Knee Special Tests Flashcards
Fluctuation test
Tests for: significant swelling of the knee
Supine, knee extended as much as possible
Cup one hand proximal to patella/joint line, the other distal
Alternating downward pressure applied
Positive : palpation of synovial fluid fluctuating under hands and moving from one hand to the other.
Valgus Stress test
Assesses integrity of the medial stabilizing structures of the knee
Supine, knee extended.
Stand outside of leg. Stabilize leg in slight knee flexion, stabilizing medial to medial malleolus.
Gap knee joint medially (apply medial pressure to distal femur)
Positive: recreation of pain, apprehension, excessive medial galling.
Varus Stress Test
Assesses integrity of the lateral stabilizing structures of the knee
Supine, knee extension.
Stabilize leg in slight knee flexion, stabilizing lateral to lateral malleolus.
Gap knee laterally (apply lateral force to joint line).
Positive: recreation of pain, apprehension, excessive lateral gapping.
Apley’s distraction test
Assesses for integrity of collateral ligaments
Prone. Knee flexed to 90°.
With hand or knee stabilize the leg at post thigh; grasp just proximal to ankle.
Traction tibia toward ceiling, apply medial and lateral rotation.
Positive: pain (medial side = MCL, lateral side = LCL). Or excess movement, apprehension
Brush Stroke test
Tests for: effusion (minimal, post acute injury)
Supine, knee as extended as possible.
Therapist applied light to moderate sweeping with fingers and hands to the knee.
“Inside Hand”: Inf/med –> sup/lat
“Outside hand”: med/inf
Positive: fluid movement, swelling developing inferior aspect of patella.
DDx: possible meniscus or cruciate injury (medical emergency)
Anterior Drawer Test
Tests for: anterior stability of the knee
Supine, 45º hip flexion, 90º knee flexion, foot on table.
Sit on foot to stabilize foot/ankle.
Grasp tibia with both hands, landmarking tibial plateaus with thumbs.
Pull tibia anteriorly.
Positive:
Excursion >6 mm; possible pain –> ACL, posterior joint capsule damage
Snapping or jerking motion: meniscal damage
Lachman’s Test
Tests for: ACL integrity
Supine. 30º knee flexion.
Stabilize femur with one hand, grab tibia with the other (or stabilize between arm and torso and grab with both hands)
Apply anterior stress to tibia
[Can also test seated, prone, leg drop]
Positive: excessive anterior motion of the tibia, disappearance of infrapatellar tendon slope, possible pain
Sag Sign
Assesses: PCL integrity
Supine: 45º hip flexion, 90º knee flexion. Feel on table.
Observe knees in profile
Positive: tibia sags posteriorly compared to the unaffected side
Posterior Drawer Test
Assesses: posterior stability of the knee
Supine, 45º hip flexion, 90º knee flexion, foot on table.
Stabilize foot by sitting on it.
Grasp tibia with both hands, landmarking plateaus with thumbs.
Apply posterior pressure
Positive: Excursion >6mm, possible pian –> PCL and anterior joint capsule damage
Snapping or jerking –> meniscus damage
McMurrays Test
Assesses: meniscal injury
Supine. Hip and knee flexed.
Cup palm over patella; palpate joint line with fingers and thumb. Other hand grasps heel.
Bring knee into slow extension and either:
IR + varus stress (test lateral meniscus)
ER + valgus stress (test medial meniscus)
Positive: clicking or catching in extension, pain, apprehension
[Prone to false negatives]
Apley’s Compression Test
Assesses: meniscal injury
Prone, knee flexed to 90º
Push foot and tibia into table (compresses menisci); IR and ER
Positive:
Pain on lateral side: lateral meniscus
Pain on medial side: medial meniscus
Patellofemoral Compression Test
AKA grind test, Clarke’s sign
Assesses for patellofemoral syndrome
Supine, knee extended.
Apply posterior and distal pressure on patella. Instruct victim to contract quads. Laugh maniacally.
Positive: pain face, curses, creptitus.
False positives. Repeat with more pressure just for shits and giggles.
Patellar Apprehension Test
Assesses: likelihood of patellar lateral dislocation
Supine, knees extended.
Apply slow moderate pressure to medial patella, translating it laterally. Observe reaction.
Positive: apprehension, avoidance.
Noble’s Compression Test
Assesses for: ITB friction syndrome
Supine. Hip and knee flexed to 90º
Apply firm pressure to ITB 2cm proximal to lateral femoral condyle
Actively extend hip and knee.
Positive: recreation of pain at about 30º extension
Joint Effusion Tests:
Brush/Stroke Test
Fluctuation Test
