MSK - Knee Flashcards
What are the active movements in the knee, normal ranges and end feels?
Flexion 135° - STA
Extension 0-15° - tissue stretch
ER of tibia on femur 30-40° - tissue stretch
IR of tibia on femur 20-30° - tissue stretch
MMT - Quads
Femoral Nerve L2-4
Sitting, holding onto table, towel under leg to protect from table edge
Resistance applied at lower leg
MMT - Semimem, Semiten
Sciatic Nerve L4-S2
Prone, thigh in medial rotation
Resistance into extension at lower leg
MMT - Biceps Femoris
Sciatic Nerve L3-S3
Prone, thigh in lateral rotation
Resistance into extension against lower leg
MMT - Popliteus
Tibial Nerve L4-S1
Sitting with knee at 90 and tibia in lateral rotation
Patient medially rotates tibia - No resistance
Valgus Stress Test
Structure: MCL (and other structures); if +ve at 0 indicates gross ligamentous laxity
Technique: Pt supine. Apply valgus force with slight ER at tibiofemoral joint to stress medial structures. Test in full ext and slight flexion
Positive Test: Symptom reproduction, excursion, endfeel
Varus Stress Test
Structure: LCL (and other structures)
Technique: Pt supine. Apply varus force with slight IR at tibiofemoral joint to stress lateral structures. Test in full ext and slight flexion
Positive Test: Symptom reproduction, excursion, endfeel
Posterior Sag Test
Structure: PCL
Technique: Pt supine with hip and knee to 90 with heels resting on PT arms or stool
Positive Test: More than 1 cm protrusion of medial tibial plateau relative to medial femoral condyle (1 cm is normal)
*Done before ACL tests to prevent false positves
Posterior Drawer Test
Structure: PCL, post joint capsule, posterior menisci
Technique: Pt supine, hip flexed to 45 and knee to 90. Sit on foot and apply posterior force to tibia
Positive Test: Symptom reproduction, excursion, endfeel
Anterior Drawer Test
Structure: ACL (primary), ant joint capsule, ant mensici
Technique: Pt supine with hip flexed to 45 and knee at 90. Sit on pt’s foot. Ant force to tibia. Palpate joint line and hamstring tendons.
Positive Test: Symptom reproduction, excursion, endfeel (early spasm of hamstring in acute, late spasm if chronic, normal firm tissue – gr 1, mushy gr 3)
Lachman Test
Structure: ACL
Technique: Pt supine with knee in resting position. Apply force in anterior direction to tibia on fixed femur (or vice versa)
Positive Test: Symptom reproduction, excursion (may be decreased is very acute due to apprehension, swelling), End feel (early spasm – acute, late spasm – chronic and unstable, normal firm tissue – gr 1, mushy – gr 3)
Lateral Pivot Shift
Structure: ACL
Technique: Hip at 30° flexion, abduction and slight IR. PT hand at calcaneus and other hand at head of the fibula. Move knee from full ext to approx 40° knee flexion. Apply slight valgus stress to knee as bringing it into flexion.
Positive Test: Subluxation-reduction test. Lat side of tibia translates during first part of test (sublux). At approx 30° knee flexion ITB pulls tibia back and clunk will occur (relocation).
Slocum Test for Anterolateral Rotational Instability
Structure: ACL + LCL (and others)
Technique: Pt supine with hip flexed to 45° and knee to 90 °with foot IR 30°. Apply ant force to tibia
Positive Test: Symptom reproduction, excursion, endfeel
Slocum Test for Anteromedial Rotational Instability
Structure: ACL + MCL (and others)
Technique: Pt supine with hip flexed to 45, knee to 90 and foot ER 15°. Apply ant force to tibia
Positive Test: Symptom reproduction, excursion, endfeel
McMurray’s Test
Structure: Mensicus
Technique: Pt’s knee in full flexion, apply rotation to tibia (medial- for lat meniscus or lateral - for medial meniscus). Extend knee through range while maintaining rotation.
Positive Test: Reproduction of pain or snap/click during test
Thessaly Test
Structure: Meniscus (developed in military pop – prob not for older people)
Technique: Pt stands on one leg (PT provide balance support). Pt flexes knee to 5° and rotates femur and tibia medially and laterally (repeat at 20°)
Positive Test: Joint line pain or sense of catching or locking
Apley’s Test
Structure: Mensicus
Technique: Pt prone with knee flexed to 90°. PT leg to stabilize thigh. Apply traction and medial and laterally rotate. Repeat with compression.
Positive Test: Pain (rotation + distraction = ligament more likely; compression + rotation = mensicus)
Clarke’s Sign
Supine, knee extended. Press down with web of hand prox to superior pole of patella. Ask pt to contract quads while pressing down. Careful with pressure because too much can be painful for anyone.
+ve= retropatellar pain and can’t hold contraction
Indicates: patellofemoral dysfunction
McConnell Test for Chondromalacia Patellae
Sitting, legs at 90 off edge of bed. Performs 5-10s iso contractions at 120, 90, 60, 30, 0 of flex. If pain then leg is passively returned to full ext. Add medial glide of patella and return to painful angle and redo contraction.
+ve = pain decreases with patellar glide
Indicates: original pain = patellofemoral dysfunction
Noble Compression Test
Flex knee to 90 with hip flexion. Apply pressure to lateral femoral epicondyle and passively extend knee.
+ve = pain at about 30° flexion over epicondyle
Indicates: ITBFS
Fairbanks’ Apprehension Test
Supine, quads relaxed and knee flexed to 30. Sit on plinth with pt’s leg over your leg and push patella laterally.
+ve = pt looks apprehensive or contracts quads
Indicates: previous patellar dislocation
Mediopatellar Plica Test
Supine, affected knee flexed to 30, resting on examiner’s arm. Medially glide patella, can have active extension to elicit pain or click
+ve = complains of pain or click
Indicates: pinching of edge of mediopatellar plica between medial femoral condyle and patella
Brush Test
Structure: To identify intracapsular swelling
Technique: Swipe 3-4 times up medial side of patella and then around superior aspect and once down lateral side from proximal to distal.
Positive Test: Small bulge on medial side of patella
