the knee

Question 1

clark’s test

Answer 1

-Press patella inferiorly
-Get patient to try to contract quads (lift foot up)
-Increases posterior pressure and will grind
testing= Posterior surface patella
Degeneration of patella femoral joint
positive test= Retropatella pain
Patient cannot holdcontraction

Question 2

bulge/ sweep test

Answer 2

-examiner palpates just below medial joint side of patella and begins stroking proximally to suprapatellar pouch 2/3 times with palm and fingers
-with opposite hand, examiner strokes down lateral side of patella joint
A wave of fluid will pass medial side and bulge below medial distal portion of patella
testing= Internal derangement, ligament sprain/ rupture, vascular damage
positive test= Increased bulge

Question 3

apley compression/ distraction

Answer 3

-Patient lying prone
-Flex leg up and push my knee into their thigh
-Pull their leg up (distraction)
- Remove knee from their thigh and push leg down (compress)
testing= Meniscal damage (compression)
Capsule/ ligament lesion/ collateral ligament sprain (distraction)
positive test= Pain
Ligaments are sore, not meniscus
Meniscus damaged not ligaments

Question 4

Mcmurray

Answer 4

-patient supine
-Knee flexed 90 degrees
-Internally rotate tibia and compress then go into extension (testing lateral meniscus)
-Externally rotate tibia and compress then go into extension (testing medial meniscus)
testing= Meniscal lesion
Tibial internal rotation- lateral meniscus
Tibial external rotation- medial meniscus
positive test= Pain/ crepitus

Question 5

thessaly test

Answer 5

Non symptomatic leg is tested first
-patient stands flat footed on one leg
-examiner provides support to balance
-patient flexes knee 5 degrees and rotates femur on tibia medially and laterally 3x
-test is repeated at 20 degrees flexion
testing= Meniscal lesion
positive test= Medial/ lateral joint line discomfort will be a meniscus tear
May have locking/ catching

Question 6

ant/ post draw

Answer 6

• The examiner’s hands are placed around the tibia to ensure that the hamstring muscles are relaxed
• The tibia is then drawn
  forward on the femur (anterior drawer test). The normal amount of movement that should be present is approximately
  6 mm.
• tibia is pushed back on the femur
  testing= Anterior Cruciate Ligament Sprain/Rupture
  Posterior Cruciate Ligament Sprain/Rupture
  positive test= Pain/ excessive motion (rupture)
  Ant- tibia moves forward more than 6mm on femur (may be injury to ant cruciate lig, posterolateral capsule, posteromedial capsule, medial collateral lig, iliotibial band, post oblique lig, arcuate-popliteus complex)

Post-posterior sag (may be injury to post cruciate lig, arcuate- popliteus complex, post oblique lig, ant cruciate lig)

Question 7

lachman

Answer 7

-Patient is supine
-Knee in 20-30 degrees’ flexion
-Leg should also be externally rotated slightly
-Examiner places one hand behind tibia and the other on the thigh
-Thumb is palpating tibial tuberosity
-Pull tibia anteriorly then posteriorly
testing= Anterior cruciate ligament injury and posterior cruciate ligament injury
positive tests= Mushy end feel (may be indicative of injury to ant cruciate ligament, post oblique lig, arcuate- popliteus complex)

Question 8

ant/ post ankle draw test

Answer 8

-Patient supine
-Knee flexed 90 degrees
-Stabilise tibia and hold under patient’s calcaneus
-Pull calcaneus anteriorly while pushing tibia posteriorly
testing= Anterior talofibular ligament instability
Posterior ankle ligament instability
positive test= Anterior motion of foot
Posterior motion of foot

Question 9

talar tilt inversion/ eversion

Answer 9

-patient seated
-foot is positioned in 10-20 degrees plantarflexion
-distal lower leg is stabilised with one hand and hindfoot is inverted with other hand
-lateral aspect of talus is palpated to determine if tilting occurs
-hindfoot is then everted
testing= Lateral ligament sprain (ant talofibular lig, calcaneofibular lig, post talofibular lig)
Deltoid lig (rare)
positive test= pain