Knee Lab Flashcards
tibiofemoral open pack
25 degrees flexion
patellofemoral open pack
5-10 knee flexion
AP glide of tibia - joint assessment and treatment
achieve indirectly by PA of femur with stabilized tibia in supine
in prone, prop femur with towel and push tibia forward
tib/fib distraction
seated position
hold tibial plateaus, squeeze leg with knees or use figure 8 gait belt to pull down
patellar tilt
open pack 5-10 degrees
med and lateral base should feel equal
palpate with length of thumb at edge of patella
patellar glides
inferior, superior, medial, lateral, med/lat rotation, tilt
superior AP/PA fibular glide
supine
knee bent, anchoring to table
thumb on fibular head, fingers posterior into gastroc
PA use fingers on gastroc to pull anterior
anterior drawer
purpose: assess ACL integrity, acute injury or repair
position: supine, hip flexed 45 knee flexed 90
action: anchor foot by sitting on it, quickly translate tibia forward
positive: excess translation of tibia compared to uninvolved
*hamstrings will try to protect, why it needs to be fast
Lachman’s
purpose: assess ACL integrity, acute and post op
position: knee flexed 20-30, knee supports femur
action: translate tibia anteriorly quickly
positive: excess tibia anterior translation
Lelli’s
purpose: assess ACL integrity
position: supine, fist under pt tibia 3 fingers under joint line
action: press femur down
positive: without ACL, tibia will not move upwards on the lever system
posterior drawer
purpose: assess PCL integrity
position: supine, hip 45 knee 90
action: posterior translation of tibia with hands on proximal tibia, doesn’t need to be fast
positive: excess posterior translation of tibia
posterior sag sign
purpose: assess PCL integrity
position: supine, hip 45 knee 90
action: observe tibial plateau compared to femoral condyles
positive: loss of step with tibial plateau sagging behind femoral condyles
valgus stress test
purpose: assess integrity of MCL
position: supine, edge of table, knee 0 and 30
action: valgus stress to lateral knee, tibia in ER
positive: reproduce pain or laxity; positive in 0 indicates larger tissue disruption
varus stress test
purpose: assess integrity of LCL
position: supine, leg edge of table
action: varus stress to medial knee at 0 and 30
positive: reproduction of pain or laxity, positive in 0 indicates larger tissue disruption
Pivot shift test
purpose: assess ACL integrity
position: supine, extended knee, slight hip flexion/abduction, 30 degrees IR at hip
action: hold lat calcaneus for IR, apply valgus force and flex knee
positive: tibia relocates backwards at 30-40 degrees knee flexion, clunk/giving way
McMurray
purpose: assess meniscus
position: supine, knee in max flexion
lateral - IR tibia
medial - ER tibia
action: extend knee
positive: reproduce click/pop or pain
Thessaly
purpose: more provocative meniscus assessment
position: standing on affected leg, holding PT or table for support
action: pt rotates body so leg int/ext rotates w knee flexed 5 degrees then 25
positive: reproduce pain, click
Patellar apprehension
purpose: assess patellar instability
position: supine, leg off the table in 30 knee flexion
action: passively translate patella laterally
positive: pt expresses apprehension, quad contraction to prevent patellar dislocation
Clarke’s
purpose: assess patellofemoral pain
position: supine
action: pt performs quad set while PT glides patella distally
positive: familiar pain, inability to hold quad set
Noble Compression Test
purpose: assess IT band syndrome
position: supine, knee flexed 90
action: apply pressure to lat femoral epicondyle over IT band, maintain and passively extend knee
positive: pain over lateral femoral condyle
stroke test
purpose: assess joint edema
position: supine
action: stroke from medial tib femoral joint upward suprapatellar, then down laterally
positive: fluid observed on medial knee, 0-5 scale
ottawa knee rules
used after trauma
- Age >55 years
- Isolated patellar tenderness without other bone tenderness
- Tenderness of the fibular head
- Inability to flex the knee to 90°
- Inability to bear weight immediately after injury and in the emergency department (4 steps) regardless of limping
Apley compression/distraction
purpose: general diagnostic
position: prone, knee flexed 90
action: compress or distract with rotation
compression would irritate joint surface, meniscus
distraction wouldn’t
mobilization for last 5 degrees of extension
stabilize tibia, held in ER
give femur post glide with IR for screw home mechanism
