knee and vascular LE orthopedic tests

Question 1

How is a Drawer test or sign performed?

Answer 1

Observe for sag sign on the symptomatic leg first
Patient is supine with the knee flexed and the examiner stabilizes the foot or ankle and firmly pulls the tibia forward and then pushes the tibia posteriorly

Question 2

If a patient reports locking in the knee what should be immediately considered?

Answer 2

Meniscal lesion or joint mice

Question 3

What ligament holds the menisci in the knee in place?

Answer 3

Coronary ligament

Question 4

What is the action of articularis genu?

Answer 4

Contracts in knee extension to move the joint capsule out of the way

Question 5

What is a positive result for a Drawer test or sign?

Answer 5

Excessive motion upon either translation as compared to the opposite side or pain in the central knee joint

Question 6

A present sag sign is indicative of a(n) ____________________ injury?

Answer 6

PCL

Question 7

What test should NOT be performed if a sag sign is present?

Answer 7

Drawer Test or Sign

Question 8

What is indicated by a positive result for a Drawer Test?

Answer 8

Excessive anterior tibial motion = ACL damage

Excessive posterior tibial motion = PCL damage

Question 9

A drawer test is performed on a patient and there is noted excessive anterior motion of the tibia compared to the opposite leg, how is this recorded and what is indicated?

Answer 9

Positive Drawer Test indicating an ACL injury

Question 10

A drawer test is performed on a patient and there is noted excessive posterior motion of the tibia compared to the opposite leg, how is this recorded and what is indicated?

Answer 10

Positive Drawer Test indicating a PCL injury

Question 11

How is a Lachman’s test performed?

Answer 11

The patient is supine with the knee flexed to 30 degrees
The examiner stabilizes the femur with one hand and exerts P to A stress on the tibia

Question 12

What orthopedic tests for the knee can determine ACL damage?

Answer 12

Drawer Test/Sign
Lachman’s Test

Question 13

What orthopedic test is specific to ACL damage?

Answer 13

Lachman’s test

Question 14

What is a positive finding for a Lachman’s test?

Answer 14

Excessive anterior translation of the tibia and or pain in the central knee

Question 15

What is indicated by a positive fining for a Lachman’s test?

Answer 15

ACL damage

Question 16

How is an ABduction or Valgus stress test for the knee performed?

Answer 16

Lower leg ABducted with lower femur stabilized opening up the medial knee joint
Perform test in full extension and repeat in slight flexion on the well side first

Question 17

What is a positive finding for an ABduction or Valgus stress test for the knee?

Answer 17

Pain or excessive motion at the medial knee

Question 18

What is indicated by a positive finding for an ABduction or Valgus stress test for the knee?

Answer 18

MCL damage

Question 19

An ABduction or Valgus stress test is testing the integrity of the _____________?

Answer 19

MCL

Question 20

An ADduction or Varus stress test is testing the integrity of the ______________?

Answer 20

LCL

Question 21

How is an ADduction or Varus stress test performed for the knee?

Answer 21

Lower leg is ADducted while the lower femur is stabilized opening up the lateral knee joint
Perform test in full extension then repeat in slight flexion on the well side first

Question 22

What is a positive result for an ADduction or Varus stress test on the knee?

Answer 22

Pain or excessive motion at the lateral knee

Question 23

What is indicated by a positive result for an ADduction or Varus stress test on the knee?

Answer 23

LCL damage

Question 24

If a patient has lateral knee pain what can be on your DDx list? What test can be performed for each?

Answer 24

LCL = Varus/ADduction stress test
Lateral meniscus = Apley’s Compression/Grind Test OR McMurray’s Test (INT Rotation)
IT Band = Noble’s Test
Common Peroneal Nerve = MRS over fibular head
Fibular head

Question 25

How is Noble's test performed?

Answer 25

Patient in a supine position, the doctor places a thumb over the lateral femoral epicondyle as the patient repeatedly flexes and extends the knee. Pain symptoms are usually most prominent with the knee at 30 degrees of flexion

Question 26

What is a positive finding for Noble's test?

Answer 26

Reproduction of pain in the iliotibial band

Question 27

What is indicated by a positive finding for Noble's test?

Answer 27

Iliotibial band tendonitis

Question 28

What orthopedic test is used for determining IT band TENDONITIS?

Answer 28

Nobles test

Question 29

What motion leads to lateral knee pain and IT tendonitis?

Answer 29

Repetitive knee flexion in runners and cyclists

Question 30

How is Apley's Compression/Grinding Test performed?

Answer 30

Patient prone with knee flexed to 90 degrees. Compress the tibia firmly down into the examining table while rotating the tibia internally. Repeat with external rotation

Question 31

What is a positive result for Apley's Compression/Grinding Test?

Answer 31

Any report of pain or clicking at the medial or lateral meniscus

Question 32

What is indicated by a positive result for an Apley's Compression/Grinding Test?

Answer 32

Pain or click in external rotation = Damage to posterior horn of medial meniscus Pain or click in internal rotation = Damage to posterior horn of lateral meniscus

Question 33

An Apley's Compression/Grinding Test is performed and the patient notes clicking during external rotation of the tibia. How is this recorded and what does it indicate?

Answer 33

Positive Apley's indicating a medial meniscus injury

Question 34

An Apley's Compression/Grinding Test is performed and the patient notes pain during internal rotation of the tibia. How is this recorded and what is indicated?

Answer 34

Positive Apley's indicating a lateral meniscus injury

Question 35

How is McMurray's test performed?

Answer 35

Flex patients knee to 90 degrees Look at the meniscus tested Press on the meniscus tested Point the patients heel toward the meniscus tested

Question 36

What is a positive finding for McMurray's test?

Answer 36

Audible or palpable click or snap in the joint or report of pain at the medial or lateral meniscus

Question 37

What is indicated by a positive finding for McMurray's test?

Answer 37

Pain or click in external rotation = Damage to posterior horn of medial meniscus Pain or click in internal rotation = Damage to posterior horn of lateral meniscus

Question 38

A McMurray's test is performed and the patient reports clicking in external rotation of the leg. How is this recorded and what does it indicate?

Answer 38

Positive McMurray's test indicating a medial meniscus injury

Question 39

A McMurray's test is performed and the patient reports pain during internal rotation of the leg. How is this recorded and what does it indicate?

Answer 39

Positive McMurray's test indicating a lateral meniscus injury

Question 40

What two LE orthopedic tests can be used to determine a meniscal injury in the knee?

Answer 40

Apley's Compression/Grinding Test McMurray's test

Question 41

How is a Patellar Scrape/Grinding Test/Clarke's Sign performed?

Answer 41

Gently hold down the patients patella and have the patient contract the quadriceps

Question 42

The patella most commonly dislocated (Medially/Laterally)?

Answer 42

Laterally

Question 43

What is a positive finding for a Patellar Scrape/Grinding Test/Clarke's sign?

Answer 43

Any grinding or pain upon movement deep to the patella

Question 44

What is indicated by a positive finding for a Patellar Scrape/Grinding Test/Clarke's sign?

Answer 44

Chondromalacia patella or retropatellar arthritis

Question 45

What test is an alternative to the Patellar Scrape/Grinding Test/Clarke's sign?

Answer 45

Fouchet's Sign

Question 46

How is Fouchet's sign performed?

Answer 46

Compression or transverse friction of the patella against the femoral condyles with the flat of the hand elicits pain

Question 47

What is a present finding for Fouchet's sign?

Answer 47

Any grinding or pain upon movement deep to the patella

Question 48

What is indicated by a present finding for Fouchet's sign?

Answer 48

Chondromalacia patella or retropatellar arthritis

Question 49

What two orthopedic tests for the knee can indicate chrondromalacia patella if present or positive?

Answer 49

Patellar Scrape/Grinding Test/Clarke's sign Fouchet's sign

Question 50

What LE orthopedic test can be used to determine a patellar fracture or suprapatellar tendon rupture?

Answer 50

Dreyer's sign

Question 51

How is Dreyer's sign performed?

Answer 51

Patient is supine and is asked to raise the affected leg off the table. If the patient is unable to perform this, the examiner then firmly encircles the lower thigh with his hands. Then the patient attempts to raise the leg

Question 52

What is a present finding for Dreyer's sign?

Answer 52

The ability to flex the hip with stabilization

Question 53

What is indicated by a present finding for Dreyer's sign?

Answer 53

Patellar fracture or suprapatellar tendon rupture

Question 54

How is a patellar apprehension test performed?

Answer 54

Patient seated or supine with knee slightly flexed. Doctor manually displaces the patella laterally and observes for apprehension, withdrawal, or quad contraction

Question 55

What is a positive finding for a patellar apprehension test?

Answer 55

Patient apprehension, withdrawal of the knee, or voluntary contraction of the quadriceps

Question 56

What is indicated by a positive finding for a patellar apprehension test?

Answer 56

Recurrent patellar dislocation

Question 57

What LE orthopedic test can be used to determine a tendency toward patellar dislocation or instability?

Answer 57

Patellar apprehension test

Question 58

What is the pain pattern of a patient with vascular claudication?

Answer 58

Dull achy pain worse with physical demand and relieved by rest with possible changes in temperature or color

Question 59

How will an arterial block look in a patient with vascular claudication?

Answer 59

White, cramping, dull ache

Question 60

How will a venous block look in a patient with vascular claudication?

Answer 60

Red, edema, pain if inflammation present

Question 61

What is the pain pattern of a patient with neurogenic claudication?

Answer 61

Worse with certain positions Relieved with hip or lumbar forward flexion

Question 62

Lateral canal stenosis will occur (Unilaterally/Bilaterally)?

Answer 62

Unilaterally

Question 63

Cauda equina syndrome will occur (Unilaterally/Bilaterally)?

Answer 63

Bilaterally

Question 64

What are signs or symptoms of Cauda Equina Syndrome?

Answer 64

Inability to initiate urination Saddle anesthesia Bilateral LE pain

Question 65

What LE vascular orthopedic test is analogous to Roos test in the UE?

Answer 65

Buerger's Test

Question 66

Patient presents with lower leg and foot pain with swelling and heat. He just returned from a vacation in England and had a long flight. What condition do you suspect and what is the BEST diagnostic protocol?

Answer 66

DVT; Doppler ultrasound

Question 67

How is Buerger's Test performed?

Answer 67

Have patient dorsiflex and plantarflex the elevated foot for 1-2 minutes. Observe for blanching. The leg is then lowered off the table and the foot is observed for color changes and refilling or collapse of superficial veins

Question 68

What is a positive finding for Buerger's Test?

Answer 68

Blanching of the foot or venous collapse with the foot elevated or failure to complete the test due to fatigue or cramping of he muscles OR a delay in filling longer than one minute after lowering the leg

Question 69

What is indicated by a positive finding for Buerger's Test?

Answer 69

Arterial insufficiency into the foot

Question 70

What are signs and symptoms of a DVT?

Answer 70

Swelling of the calf with heat Edema below the lesion Recent history of prolonged sitting or bed rest

Question 71

What is a positive result for Homan's test?

Answer 71

Acute calf pain

Question 72

What is indicated by a positive result for Homan's test?

Answer 72

Thrombophlebitis (DVT)

Question 73

What LE orthopedic test(s) can determine a deep vein thrombosis or thrombophlebitis in the LE?

Answer 73

Homan's test Moses test

Question 74

For a Homan's test the doctor will ________________ the foot with the knee extended to compress deep leg veins?

Answer 74

Dorsiflex

Question 75

For a Moses test the patient is prone with the knee flexed. The doctor ___________________ the calf of the affected leg?

Answer 75

Compresses

Question 76

What is a positive result for a Moses test?

Answer 76

Acute calf pain

Question 77

What is indicated by a positive result for a Moses test?

Answer 77

Thrombophlebitis (DVT)

Question 78

If a patient reports locking in the knee what should be immediately considered?

Answer 78

Meniscal lesion or joint mice

Question 79

What ligament holds the menisci in the knee in place?

Answer 79

Coronary ligament

Question 80

What is the action of articularis genu?

Answer 80

Contracts in knee extension to move the joint capsule out of the way

Question 81

If a patient has lateral knee pain what can be on your DDx list? What test can be performed for each?

Answer 81

LCL = Varus/ADduction stress test Lateral meniscus = Apley's Compression/Grind Test OR McMurray's Test (INT Rotation) IT Band = Noble's Test Common Peroneal Nerve = MRS over fibular head Fibular head

Question 82

The patella most commonly dislocated (Medially/Laterally)?

Answer 82

Laterally

Question 83

Patient presents with lower leg and foot pain with swelling and heat. He just returned from a vacation in England and had a long flight. What condition do you suspect and what is the BEST diagnostic protocol?

Answer 83

DVT; Doppler ultrasound