Knee Joint Special Tests Flashcards
Collateral Ligament Instability Test (LCL and MCL)
PURPOSE- To identify ligament laxity or restriction
DESCRIPTION- Entire lower limb is supported and stabilized, knee placed in 20-30 degree of flexion. Valgus force placed through knee test MCL and varus force checks LCL
(20-30 degrees is the open packed position of the knee)
RESULT- Primary finding is laxity but pain may be reproduced
Lachman’s Test
PURPOSE- Indicates integrity of ACL
DESCRIPTION- The patient lies supine with the involved leg beside the examiner. The examiner holds the patient’s knee between full extension and 30° of flexion. The patient’s femur is stabilized with one of the examiner’s hands (the “outside” hand) while the proximal aspect of the tibia is moved forward with the other (“inside”) hand
RESULT- A positive sign is indicated by a “mushy” or soft end feel when the tibia is moved forward on the femur (increased anterior translation with medial rotation of the tibia) and disappearance of the infrapatellar tendon slope
Pivot-Shift Test
Patellar Subluxation test.
This test is effectively the reverse of the reduction test. The test begins with patient’s knees flexed. The clinician internally rotates the patient’s tibias with one hand and applies a valgus stress to the knee joint with the other hand.
The clinician slowly extends the knee, maintaining rotation of the tibia. As the patient’s knee reaches full extension, the tibial plateau will be felt to relocate.
Posterior Sag Test
PURPOSE- Indicates PCL integrity
DESCRIPTION- The patient lies supine with the hip flexed to 45° and the knee flexed to 90°.
RESULT- In this position, the tibia “drops back,” or sags back, on the femur because of gravity if the posterior cruciate ligament is torn
Slocum Test
PURPOSE- To assess both anteromedial and anterolateral rotary instabilities
DESCRIPTION- The patient’s knee is flexed to 80° or 90°, and the hip is flexed to 45°.
The foot is first placed in 30° medial rotation. The examiner then sits on the patient’s forefoot to hold the foot in position and draws the tibia forward; if the test is positive, movement occurs primarily on the lateral side of the knee. This movement is excessive relative to the unaffected side and indicates ALRI.
In the second part of the test, the foot is placed in 15° of lateral rotation, and the tibia is drawn forward by the examiner. If the test is positive, the movement occurs primarily on the medial side of the knee. This movement is excessive relative to the unaffected side and indicates anteromedial rotary instability
Posterior Drawer Test
PURPOSE- Indicates integrity of PCL
DESCRIPTION- Patient supine with testing hip flexed to 45 degree and knee flexed to 90 degree. Passively glide tibia posteriorly following the joint plane
RESULT- Excess posterior glide is positive finding
Reverse Lachman Test
PURPOSE- Test for the posterior cruciate ligament integrity
DESCRIPTION- The patient lies prone with the knee flexed to 30°, and the examiner grasps the tibia with one hand while fixing the femur with the other hand. The examiner then pulls the tibia up (posteriorly), noting the amount of movement and the quality of the end feel.
McMurray’s Test
PURPOSE- Identifies meniscal tears
DESCRIPTION- The patient lies in the supine position with the knee completely flexed (the heel to the buttock).
The examiner then medially rotates the tibia and extends the knee
RESULT- If there is a loose fragment of the lateral meniscus, this action causes a snap or click that is often accompanied by pain.
Test medial meniscus with same procedure except rotate tibia into lateral rotation
Positive with Medial Rotation = Lateral Meniscus Tear
Positive with Lateral Rotation = Medial Meniscus Tear
Apley Test
PURPOSE- Help differentiate between meniscal tears and ligamentous lesion
DESCRIPTION- The patient lies in the prone position with the **knee flexed to 90°. **
The patient’s thigh is then anchored to the examining table with the examiner’s knee. The examiner medially and laterally rotates the tibia, combined first with distraction, while noting any restriction, excessive movement, or discomfort. Then the process is repeated using compression instead of distraction
RESULT- If rotation plus distraction is more painful or shows increased rotation relative to the normalside, the lesion is probably ligamentous.
Rotation + Distraction more Painful or shows Increased Rotation = Ligamentous Lesion
If the rotation plus compression is more painful or shows decreased rotation relative to the normal side, the lesion is probably a meniscus injury.
Rotation + Compression more Painful or shows Decreased Rotation = Meniscal Lesion
Bounce Home Test (Snap Extension)
PURPOSE- Indicates meniscal lesion
DESCRIPTION- The patient lies in the supine position, and the heel of the patient’s foot is cupped in the examiner’s hand. The patient’s knee is completely flexed, and the knee is passively allowed to extend.
If extension is not complete or has a rubbery end feel (“springy block”), there is something blocking full extension.
RESULT- The most likely cause of a block is a torn meniscus. May also reproduce pain
Thessaly Test
PURPOSE- Indicates meniscal lesion
DESCRIPTION- The patient stands flat footed on one leg while the examiner provides his or her hands for balance. The patient then flexes the knee to 5° and rotates the femur on the tibia medially and laterally three times while maintaining the 5° flexion. The good leg is tested first, and then the injured leg.
(The test is then repeated at 20° flexion)
RESULT- The test is considered positive for a meniscus tear if the patient experiences medial or lateral joint line discomfort. The patient may also have a sense of locking or catching in the knee.
Hughston’s Plica Test
PURPOSE- Identify dysfunction of plica
DESCRIPTION- The patient lies in the supine position, and the examiner flexes the knee and medially rotates the tibia with one arm and hand while pressing the patella medially with the heel of the other hand and palpating the medial femoral condyle with the fingers of the same hand
RESULT- The patient’s knee is passively flexed and extended while the examiner feels for “popping” of the plica band under the fingers.
The popping indicates a positive test.
Patellar Apprehension Test
PURPOSE- Indicate past history of patella dysfunction
DESCRIPTION- Patient supine, with patella passively gilded laterally
RESULT- – Patient does not allow the patella to move in lateral direction
Clarke’s Sign
PURPOSE- Identify patellofemoral dysfunction
DESCRIPTION- The examiner presses down slightly proximal to the base of the patella with the web of the hand as the patient lies relaxed with the knee extended. The patient is then asked to contract the quadriceps muscles while the examiner pushes down.
RESULT- If the patient can complete and maintain the contraction without pain, the test is considered negative.
If the test causes retropatellar pain and the patient cannot hold a contraction, the test is considered positive.
Ballotable/Ballottement Patella/ Patella Tap Test
PURPOSE- Indicates infrapatellar effusion
DESCRIPTION- With the patient’s knee extended or flexed to discomfort, the examiner applies a slight tap or pressure over the patella
RESULT- When this is done, a floating of the patella should be felt. This is sometimes called the “dancing patella” sign
Fluctuation Test
PURPOSE- Indicates knee joint effusion
DESCRIPTION- The examiner places the palm of one hand over the suprapatellar pouch and the palm of the other hand anterior to the joint with the thumb and index finger just beyond the margins of the patella
RESULT- By pressing down with one hand and then the other, the examiner may feel the synovial fluid fluctuate under the hands and move from one hand to the other, indicating significant effusion
Q Angle Measurement
The angle is obtained by first ensuring that the lower limbs are at a right angle to the line joining the two ASISs. A line is then drawn from the ASIS to the midpoint of the patella on the same side and from the tibial tubercle to the midpoint of the patella.
The angle formed by the crossing of these two lines is called the Q-angle.
Normally, the Q-angle is:
13° for males and 18° for females when the knee is straight
(Females have a larger Q angle)
Noble Compression Test (Just know what it is for)
PURPOSE- Identifies distal IT band friction syndrome
DESCRIPTION- The patient lies in the supine position, and the examiner flexes the patient’s knee to 90°, accompanied by hip flexion. Pressure is then applied to the lateral femoral epicondyle, or 1 to 2 cm (0.4 to 0.8 inch) proximal to it, with the thumb. While the pressure is maintained, the patient’s knee is passively extended
RESULT-. At approximately 30° of flexion (0° being straight leg), the patient experiences severe pain over the lateral femoral condyle
Tinel’s Sign
PURPOSE- To identify dysfunction of common fibular nerve posterior to fibular head
DESCRIPTION- Tap the region where common fibular nerve passes posterior to fibular head
RESULT- Reproduces tingling sensation or paresthesia in leg
