6 - Knee

Question 1

Anterior Drawer Sign…excessive motion indicates what?

Answer 1

-Anterior cruciate ligament tear.

Question 2

Most common tear of the knee ligaments?

Answer 2

• Medial menisci…
• (2nd) Medial collateral…
• (3rd) Anterior cruciate

Question 3

How do you stabilize for anterior drawer sign?

Answer 3

-Sit on patient’s anterior foot with your posterior thigh while patient’s knee is flexed.

Question 4

No motion on anterior drawer (A-P) sign indicates what?

Answer 4

-Posterior tibia

Question 5

Posterior Drawer sign

-Excessive (P-A) motion indicates

Answer 5

posterior cruciate ligament tear. Not as common as Anterior tears.

Question 6

Lachman’s test

Answer 6

-Same procedure as Anterior draw sign except knee is bent only up to 30 degrees.

Question 7

What is the orthopedic test of choice for anterior cruciate ligament?

Answer 7

–Lachman’s

Question 8

What follow up test to Anterior Drawer verifies cruciate ligament damage and laxity?

Answer 8

–Lachman’s

Question 9

What test would you run if you suspected a false negative on anterior drawer sign of the knee?

Answer 9

–Lachman’s

Question 10

Why is Lachman’s preferred over anterior drawer for anterior cruciate ligament testing?

Answer 10

-The lower angle of flexion does not stretch the quadriceps as much, and the condyles are not as deeply seated into the menisci.

Question 11

Tibia Posterior…what are some indications?

Answer 11

• Aching behind the knee,
• Loss of fluid motion on anterior drawer (pulling P-A)
• Full flexion ROM is lost (pulls anterior ligaments tight)

Question 12

Apley’s Compression (menisci)

Answer 12

• Positive is pain
• Indicates Meniscal damage on side of pain finding when compressed
• Is a subjective test

Question 13

If Apley’s compression causes a decrease in pain what test would you run next?

Answer 13

-Apley’s Distraction suspecting collateral ligament damage.

Question 14

What would you do to verify pain on the medial side with Apley’s compression?

Answer 14

-McMurray’s test.

Question 15

Apley’s Distraction Test Postive is what?

Answer 15

• Positive report is pain
• Indicates collateral ligament damage on side of pain
• It’s a subjective test

Question 16

If pain were decreased on Apley’s distraction what test would you run?

Answer 16

-Apley’s compression suspecting a meniscal tear.

Question 17

What if Apley’s distraction relieves the pain?

Answer 17

-It’s probably meniscal

Question 18

What does Apley’s compression test indicate?

Answer 18

-Medial or lateral meniscal damage,….. pain helps determine the side.

Question 19

McMurray’s test ..Describe the order of procedure.

Answer 19

. Pt. supine, knee bent, Dr. palpates medial joint.

-Externally rotate foot,…Varus medial stress,…extend leg while palpating the medial joint line.

Question 20

What is a positive finding for McMurray’s?

Answer 20

-Palpable or audible click, with or without pain.

Question 21

Positive McMurray’s indicates what?

Answer 21

-Tear in the medial meniscus, most likely a horizontal/bucket handle tear

Question 22

Pain alone (no click) in McMurray’s may indicate what?

Answer 22

-Medial collateral ligament tear,….-medial meniscal tear,….-anterior cruciate tear,…-Tibia AM

Question 23

What’s the most common cause of a joint mouse of the knee?

Answer 23

Medial meniscus tear.

Question 24

What orthopedic tests should be run if McMurray’s has pain only?

Answer 24

• Valgus stress,…-Appley’s compression,…Appley’s distraction…
• Anterior drawer sign…-Lachman’s,…

Question 25

Valgus stress (Pushing from lateral to medial) What is a positive?

Answer 25

-Excessive movement at the medial joint space.

Question 26

What test would you run to verify a Valgus stress test?...

Answer 26

Apley’s distraction with medial side pai

Question 27

The best way to check an Anterior-Medial Tibia for fluid motion?

Answer 27

-If there’s no motion on Valgus stress, it may be due to the tibia rotating anterior which in turn pulls the medial ligaments tight that attach to the femur. Thus restricting motion.

Question 28

Is it normal to have a little bit of movement during valgus stress?

Answer 28

-Yes! (no motion=A-M tibia;……Excess motion=Ligament tear)

Question 29

What other ligament(s) might be torn if the medial collateral is torn?

Answer 29

-Medial meniscus,…..-maybe anterior cruciate or (ligament crossing the joint space)

Question 30

With Abduction/Valgus Stress:…-Excess motion indicates medial collateral ligament tear.

Answer 30

-If pain is exacerbated during this procedure it indicates a partial tear. –If pain stays the same it indicates a complete tear.

Question 31

Should you compare valgus to varus stress on the same knee?

Answer 31

- No, the two don’t always have the same laxity. | - Compare right knee valgus to the left knee valgus,……-and right knee varus to left knee varus.

Question 32

What is the direction of pull for patella grind

Answer 32

S-I, try to not get A-P force….-A more humane way is to have supine patient lift foot off table which tightens quads & elevates patella superior

Question 33

What is the positive for Patella Femoral Grinding Test

Answer 33

Pain or crep

Question 34

What does a positive Patella Femoral Grinding Test indicate

Answer 34

Chondromalacia patella

Question 35

What is positive patella femoral grinding most likely indicative of in an adult

Answer 35

DJD or plica.

Question 36

Which direction is pressure applied for patellar apprehension test?

Answer 36

-M-L against the medial border of the patella…..-then L-M against the lateral border of the patella.

Question 37

Patella Apprehension Test What is a positive?

Answer 37

-Patient has a look of apprehension indicating a propensity to dislocate. (Look at patient’s face.)

Question 38

Most common direction of patellar dislocation?

Answer 38

?……-Superior & lateral because of quad muscle.

Question 39

How would patient present for needing patellar traction?

Answer 39

-flexed knee,...-history of impact on kneecap causing pain. (Remember baseball video?)

Question 40

What are the findings to indicate the need for patellar traction?......

Answer 40

1) Dislocation. -(2) Patient is unable to extend knee because the quadriceps become flexors. -(3) On visualization Patella is superior and lateral to knee joint Name (4) Post checks for patellar traction. -(1.) Visualization,….-(2.) Light palpation,….-(3.) Active ROM (extension)….-(4.) X-ray

Question 41

What procedures would you not use for post checking patellar traction?

Answer 41

- Fluid motion (not on a hypermobile area), - Patellar Apprehension, - Patella femoral grinding test.

Question 42

Is the tibial tuberosity medial or lateral compared to inferior tip of the patella

Answer 42

slightly lateral.