Objective - Special Tests

Question 1

Point of special tests

Answer 1

> Determine whether disease, condition or injury is present
shouldn’t be used alone to make clinical judgement
Can be provocative - be careful
*all ligament tests are accessory tests - done out of closed packed position (may be worth doing near painful range as well as recommended range)

Question 2

Looking for:

Answer 2

> amount of movement vs. normal
feeling during movement - ‘quality’
end feel
pain/resistance/muscle spasm (which is the biggest limiting factor)

Question 3

LCL

Answer 3

> Varus stress test

• 30 degrees of knee flexion
• lower leg is pushed inwards whilst thigh is pushed outwards

Question 4

MCL

Answer 4

> Valgus stress test

• 30 degrees of knee flexion
• lower leg is pushed outwards whilst thigh is pushed inwards

Question 5

ACL

Answer 5

> Lachmans

• knee in 30 degrees of flexion
• one hand fixes femur whilst other grips posterior tibia (thumb on tib tuberosity if poss) + pulls anteriorly

> Anterior Drawer

• knee in 90 degrees flexion (sit on foot to fix it)
• grip posterior tibia with thumbs on tib tuberosity and pull anteriorly

Question 6

PCL

Answer 6

> Posterior Drawer

• knee in 90 degrees of flexion (sit on foot to fix it)
• thumbs on tibial tuberosity and push posteriorly (take out of sag first)

Question 7

Meniscus

Answer 7

> Mcmurrays

• maximal knee flexion (pain permitting)
• U shaped scoop with one hand gripping joint line feeling for ‘catching’ other grips calcaneus to guide movement
• add medial and lateral rotation of tibia to target each side (med rot - lat meniscus + lat rot = med meniscus)
• extend knee in rotated position
• looking to recreate pop/click feeling - pain is less of an indicator as might be due to deep flexion or movement

> Apley’s

• prone with knee flexed to 90 degrees
• apply compressive pressure to knee + add tibial rotation

Question 8

ATFL (lateral ankle instability)

Answer 8

> Anterior Drawer
- knee into flexion to allow foot to rest flat on bed
- fix foot with hand and apply AP force to tibia and fibula above ankle
- observe medial malleolus movement
OR:
- in prone with knee flexed to 90 degrees (fix upper leg with therapist knee)
- grasp malleoli with one hand and talus with other - push talus away from head
OR:
- with knee slightly flexed
- grasp calcaneus with one hand and fix malleoli with other
- pull calcaneus anteriorly whilst pushing malleoli down

Question 9

CFL

Answer 9

> Talar tilt test

• leg flat with foot off bed
• fix tib + fib with one hand
• force foot into inversion (stretching CFL so need to target Calcaneus with inversion movement)

Question 10

Documenting Accessory Joint

Answer 10

> Joint tested
Movement
RoM (normal/abnormal/hypo/hyper)
Quality of movement (resistance/pain at what range)
End Feel (hard/muscle spasm/capsular/elastic/empty/springy block)