MSK - Knee

Question 1

What are the active movements in the knee, normal ranges and end feels?

Answer 1

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

Question 2

MMT - Quads

Answer 2

Femoral Nerve L2-4
Sitting, holding onto table, towel under leg to protect from table edge
Resistance applied at lower leg

Question 3

MMT - Semimem, Semiten

Answer 3

Sciatic Nerve L4-S2
Prone, thigh in medial rotation
Resistance into extension at lower leg

Question 4

MMT - Biceps Femoris

Answer 4

Sciatic Nerve L3-S3
Prone, thigh in lateral rotation
Resistance into extension against lower leg

Question 5

MMT - Popliteus

Answer 5

Tibial Nerve L4-S1
Sitting with knee at 90 and tibia in lateral rotation
Patient medially rotates tibia - No resistance

Question 6

Valgus Stress Test

Answer 6

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

Question 7

Varus Stress Test

Answer 7

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

Question 8

Posterior Sag Test

Answer 8

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

Question 9

Posterior Drawer Test

Answer 9

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

Question 10

Anterior Drawer Test

Answer 10

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)

Question 11

Lachman Test

Answer 11

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)

Question 12

Lateral Pivot Shift

Answer 12

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).

Question 13

Slocum Test for Anterolateral Rotational Instability

Answer 13

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

Question 14

Slocum Test for Anteromedial Rotational Instability

Answer 14

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

Question 15

McMurray’s Test

Answer 15

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

Question 16

Thessaly Test

Answer 16

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

Question 17

Apley’s Test

Answer 17

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)

Question 18

Clarke’s Sign

Answer 18

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

Question 19

McConnell Test for Chondromalacia Patellae

Answer 19

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

Question 20

Noble Compression Test

Answer 20

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

Question 21

Fairbanks’ Apprehension Test

Answer 21

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

Question 22

Mediopatellar Plica Test

Answer 22

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

Question 23

Brush Test

Answer 23

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