Special tests Flashcards
Lachman’s test
Tests stability of the ACL
- knee flexed at 25-30 degrees and the distal femur stabilized, anteriorly translate the tibia
(+) if anteriorly displace the tibia
Anterior drawer test of the knee
Tests the stability of the ACL
- with the injured knee flexed 90 degrees, grasp the proximal tibia with both hands and provide an anteriorly directed force
(+) if the tibia displaces anteriorly
- not as valid as lachman’s because ACL relaxed at 90 degrees
Pivot shift test
Pt lies supine and the examiner supports the test for with one hand while placing the other over the calf mm distal to the knee joint
- examiner flexes and extends the knee slowly and gently
- the examiner then applies axial compression while the other hand over the calf exerts an anterior pressure
(+) tibia subluxes and reduces
Active pivot test
- pt sits with the foot on the floor in neutral rotation and the knee flexed 80-90 degrees
- pt is aske to isometriclaly contract the quads while the examiner stabilizes the foot
(+) anterolateral subluxation of the lateral tibial plateau and is indicative of anterolateral instability
Mechanical ligament stability tests
- most commonly used device
- device is attached, a handle is used to direct an anterior and posterior force to the proximal tibia
- the needle on the small dial on the surface of the device deflects in a positive or negative direction, quantifying the degree of tibial translation relative to the stable femur
Posterior drawer test
Tests PCL
- with the pt lying flat the knee is flexed to 90 degrees. The examiner then places his fingers on the knee joint and attempts to shift the tibia backwards
- test places stress on the PCL
- both the amount of movement of the tibia, as well as the feet of the endpoint of movement should be assessed
- *a (+) may be mistaken for a false positive anterior drawer!
Godfrey posterior tibial sag test
- the pt is supine with the hip and knee of the affected limb held at 90 degree
- hold the heel of the affected limb and allow the tibia to translate, subluxation, or sag posteriorly by gravity
Valgus stress test
Tests MCL
- at the knee while the ankle is stabilized in slight lateral rotation either with the hand or with the leg held between the arm and trunk
- fix femur and pull tibia laterally
- test at 20-30 degrees flex, then in full ext
(+) if tibia moves away from the femur
- major disruption of the MCL if the test is (+) in full ext
Varus stress test
Tests LCL
- applied at the knee while the ankle is stabilized
- test first with the knee in 20-30 degrees of flexion, then full ext
(+) tibia moves away from the femur
- major disruption is present if the test is (+) in full ext
McMurray’s test
Tests meniscus
- pt lies supine with the knee completely flexed
- examiner medially rotates the tibial to lest lateral meniscus
- by repeatedly changing the amount of flexion, examiner can test the posterior aspect of the meniscus from the posterior horn to the mid segment
- examiner can also test the medial meniscus by placing the pt in the same position with the knee laterally rotated
(+) present with a snap or click with pain when rotation the tibia
Apley’s test
Tests meniscus
- pt lies prone with knee flex 90 degrees
- pt’s thigh is anchored with the examiner’s knee
- medial and lateral rotation of the tibia is performed first with distraction, and then with compression
- if rotation with distraction ins more painful, lesion is probably ligamentous
- if rotation with compression is more painful, it is probably more meniscus
Bounce home test
Tests meniscus
- pt lies supine while examiner cups heel
- knee is flexed and then passively allowed to extend
- if extension is not complete or rubbery, something blocks full ext (most likely torn meniscus)
McConnell test
Tests PFPS
- pt sits with femur laterally rotated
- pt is instructed to perform isometric quad contractions at 120, 90, 60, 30, and 0 degrees. Each contraction is held for 10 seconds
- if pain is produced, pt’s leg is passively returned to full extension
- pt’s leg is then fully supported on the examiner’s knee and the examiner pushes the patella medially
- the medial glide is maintained while the knee is returned to the painful angle and the pt is instructed to perform an isometric contraction of the quad again with the patella held medially by the examiner
- if pain is decreased, then patellofemoral origin
Clarke’s test
Tests PFPS
- pt is supine with knee extended (also tested in 30, 60, 90 degrees of flex)
- examiner presses down slightly proximal to the upper pole or has eof the patella with the web of the hand
- pt is instructed to contract the quad
(+) retropatellar pain
