Knee Complex Examination Flashcards Preview

PT 515 Musculo > Knee Complex Examination > Flashcards

Flashcards in Knee Complex Examination Deck (65):
1

Flexion ROM

10-0-135

2

Extension ROM

135-0-10

3

Tibiofemoral joint resting position

25 degrees of flexion

4

Tibiofemoral joint closed pack position

Full extension
Full lateral rotation of tibia

5

Ottawa Knee Rules

>55 years old
Tenderness at the head of the fibula
Isolated tenderness of the patella
Inability to flex knee to 90 degrees
Inability to walk four WB steps immediately after injury and in the emergency room
-Sensitive test

6

Pittsburgh Decision Rules

Blunt trauma or a fall as MOI and either of the following
-Age less than 12 or greater than 50
-Inability to walk four WB steps in the ER
Highly sensitive and more specific than Ottawa Knee Rules

7

Clicking

Meniscus tear

8

Snapping

Synovial plica
Tendon over bone

9

Grating

Chondromalacia
OA
Osteochondritis

10

Tearing

Muscle
Ligament

11

Catching

Meniscal Tear
Subluxing patella

12

Popping

ACL
Meniscus
Muscle

13

Tingling

Nerve
Circulation

14

Worse in morning

Arthritis
Chronic inflammation

15

Worse up stairs

Anterior horns of the meniscus

16

Worse down stairs

Posterior horns of the meniscus

17

Potential Pathologies of the knee

Patellofemoral dysfunction
Meniscal injury
Ligamentous sprain or laxity
Capsular restriction
Musculotendonous strain
ITB syndrome
Tendonitis, Bursitis, synovitis
OA/RA
Fractures
s/p TKA
s/p Scope
s/p ACL repair

18

Chrondromalacia patella

MOI: repetitive trauma, patellar misalignment
S/S: retropatellar pain
Functional Complaints: Aggravated doing stairs, running, squatting

19

Patellar subluxation/Dislocation

MOI: Lateral tightness, Q angle, Repetitive trauma, acute trauma
S/S: Apprehension, Pain, swelling

20

Patellar Tendonitis

MOI: Repetitive trauma, insidious, sports w/ eccentric load to quads
S/S: Anterior knee pain, Pain at inferior pole of patella
Functional complaints: Jumping or kneeling, during or after activity

21

Pre-patellar bursitis

MOI: Repeated friction, trauma, repetitive trauma
S/S: Redness, effusion over the patella
Functional complaints: difficulty walking, inability to kneel

22

Meniscal Injury

Valgus or Varus force applied to flexed knee
Forced medial rotation: lateral meniscus
Forced Lateral rotation: Medial meniscus
S/S:
-Acute joint line pain
-Effusion
-Locking, click, snap
-Catching sensation
-Giving way

23

ACL injury

MOI: Sudden cut or deceleration, rotation combined with varus or valgus, hyperextension
S/S:
-Pop
-Swelling
-Persistant pain unless full tear
-Hemarthrosis
-Loss of ROM
Functional c/o giving way

24

PCL Injury

MOI: Hyperflexion, Hyperextension, rotational motion w/ varus or valgus
S/S:
-Pop
-Diffuse or posterior knee pain
-Swelling
-Hemarthrosis
Functional c/o inability to bear wait

25

MCL injury

MOI: valgus force, excessive lateral rotation, overuse
S/S:
-localized pain and stiffness
-Ecchymosis after several days
-Swelling

26

LCL Injury

MOI: Varus force, excessive lateral rotation
S/S:
-localized pain and stiffness
-Echymossis
-Swelling

27

Capsular restriction

MOI: Long period of lack of movement through ROM
Flexion more limited than extension

28

Musculotendinous injury

MOI:
-Poor footwear
-Tight muscles
-Overuse
-Muscle imbalance
S/S
-Pain with active contraction and passive lengthening

29

ITB Syndrome

MOI: Repetitive use, misalignment
S/S: Pain at lateral aspect of knee
Functional c/o: worse w/ activity, may pop during movement

30

Baker's cyst

MOI: associated w/ OA, RA, Gout
S/S:
-Popliteal mass or swelling
-Aching
-Knee effusion
May be associated with medial meniscus damage

31

Location of swelling

30 min to 2 hours is hemarthrosis
-potentially ACL, patellar sub/dislocation, PCL, Fx, meniscus
6-24 hours after is synovial origin
-meniscal tear, bone chips, capsular sprain, MCL, patellar sub

32

Patella Baja

Patella sits lower than expected

33

Patella Alta

Patella sits higher than expected
Camel sign

34

Osgood Schlatter

MOI: Indirect trauma, repetitive stress, sudden powerful quad contraction, repeated knee flx against tight quads
S/S:
-ache/pain at tib tubercle
-enlarged tubercle
-swelling
-Heat and tenderness over area
-Pain increased by activity that tensions tuberosity

35

5 reasons to perform LQS

1. Insidious onset
2. Referred or radicular pain
3. Doubt about the location of pathology
4. Altered sensation
5. Unusual pattern of symptoms

36

Hip flexor flexibility

Two joint hip flexor test (Thomas test)

37

ITB/TFL flexibility

Ober's test

38

Hamstring flexibility test

90/90 position

39

Patellar ballotment test

Pt in long sit
Examiner w/ one hand above and below knee
Press over middle of patella in posterior direction
Positive if the patella flows back to its original position

40

Ballotment

Major effusion

41

Mediopatellar Plica test

Pt supine with knee flexed 10-20, leg supported
Palpate for fold in capsule medial to patella
Move patella medially over plica to pinch
Positive if painful

42

Clark's sign (Patellar grind test)

Pt supine with knees supported
Use web of hand, press down proximal to superior pole
Pt contracts quad
Positive if crepitus or pain
-Questionable chrondromalacia patella

43

Measure Q angle

Higher Q angle leads to higher likelihood of lateral tracking
Pt supine with knee full extension
Fulcrum on patella
Stationary arm ASIS
Movement arm Tibial tubercle

44

Patellofemoral Joint Apprehension test

Lateral patellar gilde:
-Pt with knees in full extesion
-Thumbs on medial border of patella push lateral
-Test repeated at 20 and 45 degrees
Positive if patella glides laterally >1/4 its width
Medial Patellar glide:
-same as above but pushing medial
Positive if patella glides >30-40% of width or >10mm

45

Figure 4 Test

-Pt supine and places ankle of affected knee on contralateral knee
-Examiner pushes affected knee towards table
-Positive is concordant pain over lateral joint line at popliteal hiatus indicates lateral meniscus tear

46

Payr's signs

Figure 4 test but patient complains of medial knee pain
Indicates posterior horn lesion of medial meniscus

47

Squat test/Duck waddle/Childress test

-Pt standing then squats
-If no pain, duck walks in squat
-Positive if a block preventing full flexion or pain at end range flexion indicates meniscal tear

48

Dynamic Test

-Pt supine with hip abd 60, flexed 45, and ER; knee flexed to 90, lateral border of foot on table
-Palpate lateral joint line then slowly adduct the hip while maintaining flx
-Positive if sharp pain at end of hip add or increase in pain
Indicates lateral meniscal tear

49

Thessaly Test at 5 degrees

-Pt stands on one leg and grasps examiners hands
-Pt flexes knee to 5 degrees and rotates R and L
-Repeat R to L motion 3 times
-Positive if joint line discomfot and sense of locking or catching
-Indicates meniscal tear

50

Thessaly test at 20 degrees (Disco Test)

-Pt stands on one leg and grasps examiners hands
-Flexes knee to 20 degrees and rotates R and L 3 times
-Positive if joint line discomfort and sense of locking or catching
-Indicates a meniscal tear

51

McMurray Click Test

Pt supine examiner stand on involved side
Grasp at heel, flex knee to end range while palpating medial and lateral joint line
-ER and extend knee to asses medial meniscus
-IR and extend knee to assess lateral meniscus
Positive if audible or palpable thud or click

52

Apley's test

Pt prone
Examiner places knee on HS of pt with pt knee flx to 90
Grasp foot w/ both hands, distract tibia and rotates tibia
-Positive if pain with rotation indicates soft tissue rotation sprain
Examiner compresses tibia and rotates
-Positive if worse with compression than distraction indicitive of meniscal tear

53

Valgus Stress Test

Pt supine with hip slightly ABD
Knee flexed to 30
Examiner applies medially directed force at lateral joint line while hand at ankle slightly ER lower leg
Repeat the test at full extension
-Positive if excessive medial opening and concordant pain implicates MCL
-If the test is positive at 0 degrees then the ACL/PCL and/or joint capsule is implicated

54

Varus Stress Test

Pt supine with hip slightly ABD
Knee flexed to 30
Examiner applies laterally directed force at medial joint line while hand at ankle slightly IR the lower leg
Repeat test with full extension
-Positive if excessive lateral opening and concordant pain implicates LCL
-If the test is positive at 0 degrees then the ACL/PCL and/or joint capsule is implicated

55

Posterior Sag Sign (Godfrey's Test)

Pt supine with hip and knee flexed to 90 degrees
Examiner or chair supports leg under calf/heel
Positive if posterior sagging of the tibia secondary to gravitational pull implicates PCL

56

Posterior Draw test

Pt supine with knee flexed to 90, hip flexed to 45, and neutral foot
Examiner sits on pt foot to stabilize
Both hands on proximal anterior tibia with thumbs on medial and lateral joint lines
Proximal tibia is translated posteriorly
Repeat with foot IR and ER
-Positive dependent on motion compared to other side implicates PCL
Grades 1-3 with 3 being most lax

57

Anterior Draw test

Pt supine with knee flx to 90 so foot is flat
Examiner sits on foot and grasps behind proximal tibia w/ thumbs on tibial plateau
Anterior tibial force applied
Positive if greater anterior displacement when compared to unaffected side implicates ACL

58

Lachman's test

Pt supine with knee flexed to 15 degrees
Examiner stabilizes distal femur with one hand and grasps proximal tibia with other
Examiner applies anterior force to tibia
Positive if greater anterior displacement on affected side when compared bilaterally
Implicates ACL

59

Hughston's Test

Pt hooklying knee at 90 with 10 degrees IR/ER
Examiner sits on patients foot
Apply posterior forces moving tibia on femur while palpating joint line
Excessive motion with IR is Posteromedial Rotary Instability
Excessive motion with ER is Posterolateral rotary instability

60

Slocum Tests

Pt hooklying with knee at 90 with IR/ER
Examiner sit on foot
Apply anterior force of tibia on femur while palpating joint line
Excessive motion with IR is Anterolateral rotary instability
(greatest at 30 degrees IR)
Excessive motion with ER is Anteromedial rotary instability (greatest at 15 degrees ER)

61

Pivot Shift (Test of Macintosh)

Pt supine
Position LE in 10-15 degrees flexion and IR tibia and apply a valgus force with hand along lateral joint line
Slowly flex knee beyond 30 maintaining rotation
Positive if audible or palpable click or thud
Rotary instability

62

Reverse Pivot Shift (Jakob test)

-Pt lies supine with knee flexed to 70-80 with ER of tibia
-Gravitiy assists the knee into extension as examiner leans slightly against the foot and provides valgus force
-As the knee approaches 20 degrees flexion, you can feel and see lateral tibial plateau move anteriorly from a posterior subluxation
-Positive test is a reduction of the tibial head
Rotary instability

63

Ober's Test

Pt sidelying, hip and knee flexed
PT extends and ABD upper leg passively
Allow the leg to lower towards table while stabilizing pelvis
Performed with knee flexed and extended
Positive if leg remains ABD, contracture of ITB is present

64

Nobel Compression Test

Pt supine with knee flexed to 90 and hip flexed
PT applies pressure over lateral femoral condyle or 1-2 cm proximal
Pt extends knee while PT maintains pressure
Positive if PT reports extreme pain over lateral femoral condyle at 30 of flexion = ITB friction syndrome

65

Functional Testing

Squat
Stairs
Walk
Run
Kneeling
LE Balance and Reach