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Clinical skills > Knee SpT > Flashcards

Knee SpT Flashcards

1
Q

Knee SpT’s

A

Anterior Drawer
Lachman’s
Posterior sag sign
MCL/ Valgus stress test
LCL/ Varus stress test
McMurray’s
Thessaly’s

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2
Q

Anterior drawer: procedure

A
  • Patient is in long sitting, with hip at 40deg flex and knee at 90deg flex
  • Foot is to be flat on the bed and clinician to sit on the foot to stabilise
  • Clinicians thumbs to be resting over the tibial tuberosity and patella tendon
  • Fingers resting into the infero-posterior J-L around the area of the hamstring tendons
  • Apply P-A force in a slow and controlled manner
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3
Q

Anterior drawer: purpose

A

Integrity of anterior cruciate ligament (ACL)

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4
Q

Anterior drawer: SPEC/SENS

A

SENS: 40.9%
SPEC: 95.2%

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5
Q

Anterior drawer: +ve -ve tests

A

+ increased glide of the tibia
+ soft end feel
+/- P
- no laxity

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6
Q

Lachman’s test: procedure

A
  • Patient in long sitting, hip 40deg flex and knee 30-40deg flex in supported position
  • Clinician to stabilise proximal to the knee
  • Other hand resting thenar eminence on tibial tuberosity with fingers around J-L
  • Apply a smooth and controlled P-A drawer
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7
Q

Lachman’s test: purpose

A

Integrity of the anterior cruciate ligamant (ACL)
Designed to assess single and sagittal plane instability

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8
Q

Lachman’s test: SPEC/SENS

A

SENS: 77.7%
SPEC: 95%

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9
Q

Lachman’s test: +ve -ve tests

A

+ increased glide of tibia
+ soft end feel
+/- P
- no laxity

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10
Q

Posterior sag sign: procedure

A
  • Patient supine
  • 90/90
  • Therapist holds calcaneus
  • Looking a drop in the tibia
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11
Q

Posterior sag sign: purpose

A

Integrity of posterior cruciate ligament

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12
Q

Posterior sag sign: SPEC/SENS

A

SENS: 100%
SPEC: 83%

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13
Q

Posterior sag sign: +ve -ve tests

A

+ posterior tibial sag
- no laxity

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14
Q

MCL/ Valgus stress test: procedure

A
  • Patient in long sitting or supine lie
  • Take shotgun handling position
    • One hand medial tibia, one hand lateral knee
  • Apply slow pressure L-M on lateral knee
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15
Q

MCL/ Valgus stress test: purpose

A

Integrity of the medial collateral ligament (MCL)

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16
Q

MCL/ Valgus stress test: SPEC/SENS

A

SENS: 78%
SPEC:67%

17
Q

MCL/ Valgus stress test: +ve -ve tests

A

+ increased gapping of medial J-L
+ soft end feel
+/- P
- no laxity

18
Q

LCL/Varus stress test: procedure

A
  • Patient in long sitting or supine lie
  • Take shot gun handling position
    • one hand lateral fibula, one hand medial femur
  • Apply external tibial rotation and apply slow pressure ML on the medial femur J-L above the knee
19
Q

LCL/Varus stress test: purpose

A

Integrity of the lateral collateral ligament (LCL)

20
Q

LCL/Varus stress test: SPEC/SENS

A

SENS: 25%
SPEC: ???

21
Q

LCL/Varus stress test: +ve -ve tests

A

+ increased gapping of lateral J-L
+ soft end feel
+/- P
- no laxity

22
Q

McMurray’s test: procedure

A
  • Patient in supine lie
  • Hold knee in one hand along the J-L, flex it to 90deg
    and hold the sole of the foot in the other hand
  • Apply pressure to the lateral side of the knee to stabilise the joint and provide valgus force
  • Externally rotate and extend the knee with the other hand
  • Repeat this process reflected on the medial side, may require a hand swap
23
Q

McMurray’s test: purpose

A

To determine the presence of a meniscal tear

24
Q

McMurray’s test: SPEC/SENS

A

SENS: 70%
SPEC: 71%

25
Q

McMurray’s test: +ve -ve tests

A

+ audible and painful click or pop (crepitus)
+ joint locking/ catching
- no crepitus/locking/catching

26
Q

Thessaly’s test: procedure

A
  • Stand patient on one leg and use arms to support
  • flex knee to 20deg
  • slow and controlled internal and external rotation
27
Q

Thessaly’s test: purpose

A

Clinical screening tool for meniscal tears/ lesions

28
Q

Thessaly’s test: SPEC/SENS

A

M Meniscus:
SENS: 66%
SPEC: 96%
L Meniscus:
SENS: 81%
SPEC: 91%
ACL&Meniscus:
SENS: 65%
SPEC: 83%

29
Q

Thessaly’s test: +ve -ve tests

A

+ audible and painful click or pop (crepitus)
+ joint locking/ catching
- no crepitus/locking/catching

Clinical skills (8 decks)

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