Practical 3 - Knee Flashcards
(34 cards)
what are the special tests for testing Ligamentous Integrity? (10)
- Valgus Stress Test
- Varus Stress Test
- Lachman
- Lever Test
- Anterior Drawer Test
- Pivot Shift Test
- Posterior Drawer Test
- Godfrey Sign (Posterior Sag Sign)
- Quadriceps Active Test
- Dial Test
How to perform the Valgus Stress Test
pt position: supine, hip slightly abducted/extended
steps: flex knee to 30° over side of table, PT places one hand about lateral aspect of knee while other hand grabs calf. gently apply a lateral to medial force to knee while other hand externally rotates. repeat with full extension.
positive test is excessive medial opening and concordant pain compared to uninvolved knee. test at 30° = MCL.
test at 0° = ACL & PCL.
How to perform the Varus Stress Test
pt position: supine, hip slightly abducted/extended
steps: flex knee to 30° over side of table, PT places one hand about lateral aspect of knee while other hand grabs calf. gently apply a medial to lateral force to knee while other hand externally rotates. repeat with full extension.
positive test is excessive lateral opening and concordant pain compared to uninvolved knee. for LCL
How to perform the Lachman Test
pt position: supine w/ knee flexed to 15°
steps: stabilizes distal femur w/ one hand and grasps proximal tibia w/ other hand. applies anterior tibial force to prox. tibia.
positive test for torn ACL = greater anterior tibial displacement on affected side compared to unaffected.
How to perform the Lever Test
pt position: supine, injured knee in full extension w/ heel on table
steps: PT places closed fist under calf/tib tube and pushes in an anterior to posterior direction on distal third of quads
results = ACL intact the heel rises off the table // ACL NOT intact = heel stays on table
how to perform the anterior drawer test
pt position: supine w/ knee flexed to 90° so foot is flat
steps: PT sits on pt’s foot and grasps prox. tib w/ thumbs palpating tib plateau. anterior tibial force is applied.
positive test = greater anterior tibial displacement for torn ACL
how to perform the pivot shift test
passive flexion of knee w/ internal rotation of tibia
anterior subluxation of lateral tibia occurs w/ IR
~20-30° flexion ITB will reduce tibial plateau resulting in shift or clunk
how to perform the posterior drawer test
pt position: supine w/ knee flexed to 90, hip flexed to 45°, neutral foot
steps: sit on pt’s foot. The prox. tib. is translated in a posterior direction and the amount of motion is estimated. Repeated with the foot internally then externally rotated and compared to the other side.
A positive test for PCL tear is dependent on the amount of posterior motion of the tibia,
Grade
1+ (0–5 mm), grade 2+ (6–10 mm),
and grade 3+ (11 mm+).
how to perform the Quadriceps Active Test
pt position: supine w flexed knee to 90
steps: watch flexed knee. PT supports thigh and confirms if they’re relaxed. pt slides foot gently down table
positive test for PCL tear = anterior tib displacement resulting from quad contraction
how to perform the Godfrey Sign (Posterior Sag Sign)
The patient is supine with the knee flexed to 90 degrees and the hip placed in 90 degrees of flexion.
The examiner supports the leg under the lower calf/heel, suspending the leg in the air.
A positive test for a PCL tear is posterior sagging of the tibia secondary to gravitational pull.
how to perform the Dial Test
- supine with knee flexed to 30.
- external rotation force applied.
- now flex knee to 90
- external rotation force is applied
3 diff positive test results =
1. More external rotation at 30 degrees than 90 degrees on the same leg = posterolateral corner injury
2. More external rotation at 90 degrees than 30 = PCL tear
3. Excessive external rotation in both positions when compared to the uninvolved leg = PCL and/or posterolateral corner tear.
what are the special tests for testing Meniscus? (5)
- McMurray Test
- Apley’s Test
- Thessaly Test
- Bounce Home Test
- Payr Test
how to perform the McMurray Test
- grasp pt’s heel and flex knee to end range while palpating w/ other hand
- medial meniscus = rotate tibia into ER, then slowly extend w/ valgus force
- lateral meniscus = internally rotate tibia and slowly extend w/ varus force
- positive test = audible or palpable thub/click
how to perform the Apley’s Test
- PT half-kneels, placing knee on hammies of pt.
- flex knee to 90.
- grasp foot, distract tibia, look for reproduced pain
- positive test = worse pain w/ rotation
how to perform the Thessaly Test
- pt stands on one leg facing PT
- pt flexes knee to 20° and rotates to the left then right
- repeat 3x
- positive test for meniscus tear = joint-line discomfort, sense of locking/catching
how to perform the Bounce Home Test
- PT extends affected knee to end range
- (+) for meniscus tear = block preventing full extension or pain at end range
how to perform the Payr Test
- pt sits at EOB and places foot of affected knee on contralateral knee in a figure 4
- examiner pushes affected knee down
- (+) for posterior horn lesion of medial meniscus = concordant pain over medial joint line
what are the special tests for testing Patellofemoral/Plica? (4)
- Medial Plica Shelf Test
- Zohler Sign
- Clarke Test
- Fairbanks Apprehension Test
how to perform the Medial Plica Shelf Test?
- knee flexed to 30. PT stands on affected side and reaches under knee to grasp opposite thigh
- using forearm as fulcrum/booster to maintain 30° flexion, PT applies manual pressure to lateral border of patella w/ opp. hand to cause medial patellar glide
- (+) = pain w/ medial patellar glide
how to perform the Zohler Sign
- pt lies supine w/ knees extended
- examiner pulls patella distally and holds it there
- ask pt to contract quads
- (+) = pain
how to perform the Clarke Test
- pt supine w/ both knees supported by bolster
- PT places hand on superior border of patella and presses distally while relaxed
- pt asked to contract quads
- (+) = reproduction of sx
how to perform the Fairbanks Apprehension Test
- pt in supine w/ relaxed knee passively flexed to 30 over side of table resting on PT.
- PT presses both thumbs on medial aspect of patella to exert lateral force
- (+) = pt shows signs of apprehension or pain is reproduced
How to perform the Q-Angle Test (for patella tracking)?
- pt supine w/ knee full extension
- PT draws a line from ASIS to mid. patella. another line from mid. patella to tib tube.
- (+) = angular value greater than 10° for males, 15° for females.
what are the special tests for testing Flexibility? (2)
- Ely’s Test
- 90-90 Straight Leg Raise
