Special Test For the Knee 3rd year final Flashcards
What does a positive finding on the Collateral Ligament Stability test confirm and how is it performed?
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
What does excessive movement during the anterior draw test or the posterior draw test indicate and how is it performed
- 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
What does a positive finding on the Lachman’s Test indicate and how do you perform it?
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
What does a positive finding on the McMurray’s Test indicate and how do you perform it?
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 into extension.
* This procedure is done again but with internal rotation of the knee
Positive = A snap, click or pain to the lateral or medial knee
Mechanism:
The tibia is rotated while moving the knee from flexion to extension.
External Rotation: Puts stress on the medial meniscus by closing the medial compartment and opening the lateral one.
Internal Rotation: Puts stress on the lateral meniscus by closing the lateral compartment and opening the medial one.
FYI: if the tibia is externally rotated, the medial part has to come a bit more forward to help it rotate externally and vice versa for internal rotation
What does a positive finding on the Apley’s Distration Test indicate or Apley Compression Test and how do you perform it?
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
What does a positive finding on the Ober’s Modified Test indicate or Ober’s Test Test and how do you perform it?
** 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
Which of the following exercises is aimed at increasing knee extension range of motion through active isometric contraction?
A) Passive low-load knee extension
B) Active isometric terminal knee extension
C) Passive knee extension in prone
D) Active-assisted knee extension using a strap
B) Active isometric terminal knee extension
Correct: This exercise focuses on engaging the quadriceps and pressing the back of the knee down into a towel while lifting the heel, with the thigh remaining on the table. This engages the quadriceps in an isometric contraction to improve knee extension.
A) Passive low-load knee extension
Wrong: This exercise is a passive stretch that helps restore knee extension with low loads. It doesn’t involve active isometric contraction.
C) Passive knee extension in prone
Wrong: This is a passive stretch performed while the patient is prone. It does not involve active isometric contraction to increase knee extension range.
D) Active-assisted knee extension using a strap
Wrong: This is an assisted movement, not an isometric contraction. The strap is used to help extend the knee, but it doesn’t involve active isometric work by the quadriceps.
What is the main purpose of the “Passive low-load knee extension” exercise?
A) To increase knee flexion
B) To restore passive knee extension in a fully supported position
C) To engage the quadriceps through active movement
D) To strengthen the hamstrings
**B) To restore passive knee extension in a fully supported position
Correct: This exercise is specifically designed to restore passive knee extension using low loads, with the knee in a supported position (e.g., with an ankle weight placed on the thigh).**
A) To increase knee flexion
Wrong: This exercise is focused on knee extension, not flexion. It helps restore knee extension by using low-load, passive methods.
C) To engage the quadriceps through active movement
Wrong: This exercise is passive and does not require active engagement of the quadriceps. It is focused on restoring extension in a passive manner.
D) To strengthen the hamstrings
Wrong: This exercise targets knee extension, which primarily involves the quadriceps. The hamstrings are not the main focus here.
Passive knee extension in prone (prone
knee hanging)
Purpose: Increase knee extension range of motion
Position
* Prone, thigh relaxed on table
* Lower leg suspended off edge of table
* Ensure that the patella is off the edge of the table or place a folded towel under distal thigh to avoid compressing the patella.
* Placing a pillow under the abdomen while a patient is in a prone position will help the patient maintain lumbar spine in a neutral position.
Action
* Passive knee extension using the weight
of leg and gravity to provide the stretch
Specific parameters
* Prolonged hold can be started at 30 seconds and built up to 3 minutes, as
tolerated.
* Short holds followed by releasing the position should be repeated to reach a total of
3–5 minutes.
What is the key benefit of controlled movements during rehabilitation exercises for the knee?
A) Reduces muscle fatigue
B) Prevents excessive joint stress and strain
C) Improves cardiovascular fitness
D) Increases muscle size
Answer: B) Prevents excessive joint stress and strain
Explanation: Controlled movements help reduce the risk of overloading the joint, preventing strain or stress that could result in further injury. They also enhance muscle activation and coordination.
A) Reduces muscle fatigue
Wrong: While controlled movements might help reduce unnecessary fatigue, the primary benefit is more about joint protection, not just muscle fatigue.
C) Improves cardiovascular fitness
Wrong: Controlled movements are more focused on joint stability and muscle activation, rather than directly improving cardiovascular fitness.
D) Increases muscle size7
Wrong: Controlled movements are generally about coordination and stability, not necessarily muscle hypertrophy (increasing muscle size).
Which of the following is an appropriate safety precaution when performing joint and muscle exercises?
A) Use heavy weights right away to build strength quickly
B) Ignore pain to push through and make progress faster
C) Warm-up and cool-down to increase circulation and reduce stiffness
D) Perform exercises without proper technique to improve efficiency
Answer: C) Warm-up and cool-down to increase circulation and reduce stiffness
Explanation: A warm-up and cool-down are essential for increasing circulation, reducing muscle stiffness, and preventing injury. Ignoring pain or using improper technique can lead to further injury, and using heavy weights too quickly may strain the joints.
A) Use heavy weights right away to build strength quickly
Wrong: Starting with heavy weights too soon can lead to overstrain and injury. It’s important to progressively increase load.
B) Ignore pain to push through and make progress faster
Wrong: Ignoring pain can lead to further injury. Listening to your body and avoiding pain is crucial to prevent setbacks in recovery.
D) Perform exercises without proper technique to improve efficiency
Wrong: Using improper technique can lead to poor movement patterns and increase the risk of injury. Proper technique is crucial for safe and effective exercise.
Safety Precautions for Joint and Muscle Exercises
* Warm-up & Cool-down: Increases circulation, reduces stiffness
* Proper Technique: Align joints correctly to avoid undue stress
* Progressive Load: Gradually increase intensity to prevent strain
* Listen to Your Body: Avoid pushing through pain
* Use Support When Needed: Stability aids like bands or braces for injury prevention
In what situation would the “Apley’s Compression Test” be most useful?
A) To assess the integrity of the collateral ligaments (MCL/LCL)
B) To test for patellar dislocation
C) To assess meniscus injury
D) To evaluate patellar tendinitis
Answer: C) To assess meniscus injury
Explanation: The Apley’s Compression Test is specifically used to assess for meniscal tears or injuries by applying pressure to the knee joint and rotating the tibia. The other tests assess ligaments, patellar positioning, or tendinitis.
A) To assess the integrity of the collateral ligaments (MCL/LCL)
Wrong: The Apley’s Compression Test specifically evaluates the meniscus, not the collateral ligaments.
B) To test for patellar dislocation
Wrong: The Apley’s Compression Test is not used to assess patellar dislocation but rather to evaluate meniscal tears.
D) To evaluate patellar tendinitis
Wrong: This test is not used to assess patellar tendinitis, which involves the patellar tendon rather than the meniscus.
Which of the following is an example of an exercise to improve knee flexion and extension mobility?
A) Supine active knee extension with a slider
B) Passive knee extension in prone with an ankle weight
C) Active hip and knee flexion on an exercise ball
D) All of the above
Answer: D) All of the above
Explanation: All of these exercises are designed to improve the mobility of the knee in both flexion and extension. They help restore motion, improve stability, and strengthen the surrounding muscles.
What is the purpose of using a “towel roll” or “half foam roll” under the Achilles tendon during the “Passive low-load knee extension” exercise?
A) To provide extra support for the knee joint
B) To elevate the leg to increase blood circulation
C) To support the Achilles tendon while stretching the knee
D) To prevent knee hyperextension during the stretch
Answer: D) To prevent knee hyperextension during the stretch
Explanation: The towel or foam roll under the Achilles tendon helps prevent hyperextension of the knee while performing passive low-load knee extension. It supports the knee in a safe range of motion and avoids overstretching.
A) To provide extra support for the knee joint
Wrong: The towel roll or foam roll is primarily there to support the Achilles tendon and prevent hyperextension of the knee, not to provide general knee joint support.
B) To elevate the leg to increase blood circulation
Wrong: Elevation for circulation is not the main purpose. The towel roll’s function is to support the Achilles tendon and control knee hyperextension.
C) To support the Achilles tendon while stretching the knee
Wrong: The roll is used to prevent hyperextension of the knee joint and not to provide specific support to the Achilles tendon. The key function is knee support, not tendon support.
he towel roll or foam roll placed under the Achilles tendon or heel does not elevate the foot in a way that encourages further hyperextension. Instead, it supports the leg in a way that helps limit excessive knee extension and provides a controlled stretch.
Here’s Why:
Natural Knee Range of Motion:
The knee joint has a natural range of extension that can be achieved without causing harm. For most people, this is around 0 degrees (fully straight).
When you passively extend the knee (for example, with ankle weights or using gravity), the knee tends to extend further.
If the knee is pushed beyond its normal range of motion, it can lead to hyperextension, which puts stress on the joint’s ligaments, like the ACL (anterior cruciate ligament).
Effect of Elevating the Heel:
Elevating the heel under the Achilles tendon does not make the knee go into further extension. Instead, it raises the foot, keeping the knee in a safe, controlled alignment.
When the heel is raised, the lower leg (specifically, the tibia) is prevented from continuing to extend. If the Achilles tendon is placed on a roll, it helps prevent the knee from overextending into hyperextension.
Tension and Limiting Hyperextension:
If the heel is flat on the surface, the weight of the leg can pull the knee further into extension (hyperextension) because there’s nothing to stop the tibia (shinbone) from moving forward.
By placing the towel roll under the Achilles tendon or heel, you’re effectively stabilizing the leg so the knee stays within its safe range of motion, preventing the tibia from moving forward too much and thus preventing hyperextension.
Why the Knee Doesn’t Drop Lower:
The height of the towel roll provides support to the lower leg in such a way that it does not let the knee drop further into hyperextension.
The position of the foot (with the heel elevated) allows the knee to stretch in a controlled manner while avoiding a deep hyperextension.
The goal of the exercise is to passively stretch the knee joint into extension without it going past a safe point where it could overstretch ligaments.
A Simple Way to Visualize It:
Imagine you’re lying down and your leg is straight. If the heel is on the ground and you pull the knee into extension (using weights or gravity), the knee may hyperextend because there’s nothing to stop the tibia from moving forward.
But when you place a towel roll under the Achilles tendon:
It elevates the heel and helps create a natural stop point for knee extension. The tibia can’t continue to move forward past that point, so the knee can’t overextend into a hyperextended position.
Conclusion:
The towel roll under the Achilles tendon does not encourage hyperextension of the knee. Instead, it limits excessive knee extension by stabilizing the foot and lower leg. By preventing the tibia from moving too far forward, it helps keep the knee joint in a safe, neutral position and allows for a controlled, passive stretch without overextending the knee.
Why is proper knee tracking important during exercises like squats?
A) It increases the range of motion of the hip
B) It prevents the knees from caving inward (valgus collapse)
C) It helps improve balance and stability of the ankle
D) It enhances the flexibility of the knee joint
Answer: B) It prevents the knees from caving inward (valgus collapse)
Explanation: Proper knee tracking ensures that the knee moves in a healthy alignment, reducing the risk of valgus collapse (when the knees cave inward), which can cause stress on the knee joint and increase the risk of injury.
A) It increases the range of motion of the hip
Wrong: Knee tracking doesn’t directly affect hip range of motion. It focuses on the knee joint itself.
C) It helps improve balance and stability of the ankle
Wrong: While knee tracking can help improve overall stability, its primary focus is on the knee joint itself, not the ankle.
D) It enhances the flexibility of the knee joint
Wrong: Proper knee tracking does not primarily focus on flexibility. It’s more about maintaining alignment and protecting the joint.
What does the “Lachman Test” primarily assess in the knee?
A) Posterior cruciate ligament (PCL) integrity
B) Meniscus tears
C) Anterior cruciate ligament (ACL) stability
D) Collateral ligament (MCL/LCL) stability
Answer: C) Anterior cruciate ligament (ACL) stability
Explanation: The Lachman Test is used to assess the integrity of the ACL by checking for abnormal anterior movement of the tibia relative to the femur. It is not used to assess the PCL, meniscus, or collateral ligaments.
A) Posterior cruciate ligament (PCL) integrity
Wrong: The Lachman Test assesses the anterior cruciate ligament (ACL) for stability, not the PCL.
B) Meniscus tears
Wrong: The Lachman Test is not used to evaluate the meniscus; it focuses on the ACL.
D) Collateral ligament (MCL/LCL) stability
Wrong: The Lachman Test is not designed to assess the stability of the MCL or LCL, but rather the ACL.
What is the primary purpose of the Hold/Relax Prone technique for knee extension?
a) Strengthening the hamstrings
b) Increasing knee flexion ROM
c) Increasing knee extension ROM
d) Reducing knee swelling
✅ Correct answer: c) Increasing knee extension ROM
The Hold/Relax technique is specifically designed to increase range of motion (ROM) in knee extension by using muscle relaxation following a resisted contraction.
❌ Wrong answers:
a) Strengthening the hamstrings → Incorrect because this technique is focused on stretching rather than strengthening.
b) Increasing knee flexion ROM → Incorrect because the goal is knee extension, not flexion.
d) Reducing knee swelling → Incorrect because it primarily targets flexibility, not swelling reduction.
In the Hold/Relax Prone technique, how long should the patient hold the contraction against resistance?
a) 4–6 seconds
b) 6–8 seconds
c) 8–10 seconds
d) 15–20 seconds
Correct answer: c) 8–10 seconds
The recommended duration for the isometric contraction in this technique is 8–10 seconds, as this helps activate the Golgi tendon reflex, leading to muscle relaxation and increased stretch.
❌ Wrong answers:
a) 4–6 seconds → Too short to effectively trigger the relaxation response.
b) 6–8 seconds → Possible but not optimal; 8–10 seconds is preferred.
d) 15–20 seconds → Too long and may cause excessive fatigue rather than relaxation.
- Is Hold/Relax Prone Technique the same as PNF and why are the timings different: Timing and PNF Differences
You’re right that different sources might provide slightly different timing recommendations. Let’s break it down:
Hold/Relax Prone Technique (from your text)
Hold contraction: 8–10 seconds (submaximal resistance)
Relaxation/stretch: 20–30 seconds
Proprioceptive Neuromuscular Facilitation (PNF) Stretching (general guidelines)
Contract: 6–10 seconds
Relax: 12–30 seconds
Stretch (Passive Hold): 20–30 seconds
So, the Hold/Relax Prone Technique is a form of PNF stretching, but PNF itself is a broader category that includes other variations like Contract-Relax and Hold-Relax-Agonist-Contract. The numbers you mentioned (6-second contraction, 12-second hold, 30-second stretch) might come from a different PNF variation or a modified protocol for specific rehab settings.
Is Hold/relax the same as PNF
Hold/Relax = a type of PNF stretching.
Timing can vary depending on protocols, but the general concept remains the same:
Contract the muscle against resistance.
Relax the muscle.
Stretch it further.
Which of the following is an advantage of the Hold/Relax Prone technique?
a) Allows detection of muscle guarding
b) Requires no manual contact
c) Eliminates pain immediately
d) Requires equipment
✅ Correct answer: a) Allows detection of muscle guarding
The therapist can feel muscle resistance (guarding) when applying resistance, allowing adjustments in force application.
❌ Wrong answers:
b) Requires no manual contact → Incorrect because this technique requires therapist involvement.
c) Eliminates pain immediately → Incorrect because it improves flexibility over time but does not provide immediate pain relief.
d) Requires equipment → Incorrect because no special equipment is needed.
Which of the following is an advantage of the Hold/Relax Prone technique?
a) Allows detection of muscle guarding
b) Requires no manual contact
c) Eliminates pain immediately
d) Requires equipment
Which of the following is NOT an alternative to Hold/Relax Prone for knee extension?
a) Active isometric knee extension in sitting
b) Prone knee hangs
c) Hamstring stretching
d) Ankle dorsiflexion exercises
✅ Correct answer: d) Ankle dorsiflexion exercises
This is incorrect because ankle dorsiflexion has no direct effect on knee extension.
❌ Wrong answers:
a) Active isometric knee extension in sitting → Correct alternative since it engages the quads in a similar way.
b) Prone knee hangs → Also a valid alternative for knee extension.
c) Hamstring stretching → Since tight hamstrings restrict knee extension, stretching them can help improve ROM.
Which of the following is a progression for Active Supine Heel Slides with a Slider?
a) Increasing range of motion as swelling decreases
b) Reducing stretch duration
c) Keeping knee completely locked throughout movement
d) Avoiding sagittal plane movement
✅ Correct answer: a) Increasing range of motion as swelling decreases
As swelling decreases, knee ROM can be gradually increased.
❌ Wrong answers:
b) Reducing stretch duration → Incorrect because increasing duration enhances flexibility.
c) Keeping knee completely locked throughout movement → Incorrect because movement is needed to increase ROM.
d) Avoiding sagittal plane movement → Incorrect because proper technique requires maintaining sagittal movement (no abduction/adduction).
What is the purpose of Active Supine Heel Slides with a Slider?
a) To increase ankle dorsiflexion
b) To increase knee range of motion with minimal stress
c) To improve upper body strength
d) To reduce foot pronation
✅ Correct answer: b) To increase knee range of motion with minimal stress
Heel slides help regain knee mobility in a controlled manner with minimal joint stress.
❌ Wrong answers:
a) To increase ankle dorsiflexion → Incorrect because this exercise targets knee motion, not the ankle.
c) To improve upper body strength → Incorrect because it involves the lower body.
d) To reduce foot pronation → Incorrect because foot position is not the focus.
Which of the following is NOT a progression for Active-Assisted Knee Extension?
a) Decrease rest periods between contractions
b) Increase repetitions
c) Increase assistance over time
d) Increase range of extension against gravity
✅ Correct answer: c) Increase assistance over time
The goal is to reduce assistance as the patient improves, not increase it.
❌ Wrong answers:
a) Decrease rest periods between contractions → Correct progression for endurance.
b) Increase repetitions → Correct progression for strengthening.
d) Increase range of extension against gravity → Correct because progressing to gravity-based movements is more challenging.
What is the primary function of the ACL?
a) Limits posterior translation of the tibia
b) Prevents knee varus collapse
c) Limits anterior translation of the tibia
d) Prevents patellar dislocation
✅ Correct answer: c) Limits anterior translation of the tibia
The ACL prevents the tibia from moving too far forward relative to the femur.
❌ Wrong answers:
a) Limits posterior translation of the tibia → This is the PCL’s function, not the ACL’s.
b) Prevents knee varus collapse → Incorrect because LCL (lateral collateral ligament) prevents varus collapse.
d) Prevents patellar dislocation → Incorrect; patellar instability is unrelated to ACL function.
