Knee Flashcards
Special tests
*** Unaffected leg then affected leg
1) Valgus
2) Varus
3) Lachmans
4) Posterior draw
5) McMurrays
6) Fluid displacement
7) Stroke test
8) Patellar tap
9) Apleys- grind + distraction
10) Thessaly’s
11) Patella femoral joint - grind, compression apprehension
12) circumferential thigh
13) circumferential calf
1) Valgus
MCL
Stand facing model put knee into full extension then repeat in 30 degrees flexion (increases sensitivity by reducing work of other knee ligaments) .
Support affected leg under your forearm stabilising it with your waist. Valgus pressure applied just above ankle and a counter pressure is applied on the lateral side of the knee
positive= joint gapping excessive valgus movement palpate medial joint line
2)Varus
LCL
Stand facing model put knee into full extension then repeat in 30 degrees flexion (increases sensitivity by reducing work of other knee ligaments) .
ensure model is near the side of the plinth. Therapsit sits on the plinth an the affected leg is supported in btween models forearm and waist. Essentailly sitting inbetween modles legs. A varus pressure is applied just above the annkle and a counter pressure is applied just above the medial aspect of the knee.
3) Lachamns
ACL
Model in supine rolled up towel underneath affected leg 15 degrees flexion. Therapist standing on affected side. With one grasp lower part of femur anteriorly to stabilise it and with the other hand grasp the upper part of the tibia posterioly and with that hand pull the tibia upwards whilst the other hand is providing a counter pressure
positive test: excessive anterior movement 1cm or more
4) Posterior draw
PCL
Patient supine lying affected leg in 70 degrees flexion stabilise foot by sitting on it.. Grasp upper en of tibia and thumbs resting on tibia tubercle push tibia backwards
positive test= excessive posterior movement, is there a visible step 1cm or more
5) McMurrays
MEDIAL/ LATERAL MENISCUS
Model in supine lying. Standing facing model. Stand on affected leg side. With one hand place a long models foot so that the palm of your hand is in contact with the sole of models foot and fingers are craddeling heel with the other hand hold above the knee hand in a C shape
bring models foot to their bum and palpate med/lat joint line
> med= laterally rotate and turn foot out as you extend knee from flexed position palpating med joint line
> lat= medially rotate and turn foot in as you extend knee from flexed position palpating lat joint line
positive test= clicks pain or apprehension
6) Fluid displacement
used to test effusion will be negative if effusion is gross and tense
1/2 lying
15cm above patella squeeze any excess fluid out of the suprapatella pouch by sliding distally using your index finger and thumb.
Stroke the medial side of the joint with your
other hand to displace any excess fluid in the main
joint cavity to the lateral side of the joint.
x1 downward stroke medial then lateral
Then repeat the procedure by stroking the lateral
side of the joint. Any excess fluid present will be
seen to move across the joint and distend the
medial side.
7) Stroke test
supine lying knee relaxed
The therapist stands at the affected side of the plinth facing the patient.
Start just below the medial tibiofemoral joint line,
strokes upward 2 or 3 times toward the suprapatellar
region to move the swelling within the joint capsule
to the suprapatellar pouch.
Then strokes downward on the distal lateral thigh from just superior to the suprapatellar pouch across the lateral joint line.
Any excess fluid present will be seen to move across the joint and distend the medial side.
This is a ‘wave of fluid’ moving into the medial joint compartment
Grading:
0- No ‘wave’ produced on downstroke
1- Small ‘wave’ on medial side with downstroke
1+ Larger bulge on medial side with downstroke
2+ Effusion spontaneously returns to medial side following upstroke (no downstroke necessary)
3+ So much effusion it is not possible to move the fluid out ofthe medial aspect of the knee
8) Patellar tap
first signs of effusion is buldging at sides of patellar lig
1/2 lying
15cm above patella squeeze any excess fluid out of the suprapatella pouch by sliding distally using your index finger and thumb.
Whilst maintaining this position with one
hand, place one or two finger tips from
your free hand on the patella and gently
apply a downwards pressure.
A positive test can be confirmed by a clicking sensation or you may feel the patella ‘floating’. This test should not be attempted in the presence of a tense effusion.
9) Apley’s grind + distraction
Grind= affected side either MEDIAL/LATERAL MENISCAL TARE
Model in prone. Position the models knee in 90 degrees flexion and dorsiflex the ankle. The therapist puts their knee on top of the patients posterior thigh. One hand on posterior tib stabilises leg. Direct pressure applied downwards on the foot whilst the tibia is rotated medially and then laterally.
Grinding sensation on the affected side,
reproducing the symptoms for the patient and
indicating a torn meniscus.
Distraction=LIGAMENT rather than meniscus
Same patient position as above but the therapist kneels
gently over the posterior aspect of the models knee
joint to stabilise it whilst hands apply an upward distraction force on the tibia while medially and laterally rotating it. If pain is reproduced in this test, it is indicative of a ligamentous rather than a meniscal injury
10) Thessaly’s
MEDIAL/LATERAL MENISCAL TARE
** Test can only be performed 4 weeks or more after injury as acutely injured knees cannot be reliably examined
The test is performed with the patient in
standing with full weight bearing on the side to
be tested. The foot should be flat on the floor.
The non-test leg is flexed at the knee to prevent
the foot on the non-test leg from contacting
with the ground
Test Movement therapist supports the
patient by the outstretched hand (or the patient
could hold onto a plinth). The patient flexes the
knee to be tested to approx 20 degrees and in
this position, the patient is instructed to rotate
the femur on the tibia three times, both
internally and externally.
Positive test= rotation movement reproduces the patient’s
symptoms at the medial or lateral joint lines.
Joint locking or catching would also be
considered positive. Anterior pain at or around
the patella when the knee is first flexed is not
considered a positive finding
11) Patella femoral joint - grind, compression apprehension
GRIND
Using the web of the hand the therapist presses the patella down towards the feet in an inferior direction. The patient is then asked to contract the quadriceps muscle as the therapist continues applying force.
The test is POSITIVE if the patient cannot complete the contraction without pain or has a great deal of apprehension about contracting their quads. (A positive test suggests patellofemoral syndrome/chondomalacia patella)
COMPRESSION
Therapist compresses the patella while the patient flexes and extends their leg within a 35 degree range (flexion and extension can be performed actively by the patient or passively by the therapist).
The test is POSITIVE if pain or discomfort is elicited (a positive test suggests patellofemoral syndrome)
APPREHENSION
Therapist performs a lateral accessory glide of the patella whilst watching the patient’s face during the manoeuvre.
A positive test is when the patient shows apprehension and/or actively contracts the quads due to a feeling of instability that the patella will sublux laterally
12) circumferential thigh
Patient 1/2 lying therapist standing affected side
Make sure thighs relaxed from base of patella measure 10 and 15 cm above and mark x2 dots and measure around x3 at each dot
13) circumferential calf
Patient 1/2 lying therapist standing affected side
5cm below tib tub
Measure x3 times
