Knee tests

Question 1

Knee orthopedic tests

Answer 1

patella tests:
– ballottment test
– Clarkes

meniscal lesion tests:
– joint line tenderness test
– thesaly test
– mcmurrays
– eges
– apleys grind

ACL and PCL test:
– anterior and posterior draw
– lachmans test

MCL and LCL test:
– accessory movement

Question 2

Ballottment test

Answer 2

Looks for:
– patella pathology

+VE:
– spongy, bounce back of the patella when pressing it

How:
– milk the patella, can do this with one or 2 hands, from above and from below up to the knee
– use other hand (non above one), to press and see if there is excess fluid or bounce back
– aims to push all fluid from behind the patella

Question 3

Clarkes test

Answer 3

Looks for:
– degenerative patellofemoral pain syndrome
– tests the articulation between the patella and the femur

+VE:
– pain on contraction of the quadriceps

How:
– pt leg extended

– place pressure above patella
– pt contract quadriceps, if pain is shown then its positive

Question 4

Thesally’s test

Answer 4

Looks for:
– medial and lateral meniscus lesions

+VE:
– pain, apprehension, unstableness when performing the test
– may experience locking and catching of the knee
– medial pain- medial meniscus lesion
– lateral pain- lateral meniscus lesion

How:
– pt stand on one leg (asymptomatic leg 1st)
– examiner holds pt arms
– twist pt body round laterally and medially with knee flexed 5 degrees
– if still no pain, get pt to flex knee to 20 degrees, twist again

Question 5

Joint line tenderness test

Answer 5

Looks for:
– meniscal damage

+VE:
– pain on palpation

How:
– knee flexed up, palpate the joint line of the patient
– look for things that dont feel right and the patient suffering pain

Question 6

McMurrays test

Answer 6

Looks for:
– medial and lateral meniscal lesions
– internal tibial rotation- lateral meniscus
– external tibial rotation- medial meniscus

+VE:
– pain

How:
– pt supine, with leg flexed
– lift pt leg up to 90 degrees flexion and flex hip
– medially and laterally rotate tibia and move knee into extension
– repeat and keep changing angle of flexion- so the whole posterior aspect of the lateral meniscus can be tested

Question 7

Apley’s grind test

Answer 7

Looks for:
– compression- meniscal lesions
– distraction- ligament damage or meniscal lesions

+VE:
– COMPRESSION:
—- increase in pain on medial or lateral side- medial or lateral meniscal lesions

– DISTRACTION:
—- increase in pain- ligament damage
—- decrease in pain- meniscal damage

How:
– couch height low
– pt knee flexed with quad against the bed
– can put pillow on top of leg, (asymptomatic leg 1st)
– put knee on top of pt hamstring
– compress and twist ankle medially and laterally and do the same but distract

Question 8

Ege’s test (active McMurrays)

Answer 8

Better than Mcmurrays
Looks for:
– meniscal lesions:
– feet turned in- lateral lesions
– feet turned outwards- medial lesions

+VE:
– pain or crepitus (either while squatting or coming out of the squat)

How:
– pt standing with feet 30-40cm apart
– pt externally rotate (turn feet outwards) and squat
—- medial meniscal lesions

– pt internally rotate (turn feet in) and squat
—- lateral meniscus lesions

Question 9

Lachmans test

Answer 9

Gold standard test for ACL and PCL damage

Looks for:
– damage or tear to the ACL or PCL

+VE:
– excessive movement anterior or posterior

– pain with normal anterior translation- ACL sprain
– pain along with increased ACL translation- ACL rupture

– pain with normal posterior translation- PCL sprain
– pain with increased posterior translation- PCL rupture

How:
– knee under pt popliteal fossa
– push down on leg or push up on leg