees knee flexion * keep foot neutral

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22
Q

How to perform

Jerk test

A

pt supine, knee flexed 80-0 degrees pt supine, opposite of pivot shift - from knee flexion of about 60 degrees, after performing pivot shift, return leg to table with same valgus force: * Thumb under fibular head, fingers to ceiling, palm on lateral joint line * give valgus force and extemd knee in one quick motion, from about 60 degrees knee flexion * keep foot neutral

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23
Q

How to perform

Apley’s Distraciton test and Apleys Dynamic Distraction Test (DDV)

A

* Pt prone, knee flexed 90 degrees * Both hands proximal to malleoli, counterforce with your knee on top of their thigh * Distract and externally rotate to tighten MCL ligaments (internally rotate to tighten LCL) Apley’s Dynamic Distraction - repeat test as above but take through ROM to extension and back three times each in ER and IR

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24
Q

test category

Sag Test

A

PCL

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25
Q

indications

Anterior drawer

A
  1. History of macrotrauma including twisting, deceleration MOI * 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn’t let quads fire normally * Not always due to a ligament instability issue * Can also be related to arthritis 3. Hear a ‘pop’ during MOI 4. Intra articular effusion * ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
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26
Q

test category

McMurray’s Test

A

Meniscus

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27
Q

test category

Valgus stress

A

Collateral Ligaments

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28
Q

indications

Dynamic McMurray’s Test

A
  1. *History of macrotrauma 2. *Twisting MOI 3. *Delayed effusion (over 12 hours) 4. *Reproducible click/clunk 5. *Pseudo locking 6. *Joint line pain
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29
Q

indications

Pivot shift

A
  1. History of macrotrauma including twisting, deceleration MOI * 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn’t let quads fire normally * Not always due to a ligament instability issue * Can also be related to arthritis 3. Hear a ‘pop’ during MOI 4. Intra articular effusion * ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
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30
Q

implications

Apley’s Compression and Dynamic Compression (DDV)

A

Compression without dynamic component: Meniscus-post. horns Dynamic Compression: Meniscus-entire

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31
Q

indications

PLRI

A

(PCL must be intact to perform the test) 1. History of macrotrauma including twisting, deceleration MOI * 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn’t let quads fire normally * Not always due to a ligament instability issue * Can also be related to arthritis 3. Hear a ‘pop’ during MOI 4. Intra articular effusion * ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis

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32
Q

test category

Posterior Drawer

A

PCL

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33
Q

implications

Clancy step-up test

A

PCL

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34
Q

indications

PMRI

A

(PCL must be intact to perform the test) 1. History of macrotrauma including twisting, deceleration MOI * 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn’t let quads fire normally * Not always due to a ligament instability issue * Can also be related to arthritis 3. Hear a ‘pop’ during MOI 4. Intra articular effusion * ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis

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35
Q

How to perform

AMRI

A

pt supine: knee flexed < 90 degrees (80-70 good) Same as Anterior drawer, except tibia is ER

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36
Q

How to perform

Lachman’s Test

A

pt supine, knee flexed 30 degrees * Elbows on iliac crests-2 clamps (I thought it was 1 elbow) - Proximal clamp on distal femur stays still - Distal clamp on proximal tibia moves it anteriorly - Positive test is > 3mm translation and an empty end feel or lack of capsular end feel o Normally you feel a clunk where the ACL stops the tibia from moving

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37
Q

test category

Apley’s Compression and Dynamic Compression (DDV)

A

Meniscus

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38
Q

test category

Milking test

A

Effusion (intra-articular swelling)

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39
Q

implications

Milking test

A

Intra articular effusion

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40
Q

implications

Recurvatum for Meniscus

A

Meniscus-ant. Horns (much less common than posterior horns, but you don’t want to miss it)

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41
Q

implications

AMRI

A

Mid 1/3 med. Cap.

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42
Q

implications

Moving Patellar Apprehension test.

A

Noncontractile tissue, patellar groove patellar dislocation or instability

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43
Q

test category

Moving Patellar Apprehension test.

A

Patello-Femoral

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44
Q

indications

Clancy step-up test

A
  1. *History of macrotrauma 2. *Hyperextension injury 3. *Fall on anterior tibia with ankle in plantarflexion 4. *Intra articular effusion 5. *Suspected ACL
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45
Q

How to perform

Medial/Lateral tilts

A

pt supine, knee at 0 degrees (take out the pillow!!). Glide patella slightly in the direction it is to be tilted in order to get fingers under the edge. Try to tilt the patella. Tilt is referenced to the direction the tip of the patella leans toward

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46
Q

implications

Varus stress

A

0 degrees is LCL,ACL,PCL, PLC (posterior lateral corner-arcuate ligament complex, devistating injury) 30 degrees is just LCL (0 degrees-55%) (30 degrees-69%)

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47
Q

implications

Jerk test

A

ACL, middle 1/3 of lateral capsule

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48
Q

test category

Flexion Rotation Drawer (FRD)

A

ACL

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49
Q

response

Apley’s Distraciton test and Apleys Dynamic Distraction Test (DDV)

A

Reproduction of Symptoms? MCL (+ with Internal rotation) LCL (+ with external rotation)

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50
Q

implications

fluid wave test

A

Intra articular effusion

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51
Q

implications

Active Tracking CKC

A

Contractile and non-contractile tissue. if there is chondral damage, you want to avoid that area in rehab by doing short arc exercises. 3rd squat: checking peri-patellar soft tissue for Hoffa’s syndrome, Tendinitis -osis, Retinacular neuroma (hard nodules), Plica syndrome (snapping), poplitial tendonitis, ITB syndrome.

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52
Q

test category

Ballotment Test

A

Effusion (intra-articular swelling)

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53
Q

indications

Dial Test

A
  1. History of macrotrauma including twisting, deceleration MOI * 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn’t let quads fire normally * Not always due to a ligament instability issue * Can also be related to arthritis 3. Hear a ‘pop’ during MOI 4. Intra articular effusion * ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
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54
Q

response

Medial/Lateral patellar glides

A

Normal is moving two quadrants, more is hypermobile, less is hypomobile.

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55
Q

indications

Cephalic/Caudal glides

A

all patients

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56
Q

Effusion Tests (3)

A
  1. Milking
  2. Fluid Wave
  3. Ballotment
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57
Q

test category

Cephalic/Caudal glides

A

Patello-Femoral

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58
Q

test category

Active Tracking CKC

A

Patello-Femoral

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59
Q

what is an ACL “coper”? How do you know? And what does it mean for them in rehab?

A

* If pt can prevent you from doing pivot shift (meaning they can control their knee motion) it can mean they have good neuro-motor control and are a coper: they can do low level activities w/o surgical reconstruction * If pt prevents you from doing it and they cant control it, they are a non-coper and won’t do well with nonsurgical rehab

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60
Q

response

Apley’s Compression and Dynamic Compression (DDV)

A

* Looking for replication of joint line pain, maybe some snapping, cracking, clicking, clunking, pseudocatching, locking

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61
Q

response

Dynamic McMurray’s Test

A

Davies original article states it doesn’t matter what way you rotate the tibia because you are affecting both sides of the joint so just look for symptom replication, clicking/clunking, psudocatching/locking

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62
Q

response

Passive Tracking

A

Patella should move through a C (right) or reverse C shape (left). Not good if it goes laterally at top especilly

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63
Q

response

McMurray’s Test

A

reproduction of symptoms: clicking/clunking, psudocatching/locking

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64
Q

ACL tests (6 general)

A
  1. Anterior Drawer
  2. Rotary Instabilities
    • ALRI
    • PLRI
    • AMRI
    • PMRI
    • Dial??
  3. Lachman’s
  4. Pivot Shift
  5. Jerk
  6. Flexion Rotation Drawer (FRD)
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65
Q

test category

Apley’s Distraciton test and Apleys Dynamic Distraction Test (DDV)

A

Collateral Ligaments

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66
Q

test category

Jerk test

A

ACL

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67
Q

test category

Active Tracking OKC

A

Patello-Femoral

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68
Q

indications (critical pathways)

Milking test

A

History of macro trauma, patient complains of stiffness, observation of swelling, increased anthropometric measurements

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69
Q

response

Pivot shift

A

reproduction of symptoms (this one is painful and scary because it reproduces MOI). Try not to do it unless necessary. Clunking (as knee subluxates)

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70
Q

implications

Recurvatum

A

PCL/Posterior capsule

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71
Q

test category

Steinman’s test

A

Meniscus

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72
Q

besides indications list, when should we use Apley’s Compression and Apley’s Dynamic Comprassion (DDV) tests?

A

Use only if we can’t figure out what is going on with meniscus.

73
Q

response

AMRI

A

abnormal: anterior subluxation of the medial side of tibia

74
Q

How to perform

Apley’s Compression and Dynamic Compression (DDV)

A

pt is prone 1) Apley’s Compression: posterior horns * Flex knee 90 degrees, hands over calcaneous * Compress, internally and externally rotate it 3 times * Looking for replication of joint line pain, maybe some snapping, cracking, clicking, clunking, pseudocatching, locking 2) Apley’s Dynamic Compression (DDV) * Make sure you put a towel/pillow or something under the patella so it isn’t being crushed by the table * Same positioning as previous test * Compress, externally rotate, and take knee into full extension-3 times * Repeat with internal rotation

75
Q

indications

AMRI

A

(PCL must be intact to perform the test) 1. History of macrotrauma including twisting, deceleration MOI * 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn’t let quads fire normally * Not always due to a ligament instability issue * Can also be related to arthritis 3. Hear a ‘pop’ during MOI 4. Intra articular effusion * ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis

76
Q

How to perform

Clancy step-up test

A

Pt supine Flex knee

77
Q

How to perform

Valgus stress

A

pt supine, perform with knee at 0 and at 30 degrees flexion Stand on outside of the leg. position it so the joint line is at your closest thigh. Face foot. If they have some recurvatum, back of to neural (0 degrees) for 0 degree test, don’t test them in hyperextension 1) Valgus stress test (0 degrees): * Keep their thigh on table, put your thigh on their lateral joint line * Palpate medial joint line with one hand and grab distal tibia with other * Close joint first, give 3 valgus stresses - Rhythm should be: close-open, close-open, close-open * Not much happens because this is closed packed position 2) Valgus stress (30 degrees): * Flex knee to 30 degrees _ make sure their knee can flex off the edge of the table so calf is not hitting table * Same thing as 0 degrees but flexed to 30 degrees * Hardest thing is to keep their hip from rotating

78
Q

implications

Pivot shift

A

ACL, middle 1/3 of lateral capsule

79
Q

indications

Recurvatum for Meniscus

A
  1. *History of macrotrauma 2. *Twisting MOI 3. *Delayed effusion (over 12 hours) 4. *Reproducible click/clunk 5. *Pseudo locking 6. *Joint line pain
80
Q

response

Valgus stress

A

reproduction of symptoms, pain, gapping??

81
Q

response

Active Tracking CKC

A

1st squat: looking to see what entire kinetic chain is doing 2nd squat, check for true chondral involvement-put finger right over patella to feel for crunching/grinding 3rd squat, make diamond over patella, palpate peri-patella soft tissue

82
Q

Why did we learn the Dial test?

A

It is being used more and more common in clinics. We should use the other four rotary instability tests we learned.

83
Q

How to perform

Sag Test

A

Pt supine Flex knee

84
Q

response

Dial Test

A

Externally rotate at feet and you are looking for one side to ER proportionally more than the other side o Then it shows that the posterior part of the tibial plateau is subluxating back into the area where the arcuate ligament is o If that is injured, the tibia will subluxate into that weak area that is loose Looking for same sign during part 1 and 2 o This is a positive test

85
Q

test category

Pivot shift

A

ACL

86
Q

indications

fluid wave test

A

History of macro trauma, patient complains of stiffness, observation of swelling, increased anthropometric measurements

87
Q

FRD

A

Flexion Rotation Drawer Test

88
Q

indications

Active Tracking OKC

A

all patients

89
Q

indications

McMurray’s Test (6)

A
  1. History of macrotrauma
  2. Twisting MOI
  3. Delayed effusion (over 12 hours)
  4. Reproducible click/clunk
  5. Pseudo locking
  6. Joint line pain
90
Q

How to perform

Varus stress

A

pt supine, perform with knee at 0 and at 30 degrees flexion Stand between leg and table. position it so the joint line is at your closest thigh. Face foot. If they have some recurvatum, back of to neural (0 degrees) for 0 degree test, don’t test them in hyperextension 1) Varus stress (0 degrees): - Want to prevent their leg from rolling up your thigh * Palpate inferior pole of patella and slide finger laterally to be over lateral joint line - Palpate with index finger and use other fingers to support the leg since it is off the table more with this test - Other hand grabbing ankle wherever is comfortable * With knee in full extension, close the joint first, then give varus stress until you feel the end feel and let if spring back, you should feel/see it clunk back in a normal knee (hysteresis)-repeat 3 times - Everybody has physiologic laxity on lateral side so watch it close 2) Varus stress at 30 degrees - same as at 0 degrees but be more careful to prevent hip rotation

91
Q

implications

Apley’s Distraciton test and Apleys Dynamic Distraction Test (DDV)

A

MCL (+ with Internal rotation) LCL (+ with external rotation)

92
Q

response

Jerk test

A

reproduction of symptoms (this one is painful and scary because it reproduces MOI). Try not to do it unless necessary. Clunking (as knee subluxates)

93
Q

response

Milking test

A

pain and obvious fluid?

94
Q

PCL Tests (4)

A
  1. recurvatum
  2. sag test
  3. clancy step-up
  4. posterior drawer
95
Q

which two tests reproduce the MOI and should be avoided if possible?

A

pivot shift and jerk tests

96
Q

implications

PLRI

A

Post 1/3 lat cap., Arcuate complex

97
Q

implications

Sag Test

A

PCL (If PCL torn, tibia will sag posteriorly due to gravity _ will see a concavity from inferior pole of patella to tibial tuberosity)

98
Q

implications

Active Tracking OKC

A

Contractile tissue, patellar groove

99
Q

How to perform

Passive Tracking

A

pt in dependant position. Watch patella movement as you passivly move pt’s knee through ROM. Stay at eye level and watch only one spot.

100
Q

response

Medial/Lateral tilts

A

normal is about 15 degrees of tilt (referenced to the table)

101
Q

implications

Lachman’s Test

A

ACL (gold standard test, pathoneumonic)

102
Q

Patello-femoral tests (7)

A
  1. medial/lateral glides
  2. cephalic/caudal glides
  3. medial/lateral tilts
  4. passive tracking
  5. active tracking OKC
  6. active tracking CKC
  7. moving patellar apprehension test
103
Q

implications

Ballotment Test

A

Intra articular effusion

104
Q

test category

Dynamic McMurray’s Test

A

Meniscus

105
Q

indications

Lachman’s Test

A
  1. History of macrotrauma including twisting, deceleration MOI * 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn’t let quads fire normally * Not always due to a ligament instability issue * Can also be related to arthritis 3. Hear a ‘pop’ during MOI 4. Intra articular effusion * ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
106
Q

implications

Medial/Lateral patellar glides

A

Medial/Lateral retinaculum (superficial fibers)

107
Q

indications

Moving Patellar Apprehension test.

A

all patients

108
Q

How to perform

McMurray’s Test

A

pt supine * Flex hip to 90 degrees * GENTLY flex knee fully (depends on how much ROM they have due to pain and swelling) * Palpating over joint line *internally and externally rotate tibia on femur 3 times in each directions

109
Q

implications

Medial/Lateral tilts

A

Medial/Lateral retinaculum (deep fibers)

110
Q

indications

Active Tracking CKC

A

all patients

111
Q

indications

Jerk test

A
  1. History of macrotrauma including twisting, deceleration MOI* 80% or more of ACL injuries are non-contact2. Giving way-could be effusion creating an arthrogenic inhibition that doesn’t let quads fire normally* Not always due to a ligament instability issue* Can also be related to arthritis3. Hear a ‘pop’ during MOI4. Intra articular effusion* ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
112
Q

test category

PMRI

A

ACL - Rotary Instabillities

113
Q

How to perform

PMRI

A

pt supine: knee flexed < 90 degrees (80-70 good) Same as Posterior drawer, except tibia is ER

114
Q

test category

ALRI

A

ACL - Rotary Instabillities

115
Q

response

Moving Patellar Apprehension test.

A

Part 1: + Test: oral apprehension or quad apprehensive activation Only do part 2 if part one is + Part 2: + is No apprehension allowin full ROM

116
Q

How to perform

Steinman’s test

A

pt supine* Flex hip to 90 degrees* GENTLY flex knee fully (depends on how much ROM they have due to pain and swelling)* Palpating over joint line* 3 gentle overpressures-looking for replication of symptoms

117
Q

indications

Posterior Drawer

A
  1. *History of macrotrauma 2. *Hyperextension injury 3. *Fall on anterior tibia with ankle in plantarflexion 4. *Intra articular effusion 5. *Suspected ACL
118
Q

Collateral Ligament tests (3 general)

A
  1. Valgus stress (at 0 and 30 degrees)
  2. Varus stress (at 0 and 30 degrees)
  3. Apley’s Distraction and Apley’s Dynamic Distraction (DDV)
119
Q

How to perform

Dial Test

A

pt position supine. Part 1: * Flex patients knees to less than 80* (helps if someone can hold them but you don’t really need that) * have pt keep heels together and let feet ER. One more than the other implicates that side Part 2: (often times when there is a posterior lateral corner injury, you also have a concomitant PCL injury) hen need to test for PCL o Restest with knees at 90* With the knees at 90*, the PCL is tightened o If the same side goes further into ER, not only does that implicate posterior lateral corner and arcuate ligament complex but PCL as well

120
Q

indications

ALRI

A

(PCL must be intact to perform the test) 1. History of macrotrauma including twisting, deceleration MOI * 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn’t let quads fire normally * Not always due to a ligament instability issue * Can also be related to arthritis 3. Hear a ‘pop’ during MOI 4. Intra articular effusion * ACL supplied by genicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis

121
Q

implications

Cephalic/Caudal glides

A

infrapatellar tendon. Quadriceps tendon

122
Q

test category

Lachman’s Test

A

ACL

123
Q

indications

Passive Tracking

A

all patients

124
Q

response

Sag Test

A

If PCL torn, tibia will sag posteriorly due to gravity. will see a concavity from inferior pole of patella to tibial tuberosity

125
Q

How to perform

fluid wave test

A

pt supine, knee in 30 degrees of flexion. Keep hand in place after last milking test. And sweep fingers of other hand over spot on each side of the knee cap, alternating sides.

126
Q

Meniscus Tests (4 general)

A
  1. Recuratum
  2. Steinman’s test
  3. McMurray’s and Dynamic McMurray’s
  4. Apley’s Compression and Apley’s Dynamic Compression (DDV)
127
Q

implications

Anterior drawer

A

ACL (Anterior medial bundle - AMB)

128
Q

indications

Ballotment Test (4)

A
  1. History of macro trauma,
  2. patient complains of stiffness,
  3. observation of swelling,
  4. increased anthropometric measurements

(Effusion indications)

129
Q

response

Clancy step-up test

A

distal end of femur should feel 10mm away from plateau of tibia (should be a 10mm step up of the tibia toward you relative to the distal end of femur)

130
Q

implications

Valgus stress

A

0 degrees is MCL,ACL,PCL, PMOL 30 degrees is just MCL (0 degrees-57%) (30 degrees-78%)

131
Q

How to perform

PLRI

A

pt supine: knee flexed < 90 degrees (80-70 good) Same as Posterior drawer, except tibia is IR

132
Q

test category

AMRI

A

ACL - Rotary Instabillities

133
Q

test category

Anterior drawer

A

ACL

134
Q

How to perform

Anterior drawer

A

Pt supine Flex knee s an ACL tear

135
Q

response

PLRI

A

abnormal: posterior subluxation of the lateral side of tibia

136
Q

implications

Dynamic McMurray’s Test

A

entire meniscus from posterior horn, to middle, to anterior horn

137
Q

test category

Recurvatum for Meniscus

A

Meniscus

138
Q

indications

Flexion Rotation Drawer (FRD)

A
  1. History of macrotrauma including twisting, deceleration MOI * 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn’t let quads fire normally * Not always due to a ligament instability issue * Can also be related to arthritis 3. Hear a ‘pop’ during MOI 4. Intra articular effusion * ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
139
Q

implications

Posterior Drawer

A

PCL Acute PCL tears are often missed because people don’t do first 3 tests and tibia is already sagged back so it doesn’t move during the posterior drawer test * Chronic PCL tears-secondary restraints (capsule) become loose so, even though the tibia is already sagged back, as you push back there will be more give in the joint

140
Q

response

Steinman’s test

A

reproduction of symptoms: clicking/clunking, psudocatching/locking

141
Q

implications

Dial Test

A

Post 1/3 lat cap., Arcuate complex Part 2: PCL too

142
Q

response

Recurvatum for Meniscus

A

reproduction of symptoms?: clicking/clunking, psudocatching/locking pain?

143
Q

test category

Medial/Lateral tilts

A

Patello-Femoral

144
Q

response

Cephalic/Caudal glides

A

only cephalic has norm: 10mm.

145
Q

indications

Valgus stress

A
  1. *MOI-macrotraumatic injury with twisting 2. *MOI-history of frontal plane macrotrauma 3. *Localized edema without intra articular effusion 4. *Localized pain over collateral ligaments
146
Q

How to perform

Medial/Lateral patellar glides

A

pt position, supine, knee flexed to 30 degrees. Place hands superior and inferior to patella. Use thumbs to produce medial glide and fingers to produce lateral glide (perform 3 times)

147
Q

Rotary Instability Tests (5)

A
  1. ALRI
  2. PLRI
  3. AMRI
  4. PMRI
  5. Dial
148
Q

indications

Varus stress

A
  1. *MOI-macrotraumatic injury with twisting 2. *MOI-history of frontal plane macrotrauma 3. *Localized edema without intra articular effusion 4. *Localized pain over collateral ligaments
149
Q

indications

Apley’s Distraciton test and Apleys Dynamic Distraction Test (DDV)

A

(perform this test if other tests for collateral ligaments are equivocal) 1. *MOI-macrotraumatic injury with twisting 2. *MOI-history of frontal plane macrotrauma 3. *Localized edema without intra articular effusion 4. *Localized pain over collateral ligaments

150
Q

How to perform

Active Tracking OKC

A

pt in dependant position. Watch patella movement as pt extends/flexes knee through ROM. Stay at eye level and watch only one spot.

151
Q

implications

Steinman’s test

A

posterior horns of meniscus (most common problem)

152
Q

How to perform

Cephalic/Caudal glides

A

pt supine, knee flexed to 30 degrees. Use thumb web to puch knee cap distally three times, then the opposite hand to push it proximally. KEEP ELBOW DOWN on leg: you could hurt the infrapatellar fat pad or something above the knee cap

153
Q

How to perform

Milking test

A

pt position: supine, knee in 30 degrees of flexion. Use wrist crease to find edge of superior joint capsule. Gently sweep hand down to knee cap (like you are milking fluid down) three times.

154
Q

How to perform

Ballotment Test

A

pt supine, knee in 30 degrees of flexion. Use two fingers to push on the patella straight towards the table, then release pressure. Do not take fingers off of the patella even when releasing pressure or you will not feel quality of spring back.

155
Q

test category

PLRI

A

ACL - Rotary Instabillities

156
Q

How to perform

Dynamic McMurray’s Test

A

pt supine * Start with hip and knee flexed to 90 degrees for both parts Part 1: * Keep hand on heel, forearm on medial side of foot to externally rotate tibia * Give valgus force with palm of one hand on lateral femoral epicondyle-fingers toward ceiling-and take knee from flexion to extension - Don’t internally rotate hip - Rotate proximal hand as you bring them into extension to catch the leg - DO NOT let it clunk back to extension-that’s a different test called clunk/bounce home Part 2: * Opposite of part 1 * Hand on heel, forearm on lateral side of foot to internally rotate tibia * Give varus force to medial side of knee - Don’t want to abduct the hip

157
Q

indications

Steinman’s test

A
  1. *History of macrotrauma 2. *Twisting MOI 3. *Delayed effusion (over 12 hours) 4. *Reproducible click/clunk 5. *Pseudo locking 6. *Joint line pain
158
Q

indications

Sag Test

A
  1. *History of macrotrauma 2. *Hyperextension injury 3. *Fall on anterior tibia with ankle in plantarflexion 4. *Intra articular effusion 5. *Suspected ACL
159
Q

What order are the four main rotational instability tests usually positive in?

A

o ALRI- 1st most common o PLRI- 2nd most common o AMRI- 3rd most common o PMRI- least common

160
Q

How to perform

Posterior Drawer

A

Pt supine Flex knee s a PCL tear

161
Q

implications

ALRI

A

ACL Mid-1/3 lat. Cap.

162
Q

test category

Varus stress

A

Collateral Ligaments

163
Q

response

PMRI

A

abnormal: posterior subluxation of the medial side of tibia

164
Q

response

fluid wave test

A

Pressure on one side will produce outpoutching on onther side if effusion is present.

165
Q

response

Varus stress

A

repod of symptoms? Pain, gapping??

166
Q

test category

Dial Test

A

Rotational Instabilities

167
Q

test category

Clancy step-up test

A

PCL

168
Q

response

ALRI

A

abnormal: anterior subluxation of the lateral side of tibia

169
Q

How to perform

Active Tracking CKC

A

Instruct pt to do squat to assess weight bearing active tracking. Make sure they step away from table. Do not specify how, just however they decide to do a squat and observe how they do it:( 1st squat: looking to see what entire kinetic chain is doing 2nd squat, check for true chondral involvement - put finger right over patella to feel for crunching/grinding if there is chondral damage, you want to avoid that area in rehab by doing short arc exercises? 3rd squat, make diamond over patella (palpate peri-patella soft tissue )

170
Q

implications

Flexion Rotation Drawer (FRD)

A

): ACL, middle 1/3 of lateral capsule

171
Q

implications

McMurray’s Test

A

posterior horns of meniscus (most common problem)

172
Q

TF: Meniscus tear could happen just from ADLs?

A

true. Especially in older folks.

173
Q

test category

Passive Tracking

A

Patello-Femoral

174
Q

response

Posterior Drawer

A

If tibia subluxates back, you know it’s a PCL * Acute PCL tears are often missed because people don’t do first 3 tests and tibia is already sagged back so it doesn’t move during the posterior drawer test Chronic PCL tears-secondary restraints (capsule) become loose so, even though the tibia is already sagged back, as you push back there will be more give in the joint

175
Q

what is the gold standardr ACL special test?

A

Lachman’s

176
Q

response

Ballotment Test

A

can tell if there is effusion based on the feel of the bounce back

177
Q

8 Rules of Rotary instability test interpretation

A
  1. PCL is intact and serves as the axis of rotation 2. Properly position the knee into IR or ER to selectively bias the tissues 3. Force is applied in a straight sagittal plane 4. Direction of applied force 5. Which tibial plateau translates in the direction of the applied force 6. Names the rotary instability 7. Anterior rotary instabilities are actually named opposite of the true rotation 8. Posterior rotary instabilities are actually named same as the true rotation
178
Q

indications

Recurvatum, not for meniscus (5)

A
  1. History of macrotrauma
  2. Hyperextension injury
  3. Fall on anterior tibia with ankle in plantarflexion
  4. Intra articular effusion
  5. Suspected ACL

(PCL indications)

PHTH 7232 Ortho (21 decks)

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