Special Tests

Question 1

Test(s) for ACL Injury?

Answer 1

Lachman
Anterior Drawer
Pivot Shift

Question 2

Describe how you would carry out the Dial Test and what a positive diagnoses indicates:

Answer 2

Posterolateral Knee Instability (PLC)
Patient lying prone, cup both heels of the feet then flex knee to 30. Apply maximal external rotation force (heels together). Then flex the knees to 90 and apply the same force.
+ve = excessive ER (>10*) compared to uninjured leg.

Question 3

Test(s) for ITB Syndrome?

Answer 3

Noble’s Compression Test
Renne’s Test
Ober’s Test (Hip Aswell)

Question 4

Test(s) for MCL Injury?

Answer 4

Varus Stress Test

Question 5

Describe how you would carry out Thessaly’s Test and what a positive diagnoses indicates:

Answer 5

Meniscal Tears
Patient standing on affected leg (can hold onto examiner for balance). Patient slightly flexes on affected leg then rotates both ways.
+ve = pain, locking or catching

Question 5

Test(s) for Meniscal Injury?

Answer 5

McMurray Test
Apleys Test
Ege’s Test
Thessaly’s Test

Question 6

Test(s) for Osteochondritis Dessicans?

Answer 6

Wilson’s Test

Question 6

Describe how you would carry out McMurray’s Test and what a positive diagnoses indicates:

Answer 6

Meniscal Tears
Patient supine, grasp knee joint line and sole of foot. Enter into maximal flexion, then extend the knee with either:
IR + Varus force (lateral meniscus)
ER + Valgus force (medial meniscus)
+ve = pain, snapping, locking or audible clicking

Question 7

Test(s) for PFJ joint Disorder?

Answer 7

Clarke’s (A.K.A Patellar Grind)

Question 7

Describe how you would carry out Lachman’s Test and what a positive diagnoses indicates:

Answer 7

ACL Injury
Patient supine with testing knee flexed 20-30°. Stabilize femur
anteriorly and pull tibia anteriorly.
+ve = excessive anterior translation with lack of end-feel.

Question 8

Describe how you would carry out Wilson’s Test and what a positive diagnoses indicates:

Answer 8

Osteochondritis Dissecans
patient seated with legs over plinth, bend to 90* angle then grasp foot and bring tibia in internal rotation. Then instruct the patient to extend his leg.
+ve = Pain (expected at 30* flexion)

Question 8

Describe how you would carry out Apleys Test and what a positive diagnoses indicates:

Answer 8

Meniscal Injuries
Patient lying prone with 90* flexion, place knee over patients hamstring. Then apply compression and rotation, then with distraction and rotation.
+ve = pain or excessive rotation.

Question 9

Test(s) for MCL Injury?

Answer 9

Valgus Stress Test

Question 10

Describe how you would carry out the Anterior Drawer Test and what a positive diagnoses indicates:

Answer 10

ACL Integrity.
Patient lies with bend in knee, PT sits on pateints foot. Pull lower leg towards you attempting to anteriorly displace tibia.
+ve = anterior displacement of tibia or lack of end feel.

Question 10

Describe how you would carry out Varus Stress Test and what a positive diagnoses indicates:

Answer 10

LCL Integrity
Patient supine with knee in full extension. Apply a varus force to the tibia with a countering stabilisation of the femur.
+ve = laxity (potentially pain).

Question 10

Describe how you would carry out Ely’s Test and what a positive diagnoses indicates:

Answer 10

Rec Fem Tightness / Spasticity
Patient prone, place hand on lower back and grasp heel then passively flex the knee quickly touching heel to buttock.
+ve = heel does not touch buttock or hip rises up from the table (or pain / tingling)

Question 10

What is the Insall-Salvati Ratio?

Answer 10

The ratio used in measuring patellar height to detect alta & baja.

The length of the patellar tendon in relation to length of the patella bone using XR or MRI.

Question 10

Test(s) for Rectus Femoris Spasticity or Tightness?

Answer 10

Ely’s Test

Question 10

Test(s) for Effusion?

Answer 10

Patellar Tap Test
Fluid Displacement Test

Question 10

Describe how you would carry out Valgus Stress Test and what a positive diagnoses indicates:

Answer 10

MCL Integrity
Patient supine with knee in full extension. Apply a valgus force to the tibia with a countering stabilisation of the femur.
Can be performed with 30* flexion to isolate the MCL further.
+ve = laxity (potentially pain).

Question 10

Describe how you would carry out Fluid Displacement Test and what a positive diagnoses indicates:

Answer 10

Effusion.
Supine with knee extended, stroke upwards on the medial aspect of the knee then downwards on the lateral aspect.
+ve = fluid moving towards the medial aspect of knee on lateral stroke.

Question 10

Describe how you would carry out Ege’s Test and what a positive diagnoses indicates:

Answer 10

Meniscal Injury
Patient standing, feet shoulder width then squat down with either:
Feet & knees pointing outwards, = Medial Meniscus
Feet & knees pointing inwards = Lateral Meniscus
+ve = pain and/or clicking

Question 10

Describe how you would carry out Patellar Apprehension Test and what a positive diagnoses indicates:

Answer 10

Lateral Patellar Instability
Supine position with knee flexed to 30*. Relax the quadriceps to allow passive movement of the patella, using both thumbs press the medial aspect of the patella moving it laterally.
Modified = Moving Apprehension - get the patient to flex and extend with the medial pressure.
+ve = Pain and/or apprehension.

Question 10

Describe how you would carry out Patellar Tap Test and what a positive diagnoses indicates:

Answer 10

Infrapatellar Effusion
Supine lying with knee extended, apply pressure proximally to patella then ‘tap’ on patella to push fluid around.
+ve = ‘floating’ patella (-ve would have patella already in contact with the femur.

Question 10

Test(s) for Lateral Instability?

Answer 10

Patellar Apprehension Test

Question 10

Describe how you would carry out Clarke’s Test and what a positive diagnoses indicates:

Answer 10

PFJ Joint Disorder
Patient supine with full extension of knee. Place web of hand just superior to patella and apply pressure. Ask patient to contract quadriceps
+ve = Retropatellar Pain or inability to maintain contraction

Question 10

Test(s) for PCL Injury?

Answer 10

Posterior Drawer Test
Muller’s Test

Question 10

Describe how you would carry out the Pivot Shift Test and what a positive diagnoses indicates:

Answer 10

ACL Tears.
Patient lies supine with relaxed leg, place hands at ankle and outer quad.
Passively flex the knee whilst applying a strong valgus force.
+ve = audible clunking as tibia displaces itself.

Question 10

Describe how you would carry out Muller’s Test and what a positive diagnoses indicates:

Answer 10

PCL injury
Pateint supine with 90* knee flexion & 45* hip flexion (Posterior Drawer Setup). Ask the patient to actively contract the quadriceps.
+ve = Sag Sign (anterior translation of the tibia due to PCL laxity at rest)

Question 10

Describe how you would carry out Renne’s Test and what a positive diagnoses indicates:

Answer 10

ITB Syndrome
Patient standing on affected leg with non-wb leg flexed (if unable they can hold something for balance). Ask them to squat 30* and come back up. If no pain recreated ask them to repeat with a first pressure on the ITB.
+ve = pain recreation at ITB.

Question 10

Describe how you would carry out the Posterior Drawer Test and what a positive diagnoses indicates:

Answer 10

PCL Integrity.
Patient lies with bend in knee, PT sits on patients foot. push lower leg away from you attempting to posteriorly displace tibia.
+ve = excessive posterior displacement of tibia or lack of end feel.

Question 10

Test(s) for Posterolateral Knee Instability (PLC)?

Answer 10

Dial Test

Question 10

Describe how you would carry out Noble’s Test and what a positive diagnoses indicates:

Answer 10

ITB Syndrome
Supine lying, grasp above the ankle and slowly bend the knee several times 0-90* whilst palpating and applying firm pressure on the lateral epicondyle of hte femur.
+ve = pain recreation at ~30*

Question 11

What is the function of the Ottawa Knee Rules?

Answer 11

To determine whether a patient requires a Knee XR following a traumatic incident.

Question 12

What are the criteria for an XR of the knee according to the Ottawa Knee Rules.

Answer 12

One or more of the following findings:
Age 55+
Isolated tenderness of fibular head or patella.
Inability to flex past 90*.
Inability to weight bear 4 steps.