MMT The Knee

Question 0

Knee flexion- medial hamstrings

Answer 0

Semimembranosus and semitendinosus
Pt position: prone, knee flexed to less than 90 degrees; leg in internal rotation
Position of therapist: standing next to limb being tested, resistance just superior to ankle in oblique direction (down and out)
Test: pt flexes knee while maintaining leg in internal rotation
Instructions: “bend your knee, hold it, don’t let me straighten your leg”

Question 1

Knee flexion- hamstring muscles in aggregate

Answer 1

Biceps femoris, semitendinosus, semimembranosus (sciatic nerve)
**three basic muscle tests for the hamstrings for grades 5 and 4
**first test aggregate and only if there is deviation (asymmetry) is there a need to test the medial and lateral hamstrings separately
Hamstrings muscles in aggregate
Test position: pt prone, knee in about 45 degrees flexion
Therapist position: standing next to limb being tested, resistance just superior to ankle in direction of extension
Test: pt flexes knee while maintaining leg in neutral rotation
Instructions: “bend knee, hold it, don’t let me straighten it”

Question 2

Knee flexion- lateral hamstrings

Answer 2

Biceps femoris
Pt position: prone with knee flexed less than 90 degrees; leg in external rotation
Therapist position: standing next to limb being tested, resistance given just superior to ankle in oblique direction (down and in)
Test: pt flexes knee while maintaining leg in external rotation
Instructions: “bend your knee, hold it, don’t let me straighten it”

Question 3

Knee flexion grades 2,1,0

Answer 3

Grade 2
Pt position: side lying with test limb supported; lower limb flexed for stability
Therapist position: standing next to limb being tested, one hand cradles thigh and medial knee, other hand supports ankle at malleolus
Test: pt flexes knee through available range
Instructions: “bend your knee”
Grades 1,0
Pt position: prone, limbs straight with toes over edge of table; knees partially flexed by examiner (and supported at ankle)
Therapist position: standing next to limb being tested, palpate both medial and lateral hamstring tendons just above posterior knee
Test: pt attempts to flex the knee
Instructions: “try to bend your knee”

Question 4

Knee extension

Answer 4

Rectus femoris, Vastus intermedius, Vastus lateralis, Vastus medialis longus and oblique (femoral nerve)
Grades 5,4,3
Pt position: short sitting; place wedge or pad under distal thigh
Therapist position: standing at side of limb to be tested, resistance just superior to ankle in direction of flexion
Test: pt extends knee through available range but not beyond 0 degrees
Instructions: “straighten your knee, hold it, don’t let me bend it”
Grade 2
Pt position: side lying
Therapist position: standing behind limb at knee level, support leg at knee and ankle
Test: pt extends knee through available range
Instructions: “straighten your knee”
Grade 1,0
Pt position: supine
Therapist position: standing next to limb being tested, palpate quadriceps tendon just above the knee with tendon btw thumb and fingers
Test: pt attempts to extend knee
Instructions: “push the back of your knee down into the table, tighten your knee cap”