OSCE regional tests Knee, leg, ankle foot Flashcards
Knee: Describe the valgus stress test
1) The patient is lying supine on the treatment table.
2) The practitioner places the palmar aspect of one hand over the lateral joint line and the opposite hand holds the distal leg.
3) The practitioner applies a medial force through the knee at the joint line, while simultaneously applying a lateral (stabilizing) force at the distal leg.
a. The test is performed first in neutral (full knee extension) and then in 20-30 degrees of flexion so as to ‘unlock’ the knee
Knee: what is the purpose of the valgus stress tests
This test is used to assess for medial instability of the knee
Knee: What is a positive result of the valgus stress test? What is the interpretation of a positive result of the valgus stress test while the knee is neutral? There are four ligaments and two muscles plus one capsule that could be injured- name them.
The test is considered positive if the practitioner observes an excessive amount of movement of the tibia away from the femur on the medial side of the knee.
A positive test in neutral may indicate injury to the:
- Medial collateral ligament
- Posterior oblique ligament
- Posteromedial capsule
- Anterior cruciate ligament
- Posterior cruciate ligament
- Medial quadriceps
- Semimembranosus muscle
Knee: What is a positive result of the valgus stress test at 20-30 degrees of flexion? What is the interpretation of a positive result of the valgus stress test while the knee is in 20-30 degrees of flexion? What are the three ligaments and one capsule affected?
The test is considered positive if the practitioner observes an excessive amount of movement of the tibia away from the femur on the medial side of the knee.
A positive test in 20-30 degrees flexion may indicate injury to the:
- Medial collateral ligament
- Posterior oblique ligament
- Posterior cruciate ligament
- Posteromedial capsule
Knee: Describe the varus stress test
1) The patient is lying supine on the treatment table.
2) The practitioner places the palmar aspect of one hand over the medial joint line and the opposite hand holds the distal leg.
3) The practitioner applies a lateral force through the knee at the joint line, while
simultaneously applying a medial (stabilising) force at the distal leg.
a. The test is performed first in neutral (full knee extension) and then in 20-30 degrees of flexion so as to ‘unlock’ the knee.
Knee: What is the purpose of the varus stress tests?
This test is used to assess for lateral instability of the knee
Knee: What is a positive result of the varus test? What is the interpretation of a positive result of the varus stress test while the knee is neutral? What are the eight knee components that could be injured?
The test is considered positive if the practitioner observes an excessive amount of movement of the tibia away from the femur on the medial side of the knee.
A positive test in neutral may indicate injury to the:
- Lateral collateral ligament
- Posterolateral capsule
- Arcuate-Popliteus complex
- Biceps femoris tendon
- Posterior cruciate ligament
- Anterior cruciate ligament
- Lateral gastrocnemius muscle
- Iliotibial band
Knee: What is a positive result of the varus test at 30-40 degrees of flexion? What is the interpretation of a positive result of the varus stress test while the knee is in 20-30 degrees of flexion? what are the five knee components that could be injured?
The test is considered positive if the practitioner observes an excessive amount of movement of the tibia away from the femur on the medial side of the knee.
A positive test in 20-30 degrees flexion may indicate injury to the:
- Lateral collateral ligament
- Arcuate-Popliteus complex
- Iliotibial band
- Biceps femoris tendon
- Posterolateral capsule
Knee: Describe the drawer test
1) The patient is lying supine on the treatment table.
2) The practitioner flexes the patient’s hip to approximately 45 degrees and knee to 90 degrees
3) The practitioner sits gently on the patient’s forefoot to anchor the limb and places both hands around the tibia.
4) The practitioner then draws the tibia forward, assessing the amount of available anterior glide the tibia has under the femur.
5) The tibia is then pushed posteriorly with the practitioner assessing the amount of posterior translation of the tibia under the femur
Knee: What is the purpose of the drawer tests?
This test is used to assess for anterior and posterior instability of the knee
Knee: What is a positive result of the anterior drawer test? What is the interpretation of a positive result of the anterior drawer test? What are the seven areas that could be compromised?
The anterior drawer is considered positive if the tibia translates more than 6mm on the femur and may indicate injury of the:
- Anterior cruciate ligament
- Posterolateral capsule
- Posteromedial capsule
- Medial collateral ligament
- Iliotibial band
- Posterior oblique ligament
- Arcuate-popliteus complex
Knee: What is a positive result of the posterior drawer test? What is the interpretation of a positive result of the posterior drawer test? What are the four knee components that could be compromised?
The posterior drawer is considered positive if the tibia shifts posteriorly on the femur and may indicate injury to the:
- Posterior cruciate ligament
- Arcuate-popliteus complex
- Posterior oblique ligament
- Anterior cruciate ligament
Knee: Describe the Lachman test
1) The patient is lying supine on the treatment table
2) The practitioner positions the patient’s knee between full extension and 30 degrees of flexion.
3) The practitioner stabilizes the femur with one hand and grasps the patient’s leg with the other hand.
4) The tibia is then drawn forward on the femur
Knee: What is a positive result of the Lachman test? What is the interpretation of a positive result of the Lachman test? What are the three knee components that might be compromised?
The test is considered positive if a soft (or ‘mushy’) end feel is felt or there is a disappearance of the infrapatellar tendon slope on anterior translation. A positive test may indicate injury to the:
- Anterior cruciate ligament
- Posterior oblique ligament
- Arcuate-popliteus complex
Knee: What is the purpose of the Lachman test?
This test is used to assess for injury to the anterior cruciate ligament
Knee: Describe the Lelli test
1) The patient is lying supine on the treatment table
2) The practitioner places a closed fist under the proximal third of the patient’s calf (resulting in slight flexion of the patient’s knee).
3) The practitioner then uses the other hand to apply a downward force on the patient’s distal thigh
Knee: What is the purpose of the Lelli test
This test is used to assess for potential injury to the anterior cruciate ligament
Knee: What is a positive result of the Lelli test? What is the interpretation of a positive result of the Lelli test?
If the anterior cruciate ligament is intact the patient’s heel will lift off the treatment table. If the heel does not lift off (and translation occurs between the tibia and femur) there is a suspected tear of the
anterior cruciate ligament.
Knee: Describe the Posterior sag test
1) The patient is lying supine on the treatment table with the hip flexed to 45 degrees and the knee flexed to 90 degrees
Knee: What is the purpose of the Posterior Sag test
This test is used to assess for instability of the knee due to injury of supportive tissues
Knee: What is a positive result of the Posterior sag test? What is the interpretation of a positive result of the Posterior Sag test? What are the four knee components that a positive Posterior Lag Sign might indicate as injured?
In this position the tibia ‘sags’ back on the femur due to gravity if the posterior cruciate ligament is compromised. Typically the tibial plateau extends approximately 1cm anteriorly in relation to the
femoral condyle when the knee is in 90 degrees of flexion.
If this ‘step’ caused by the tibia is lost this is referred to as a posterior sag sign and may indicate injury of the:
- Posterior cruciate ligament
- Arcuate-popliteus complex
- Posterior oblique ligament
- Anterior cruciate ligament
Knee: Describe the Lateral Pivot-Shift test
1) The patient is lying supine on the treatment table
2) The patient’s hip is flexed and abducted to approximately 30 degrees and in slight medial rotation.
3) The practitioner holds the patient’s ankle with one hand (with the heel of the palm posterior to the fibula assisting in introducing medial rotation to the tibia) and places the other hand
on the lateral aspect of the proximal leg.
4) A valgus force is introduced by the cephalad hand while both hands maintain a medial rotation of the tibia.
5) The patient’s knee is then taken into flexion while the practitioner maintains a valgus force at the knee.
Knee: Describe Apley’s Test.
1) The patient is lying prone on the treatment table
2) The patient’s hip is in neutral and the knee if flexed to 90 degrees.
3) The practitioner rests their knee over the posterior aspect of the patient’s thigh to stabilise the limb.
4) The practitioner applies a compressive force through the knee by pressing through the foot toward the table and then rotates the patient’s tibiofemoral joint into medial and lateral
rotation (while maintaining the downward force). The practitioner notes restriction, excessive movement, or discomfort.
5) The practitioner then applies a distraction force by lifting the leg and applying medial and lateral rotation (while maintaining the distraction force)
Knee: Describe Ege’s Test
1) The patient stands with the feet 30-40cm apart and the knees extended.
2) To test the medial meniscus the patient bends the knees slightly, fully rotates the tibias laterally under the femurs and squats down and then stands back up slowly.
3) To test the lateral meniscus the patient bends the knees slightly, fully rotates the tibias medially under the femurs and squats down and then stands back up slowly.
Knee: Describe McMurray Test
1) The patient is lying supine on the treatment table
2) To test the lateral meniscus the patient’s knee to be tested is taken into full flexion and the practitioner rotates the tibia medially/internally and then extends the knee.
3) To test the medial meniscus the patient’s knee to be tested is taken into full flexion and the practitioner rotates the tibia laterally/externally and then extends the knee.
Knee: Describe the Brush (or Stroke) Test
1) The patient is lying supine on the treatment table
2) The practitioner uses the palm and three fingers to stroke from just below the knee joint on the medial side up toward the hip. The opposite hand strokes inferiorly toward the lateral
side of the patella.
Ankle Foot: Describe the Anterior Drawer Test of the ankle
1) The patient is lying supine on the treatment table.
2) The practitioner stabilises the tibia and fibula with one hand and grasps around the foot with the other hand.
3) The ankle is placed in approximately 20 degrees of plantarflexion and then drawn anteriorly (moving the talus forward under the tibia/fibula).
a. The test should be performed in both plantarflexion and dorsi flexion as this alters the tension placed on ligaments of the ankle
The test can also be performed by flexing the hip and knee, placing the foot flat on the table and pressing the tibia posteriorly in relation to the fixed ankle/foot.
Ankle Foot: Describe the External Rotation Stress Test
1) The patient is seated on the treatment table with the knee flexed 90 degrees and the leg hanging over the edge of the table.
2) The practitioner stabilises the leg with one hand and with the other hand places the ankle in neutral and applies an external (lateral) rotation stress to the foot and ankle.
Ankle Foot: Describe the Talar Tilt Test
1) The patient is lying supine or in side-lying on the treatment table
2) The practitioner takes the patient’s ankle into 90 degrees (anatomical position) and then tilts the talus back and forth from inversion to eversion repetitively. This can be done by cupping
around the talus with the thumb and finger of one hand and tilting back and forth.
Ankle Foot: Describe the Morton’s (Squeeze) Test
1) The patient is lying supine on the treatment table
2) The practitioner uses the thumb and index finger of one hand to apply pressure to the intermetatarsal tissues.
3) The other hand grasps around the metatarsal heads and squeezes them together.
a. This is then repeated with pressure at the next intermetatarsal space until all have been tested.
Ankle Foot: Describe Simmond’s Test
1) The patient is lying prone on the treatment table with the leg on a bolster or the foot hanging over the end of the treatment table.
2) The practitioner squeezes the belly of the calf several times
Ankle Foot: Describe Tinel’s sign
There are 3 locations that can be tested for Tinel’s sign:
- The anterior tibial branch of the deep peroneal nerve at the anterior ankle
- The posterior tibial nerve posterior to the medial malleolus
- Between the distal aspect of the metatarsals to assess Morton’s neuroma
1) The patient is lying supine, prone, or seated depending on the area being assessed.
2) Using the index and middle fingers tap over the nerve with the pads of the fingers several times.
