Special Test For the Knee

Question 1

What does a positive finding on the Collateral Ligament Stability test confirm and how is it performed?

Answer 1

Indicates = Damage to the MCL or LCL

Support the lower leg or ankle and apply a valgus stress to the knee to test the MCL
* Then switch hands and apply a varus stress to the knee to test the LCL
* These tests are done first in full extension then in 20- 30 degrees of flexion
* Positive = excess movement or pain to the medial or lateral knee being tested

Question 2

What does excessive movement during the anterior draw test or the posterior draw test indicate and how is it performed

Answer 2

• Positive = excessive movement of the tibia on the femur
  Indicates = Anterior drawer = anterior cruciate instability, posterior drawer = posterior cruciate ligament instability
• Patient lying supine, flex knee and hip
• Dr sits on patients foot, places hands around the knee with thumbs in the eyes of the knee (Medial and Lateral of Patellar Tendon)
• Dr applies an anterior force to test for ACL. Repeat 2-3 times
• Then Dr applies a posterior force to the tibia on the femur to test for PCL. Repeat 2-3 times

Question 3

What does a positive finding on the Lachman’s Test indicate and how do you perform it?

Answer 3

Indicates = Anterior cruciate ligament (especially the posterolateral band), instability test

• Patient supine, with involved leg beside examiner,
• examiner holds patients knee between full extension and 30 degrees flexion, femur is stabilized with one of examiners hands while proximal aspect of the tibia is moved forward with the other hand
• Positive = Mushy or soft end feel when the tibia is moved forward on the femur And the infrapatellar tendon slope disappears

Question 4

What does a positive finding on the McMurray’s Test indicate and how do you perform it?

Answer 4

Indicates = Medial (on external rotation) or lateral (on internal rotation) meniscus damage (tear)

How to perform:
* Patient supine and Dr has one hand supporting the patients knee
* The other hand externally rotates the tibia while taking the patient out of knee flexion
* This procedure is done again but with internal rotation of the knee
Positive = A snap, click or pain to the lateral or medial knee

Question 5

What does a positive finding on the Apley’s Distration Test indicate or Apley Compression Test and how do you perform it?

Answer 5

Apley Distraction Test Indicates = Collateral ligament sprain

How to perform: * Stabilizing the patients thigh by placing your knee on it
* Pull upwards on the tibia while stabilizing the patients thigh
* Rotate the tibia internally and then externally
Positive = Pain in collateral ligaments, excessive motion

Apley Compression Test Indicates=Medial or lateral meniscus pathology

How to perform: Patient is prone, Dr. flexes knee 90 degrees, laterally rotates tibia and pushes down
* Next Dr medially rotates tibia and pushes down
* Positive = Pain on medial side with lateral rotation or pain on lateral side with medial rotation

Question 6

What does a positive finding on the Ober’s Modified Test indicate or Ober’s Test Test and how do you perform it?

Answer 6

** Ober’s Modified Test Indicates = Contracture of the IT ban**

How to perform: * Patient is sidelying, with his involved leg uppermost
* Abduct the and extend the thigh. While keeping the hip joint in neutral slowly lower the leg towards the table
* If the IT band is normal, the thigh should drop to the adducted position
Positive = Thigh remains abducted when the leg is released

Ober’s Test Indicates: Indicates = Contracture of the Glute Medius more than IT Band

How to perform:
* Patient is sidelying, with his involved leg uppermost
* Abduct the leg and flex the knee to 90 degrees. While keeping the hip joint in neutral position to relax the IT band
* If the IT band is normal, the thigh should drop to the adducted position
Positive = Thigh remains abducted when the leg is released