KNEE

Question 1

CLARKS

Answer 1

Pt supine
Push patella inferiorly
Pin in position
Ask pt to contract quads slowly

Question 2

CLARKS - WHAT DOES IT TEST?

Answer 2

Chondromalacia patella
Degenerative patella femoral joint

Question 3

CLARKS - POSITIVE TEST

Answer 3

Retropatella pain (Pain on posterior surface of patella)

Question 4

BALLOTTMENTS/SWEEP

Answer 4

Pt supine
Pillow under knee
Milk knee/quads
Keeping pressure on femur, tap patella

Question 5

BALLOTTMENTS - WHAT DOES IT TEST?

Answer 5

Internal derangement
Ligament sprain/strain or rupture
Vascular damage

Question 6

BALLOTTMENTS - POSITIVE TEST

Answer 6

Increases bulge over patella
Rapid bounce back
Spongy feel
‘Floating” patella

Question 7

APLEY’S COMPRESSION

Answer 7

Pt prone
Leg to 90
Dorsiflex foot and compress
Apply pressure into internal rotation (lateral meniscus)
Repeat while applying external rotation (medial meniscus)

Question 8

APLEY’S COMPRESSION - WHAT DOES IT TEST?

Answer 8

Meniscal damage
External rotation = medial meniscus
Internal rotation = lateral meniscus

Question 9

APLEY’S COMPRESSION - POSITIVE TEST

Answer 9

Pain on compression and external rotation = medial meniscus tear
Pain on compression and internal rotation = lateral meniscus tear
Locking of knee

Question 10

APLEY’S DISTRACTION

Answer 10

Pt prone
Leg up to 90
Examiner place their knee on pt hamstring
Distract by holding around pt ankle and lifting leg
Internally and externally rotate foot

Question 11

APLEY’S DISTRACTION - WHAT DOES IT TEST?

Answer 11

Capsule/ligament lesion
Colateral lateral ligament sprain

Question 12

APLEY’S DISTRACTION - POSITIVE TEST

Answer 12

Pain on distraction (ligament lesion/colateral lateral ligament sprain)
Decrease pain (suggests meniscal lesion)

Question 13

MCMURRAY

Answer 13

Pt supine
Knee fully flexed
One hand holding underneath pt foot
Other hand palpating knee joint line
Slowly extend the knee applying an internal rotation and varus force
Repeat again applying an external rotation and valgus force

Question 14

MCMURRAY - WHAT DOES IT TEST?

Answer 14

Meniscal lesion
Tibial internal rotation - Lateral meniscus
Tibial external rotation - Medial meniscus

Question 15

MCMURRAY - POSITIVE TEST

Answer 15

Pain
Crepitus
Locking
Clicking
Grinding

Question 16

EGE’S (MEDIAL MENISCUS)

Answer 16

Pt standing
Laterally rotate each tibia maximally (feet turned out)
Pt squat

Question 17

EGE’S (LATERAL MENISCUS)

Answer 17

Pt standing
Medially rotate each tibia maximally (feet turned in)
Pt squat
Difficult even for healthy pt

Question 18

EGE’S - WHAT DOES IT TEST?

Answer 18

Meniscal lesion
Tibial internal rotation - Lateral meniscus
Tibial external rotation - Medial meniscus

Question 19

EGE’S - POSITIVE TEST

Answer 19

Pain
Crepitus
Early flexion pain - anterior tears
Deep flexion pain - posterior horn tears

Question 20

THESSALY’S

Answer 20

Pt standing
Use examiners hands for balance
Pt stand on one leg with knee flexed 5
Examiner walks round so pt trunk is following the examiner
Repeat with pt knee flexed 20

Question 21

THESSALY’S - WHAT DOES IT TEST?

Answer 21

Meniscal lesion

Question 22

THESSALY’S - POSITIVE TEST

Answer 22

Pain
Buckling of knee
Catching
Clicking
Medial/lateral joint line discomfort

Question 23

ANTERIOR DRAW

Answer 23

Pt supine
Pt knee flexed
Examiner holds around top of tibia and fibula
Examiner pulls leg towards them
(same as accessory movement)

Question 24

ANTERIOR DRAW - WHAT DOES IT TEST?

Answer 24

Anterior cruciate ligament sprain/rupture

Question 25

ANTERIOR DRAW - POSITIVE TEST

Answer 25

Pain Excessive movement (rupture)

Question 26

POSTERIOR DRAW

Answer 26

Pt supine Pt knee flexed Examiner holds around top of tibia and fibula Examiner pushes leg away from them (same as accessory movement)

Question 27

POSTERIOR DRAW - WHAT DOES IT TEST?

Answer 27

Posterior cruciate ligament sprain/rupture

Question 28

POSTERIOR DRAW - POSITIVE TEST

Answer 28

Pain Excessive movement (rupture)

Question 29

LACHMAN

Answer 29

Pt supine Examiner place knee under pt leg to flex leg 15-30 Anterior - Stabilise femur, pull tibia anteriorly Posterior - Stabilise femur, push tibia posteriorly

Question 30

LACHMAN - WHAT DOES IT TEST?

Answer 30

Anterior - ACL injury Posterior - PCL injury Considered gold standard

Question 31

LACHMAN - POSITIVE TEST

Answer 31

Pain Excessive movement (rupture) Mushy/soft end feel Disappearance of infra patella slope

Question 32

PATELLA DECOMPRESSION

Answer 32

Pt supine Leg straight Pick up patella and move it

Question 33

NOBLE COMPRESSION TEST

Answer 33

Pt supine Flex knee to 90 Apply pressure with thumb to lateral femoral condyle With thumb pressure maintained extend knee passively

Question 34

NOBLE COMPRESSION TEST - POSITIVE TEST

Answer 34

Pain over lateral femoral condyle

Question 35

NOBLE COMPRESSION TEST - WHAT DOES IT TEST?

Answer 35

ITB syndrome

Question 36

STUTTER TEST

Answer 36

Pt seated on the edge of the couch Both knees bent to 90 Place one finger over the patella Pt extends knee slowly

Question 37

STUTTER TEST - POSITIVE TEST

Answer 37

Patella stutters or jumps between 60-45 degrees of flexion

Question 38

STUTTER TEST - WHAT DOES IT TEST?

Answer 38

Plica syndrome