Effusion & Muscle Testing

Question 1

What tests can you do to test effusion in the knee?

Answer 1

Patella tap - push patella into patella groove of femur. +ve spongy/soft end feel for swelling (normal end feel - bone on bone)

Sweep test - sweep from inferior medial to superior and then down laterally. Observe medial aspect of knee or palpate it for fluid.

Question 2

How would you test muscles? What might you find?

Answer 2

1. Resisted (isometric) testing - pain
2. Strength tests - through range (MRC/oxford grading) - reduced strength/weakness
3. Length tests - reduced ROM/length and possible pain
4. Palpation - identify site of lesion
   ——————
   Control tests
   Bulk
   Special tests/Diagnostic tests

Question 3

Findings on isometric muscle testing:

1. Strong and painful = ?
2. Strong and painless = ?
3. Weak and painless = ?
4. Weak and painful = ?
5. All movements painful = ?

Answer 3

1. Tendinopathy/minor muscle injury
2. Normal
3. Muscle rupture/neuropathy
4. Major muscle injury/Fracture
5. Could be BPS?

Question 4

How to test Oxford grading on muscles?

Answer 4

Concentric/eccentric muscle tested THROUGH full range

Question 5

What are the Oxford grading scales?

Answer 5

0 - no contraction
1 - flicker of contraction
2 - contraction with gravity eliminated 
3 - contraction against gravity
4 - contraction against resistance
5 - contraction against strong resistance (should be used in all contractions for true strength - concentric, eccentric, isometric and isotonic)

Question 6

What do muscle length tests look for?

Answer 6

Quality
ROM (what is normal?)
Pain
Resistance (end feel)

P > R
R > P
P = R

Question 7

What to look for in accessory movements (including ligs)?

Answer 7

Amount of movement (normal?)
Movement in range - quality
End feel
Pain, resistance, muscle spasm
What limits the movement? P or R? Equal?

Question 8

How to document accessory?

Answer 8

The joint being tested - e.g hip
The movement/test - e.g AP on greater trochanter
ROM - e.g normal, abnormal (hypo/hyper)
Quality of movement - e.g. resistance at half range, pain at 3/4
End feel, what limited it - R>P