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PHTH 7232 Ortho > Knee Special Tests > Flashcards

Knee Special Tests Flashcards

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1
Q

How to perform

Anterior drawer

A

Pt supine, Flex knee to

  • place hands in starting reference position
  • You know from the previous test if the tibia has not sagged back,
  • Keeping elbows straight, pull body straight forward (just rock body), feel for hamstring guarding
  • If it subluxates toward you, you know it’s a PCL tear
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2
Q

implications

Passive Tracking

A

Noncontractile tissue, patellar groove

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3
Q

indications

Medial/Lateral patellar glides

A

all patients

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4
Q

How to perform

Flexion Rotation Drawer (FRD)

A

pt in supine, knee flexed 0-60 degrees * Hug ankle under arm and grab proximal tibia with both hands - Good test because 2 planar and doesn’t hurt them * Valgus and compressive force-trying to take patella to contralateral ASIS - Go fly fishing - Normal knee will see nice smooth motion - Abnormal knee gives wiggle/wabble - Like pivot shift but less aggressive, positive test is subluxation of femur on fixed tibia

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5
Q

response

Anterior drawer

A

If tibia subluxates forwards, you know it’s an ACL tear

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6
Q

How to perform

Recurvatum

A

Pt. supine, stabilized the distal femur with one hand, grab ankle with other hand Pull up on ankle, trying to hyperextend knee 3 times 10 degrees is normal amount of recurvatum

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7
Q

indications

Apley’s Compression and Dynamic Compression (DDV)

A
  1. *History of macrotrauma 2. *Twisting MOI 3. *Delayed effusion (over 12 hours) 4. *Reproducible click/clunk 5. *Pseudo locking 6. *Joint line pain
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8
Q

What test is for meniscus and PCL?

A

Recurvatum (Laxity -> PCL/posterior capsule; palpate over joint [prob reprod of symptoms] -> anterior horns of meniscus).

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9
Q

How to perform

Recurvatum for Meniscus

A

Pt. supine, stabilized the distal femur with one hand and PALPATE JOINT, grab ankle with other hand Pull up on ankle, trying to hyperextend knee-3 times 10 degrees is normal amount of recurvatum Same as PCL recurvatum test except palpate joint line

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10
Q

implications

PMRI

A

Post 1/3 med. Cap., PMOL (some say this can’t happen with PCL intact) PCL must be intact to perform the test

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11
Q

response

Recurvatum

A

10_ is normal amount of recurvatum

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12
Q

response

Active Tracking OKC

A

Patella should move through a C (right) or reverse C shape (left). Not good if it goes laterally at top especilly

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13
Q

test category

Medial/Lateral patellar glides

A

Patello-Femoral

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14
Q

response

Lachman’s Test

A

Positive test is > 3mm translation and an empty end feel or lack of capsular end feel o Normally you feel a clunk where the ACL stops the tibia from moving

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15
Q

test category

fluid wave test

A

Effusion (intra-articular swelling)

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16
Q

response

Flexion Rotation Drawer (FRD)

A

Normal knee will see nice smooth motion - Abnormal knee gives wiggle/wabble - Like pivot shift but less aggressive - positive Test is subluxation of femur on fixed tibia

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17
Q

How to perform

Moving Patellar Apprehension test.

A

Two parts (first part must be + to move to part 2): pt supine, leg off table. 1) Use thumb to Manually glide patella laterally with knee Extended and passivly Flex to 90 degrees with Patella. Check for pt apprehension and pain. + Test: oral apprehension or quad apprehensive activation 2) Repeat with medial glide. + is No apprehension allowin full ROM

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18
Q

How to perform

ALRI

A

pt supine: knee flexed < 90 degrees (80-70 good) Same as Anterior drawer, except tibia is IR

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19
Q

indications

Medial/Lateral tilts

A

all patients

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20
Q

test category

Recurvatum

A

PCL

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21
Q

How to perform

Pivot shift

A

pt supine, knee 0-80 degrees * Grab under heel and flex hip * Thumb under fibular head, fingers to ceiling, palm on lateral joint line - 2 planar instability: tibia moves anteriorly and internally rotates * give valgus force and flex knee in one quick motion - move to about 60 degrees knee flexion * keep foot neutral

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22
Q

How to perform

Jerk test

A

pt supine, knee flexed 80-0 degrees pt supine, opposite of pivot shift - from knee flexion of about 60 degrees, after performing pivot shift, return leg to table with same valgus force: * Thumb under fibular head, fingers to ceiling, palm on lateral joint line * give valgus force and extemd knee in one quick motion, from about 60 degrees knee flexion * keep foot neutral

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23
Q

How to perform

Apley’s Distraciton test and Apleys Dynamic Distraction Test (DDV)

A

* Pt prone, knee flexed 90 degrees * Both hands proximal to malleoli, counterforce with your knee on top of their thigh * Distract and externally rotate to tighten MCL ligaments (internally rotate to tighten LCL) Apley’s Dynamic Distraction - repeat test as above but take through ROM to extension and back three times each in ER and IR

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24
Q

test category

Sag Test

A

PCL

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25
# indications Anterior drawer
1. History of macrotrauma including twisting, deceleration MOI \* 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn't let quads fire normally \* Not always due to a ligament instability issue \* Can also be related to arthritis 3. Hear a 'pop' during MOI 4. Intra articular effusion \* ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
26
# test category McMurray's Test
Meniscus
27
# test category Valgus stress
Collateral Ligaments
28
# indications Dynamic McMurray's Test
1. \*History of macrotrauma 2. \*Twisting MOI 3. \*Delayed effusion (over 12 hours) 4. \*Reproducible click/clunk 5. \*Pseudo locking 6. \*Joint line pain
29
# indications Pivot shift
1. History of macrotrauma including twisting, deceleration MOI \* 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn't let quads fire normally \* Not always due to a ligament instability issue \* Can also be related to arthritis 3. Hear a 'pop' during MOI 4. Intra articular effusion \* ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
30
# implications Apley's Compression and Dynamic Compression (DDV)
Compression without dynamic component: Meniscus-post. horns Dynamic Compression: Meniscus-entire
31
# indications PLRI
(PCL must be intact to perform the test) 1. History of macrotrauma including twisting, deceleration MOI \* 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn't let quads fire normally \* Not always due to a ligament instability issue \* Can also be related to arthritis 3. Hear a 'pop' during MOI 4. Intra articular effusion \* ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
32
# test category Posterior Drawer
PCL
33
# implications Clancy step-up test
PCL
34
# indications PMRI
(PCL must be intact to perform the test) 1. History of macrotrauma including twisting, deceleration MOI \* 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn't let quads fire normally \* Not always due to a ligament instability issue \* Can also be related to arthritis 3. Hear a 'pop' during MOI 4. Intra articular effusion \* ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
35
# How to perform AMRI
pt supine: knee flexed \< 90 degrees (80-70 good) Same as Anterior drawer, except tibia is ER
36
# How to perform Lachman's Test
pt supine, knee flexed 30 degrees \* Elbows on iliac crests-2 clamps (I thought it was 1 elbow) - Proximal clamp on distal femur stays still - Distal clamp on proximal tibia moves it anteriorly - Positive test is \> 3mm translation and an empty end feel or lack of capsular end feel o Normally you feel a clunk where the ACL stops the tibia from moving
37
# test category Apley's Compression and Dynamic Compression (DDV)
Meniscus
38
# test category Milking test
Effusion (intra-articular swelling)
39
# implications Milking test
Intra articular effusion
40
# implications Recurvatum for Meniscus
Meniscus-ant. Horns (much less common than posterior horns, but you don't want to miss it)
41
# implications AMRI
Mid 1/3 med. Cap.
42
# implications Moving Patellar Apprehension test.
Noncontractile tissue, patellar groove patellar dislocation or instability
43
# test category Moving Patellar Apprehension test.
Patello-Femoral
44
# indications Clancy step-up test
1. \*History of macrotrauma 2. \*Hyperextension injury 3. \*Fall on anterior tibia with ankle in plantarflexion 4. \*Intra articular effusion 5. \*Suspected ACL
45
# How to perform Medial/Lateral tilts
pt supine, knee at 0 degrees (take out the pillow!!). Glide patella slightly in the direction it is to be tilted in order to get fingers under the edge. Try to tilt the patella. Tilt is referenced to the direction the tip of the patella leans toward
46
# implications Varus stress
0 degrees is LCL,ACL,PCL, PLC (posterior lateral corner-arcuate ligament complex, devistating injury) 30 degrees is just LCL (0 degrees-55%) (30 degrees-69%)
47
# implications Jerk test
ACL, middle 1/3 of lateral capsule
48
# test category Flexion Rotation Drawer (FRD)
ACL
49
# response Apley's Distraciton test and Apleys Dynamic Distraction Test (DDV)
Reproduction of Symptoms? MCL (+ with Internal rotation) LCL (+ with external rotation)
50
# implications fluid wave test
Intra articular effusion
51
# implications Active Tracking CKC
Contractile and non-contractile tissue. if there is chondral damage, you want to avoid that area in rehab by doing short arc exercises. 3rd squat: checking peri-patellar soft tissue for Hoffa's syndrome, Tendinitis -osis, Retinacular neuroma (hard nodules), Plica syndrome (snapping), poplitial tendonitis, ITB syndrome.
52
# test category Ballotment Test
Effusion (intra-articular swelling)
53
# indications Dial Test
1. History of macrotrauma including twisting, deceleration MOI \* 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn't let quads fire normally \* Not always due to a ligament instability issue \* Can also be related to arthritis 3. Hear a 'pop' during MOI 4. Intra articular effusion \* ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
54
# response Medial/Lateral patellar glides
Normal is moving two quadrants, more is hypermobile, less is hypomobile.
55
# indications Cephalic/Caudal glides
all patients
56
Effusion Tests (3)
1. Milking 2. Fluid Wave 3. Ballotment
57
# test category Cephalic/Caudal glides
Patello-Femoral
58
# test category Active Tracking CKC
Patello-Femoral
59
what is an ACL "coper"? How do you know? And what does it mean for them in rehab?
\* If pt can prevent you from doing pivot shift (meaning they can control their knee motion) it can mean they have good neuro-motor control and are a coper: they can do low level activities w/o surgical reconstruction \* If pt prevents you from doing it and they cant control it, they are a non-coper and won't do well with nonsurgical rehab
60
# response Apley's Compression and Dynamic Compression (DDV)
\* Looking for replication of joint line pain, maybe some snapping, cracking, clicking, clunking, pseudocatching, locking
61
# response Dynamic McMurray's Test
Davies original article states it doesn't matter what way you rotate the tibia because you are affecting both sides of the joint so just look for symptom replication, clicking/clunking, psudocatching/locking
62
# response Passive Tracking
Patella should move through a C (right) or reverse C shape (left). Not good if it goes laterally at top especilly
63
# response McMurray's Test
reproduction of symptoms: clicking/clunking, psudocatching/locking
64
ACL tests (6 general)
1. Anterior Drawer 2. Rotary Instabilities * ALRI * PLRI * AMRI * PMRI * Dial?? 3. Lachman's 4. Pivot Shift 5. Jerk 6. Flexion Rotation Drawer (FRD)
65
# test category Apley's Distraciton test and Apleys Dynamic Distraction Test (DDV)
Collateral Ligaments
66
# test category Jerk test
ACL
67
# test category Active Tracking OKC
Patello-Femoral
68
# indications (critical pathways) Milking test
History of macro trauma, patient complains of stiffness, observation of swelling, increased anthropometric measurements
69
# response Pivot shift
reproduction of symptoms (this one is painful and scary because it reproduces MOI). Try not to do it unless necessary. Clunking (as knee subluxates)
70
# implications Recurvatum
PCL/Posterior capsule
71
# test category Steinman's test
Meniscus
72
besides indications list, when should we use Apley's Compression and Apley's Dynamic Comprassion (DDV) tests?
Use only if we can't figure out what is going on with meniscus.
73
# response AMRI
abnormal: anterior subluxation of the medial side of tibia
74
# How to perform Apley's Compression and Dynamic Compression (DDV)
pt is prone 1) Apley's Compression: posterior horns \* Flex knee 90 degrees, hands over calcaneous \* Compress, internally and externally rotate it 3 times \* Looking for replication of joint line pain, maybe some snapping, cracking, clicking, clunking, pseudocatching, locking 2) Apley's Dynamic Compression (DDV) \* Make sure you put a towel/pillow or something under the patella so it isn't being crushed by the table \* Same positioning as previous test \* Compress, externally rotate, and take knee into full extension-3 times \* Repeat with internal rotation
75
# indications AMRI
(PCL must be intact to perform the test) 1. History of macrotrauma including twisting, deceleration MOI \* 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn't let quads fire normally \* Not always due to a ligament instability issue \* Can also be related to arthritis 3. Hear a 'pop' during MOI 4. Intra articular effusion \* ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
76
# How to perform Clancy step-up test
Pt supine Flex knee
77
# How to perform Valgus stress
pt supine, perform with knee at 0 and at 30 degrees flexion Stand on outside of the leg. position it so the joint line is at your closest thigh. Face foot. If they have some recurvatum, back of to neural (0 degrees) for 0 degree test, don't test them in hyperextension 1) Valgus stress test (0 degrees): \* Keep their thigh on table, put your thigh on their lateral joint line \* Palpate medial joint line with one hand and grab distal tibia with other \* Close joint first, give 3 valgus stresses - Rhythm should be: close-open, close-open, close-open \* Not much happens because this is closed packed position 2) Valgus stress (30 degrees): \* Flex knee to 30 degrees _ make sure their knee can flex off the edge of the table so calf is not hitting table \* Same thing as 0 degrees but flexed to 30 degrees \* Hardest thing is to keep their hip from rotating
78
# implications Pivot shift
ACL, middle 1/3 of lateral capsule
79
# indications Recurvatum for Meniscus
1. \*History of macrotrauma 2. \*Twisting MOI 3. \*Delayed effusion (over 12 hours) 4. \*Reproducible click/clunk 5. \*Pseudo locking 6. \*Joint line pain
80
# response Valgus stress
reproduction of symptoms, pain, gapping??
81
# response Active Tracking CKC
1st squat: looking to see what entire kinetic chain is doing 2nd squat, check for true chondral involvement-put finger right over patella to feel for crunching/grinding 3rd squat, make diamond over patella, palpate peri-patella soft tissue
82
Why did we learn the Dial test?
It is being used more and more common in clinics. We should use the other four rotary instability tests we learned.
83
# How to perform Sag Test
Pt supine Flex knee
84
# response Dial Test
Externally rotate at feet and you are looking for one side to ER proportionally more than the other side o Then it shows that the posterior part of the tibial plateau is subluxating back into the area where the arcuate ligament is o If that is injured, the tibia will subluxate into that weak area that is loose Looking for same sign during part 1 and 2 o This is a positive test
85
# test category Pivot shift
ACL
86
# indications fluid wave test
History of macro trauma, patient complains of stiffness, observation of swelling, increased anthropometric measurements
87
FRD
Flexion Rotation Drawer Test
88
# indications Active Tracking OKC
all patients
89
# indications McMurray's Test (6)
1. History of macrotrauma 2. Twisting MOI 3. Delayed effusion (over 12 hours) 4. Reproducible click/clunk 5. Pseudo locking 6. Joint line pain
90
# How to perform Varus stress
pt supine, perform with knee at 0 and at 30 degrees flexion Stand between leg and table. position it so the joint line is at your closest thigh. Face foot. If they have some recurvatum, back of to neural (0 degrees) for 0 degree test, don't test them in hyperextension 1) Varus stress (0 degrees): - Want to prevent their leg from rolling up your thigh \* Palpate inferior pole of patella and slide finger laterally to be over lateral joint line - Palpate with index finger and use other fingers to support the leg since it is off the table more with this test - Other hand grabbing ankle wherever is comfortable \* With knee in full extension, close the joint first, then give varus stress until you feel the end feel and let if spring back, you should feel/see it clunk back in a normal knee (hysteresis)-repeat 3 times - Everybody has physiologic laxity on lateral side so watch it close 2) Varus stress at 30 degrees - same as at 0 degrees but be more careful to prevent hip rotation
91
# implications Apley's Distraciton test and Apleys Dynamic Distraction Test (DDV)
MCL (+ with Internal rotation) LCL (+ with external rotation)
92
# response Jerk test
reproduction of symptoms (this one is painful and scary because it reproduces MOI). Try not to do it unless necessary. Clunking (as knee subluxates)
93
# response Milking test
pain and obvious fluid?
94
PCL Tests (4)
1. recurvatum 2. sag test 3. clancy step-up 4. posterior drawer
95
which two tests reproduce the MOI and should be avoided if possible?
pivot shift and jerk tests
96
# implications PLRI
Post 1/3 lat cap., Arcuate complex
97
# implications Sag Test
PCL (If PCL torn, tibia will sag posteriorly due to gravity _ will see a concavity from inferior pole of patella to tibial tuberosity)
98
# implications Active Tracking OKC
Contractile tissue, patellar groove
99
# How to perform Passive Tracking
pt in dependant position. Watch patella movement as you passivly move pt's knee through ROM. Stay at eye level and watch only one spot.
100
# response Medial/Lateral tilts
normal is about 15 degrees of tilt (referenced to the table)
101
# implications Lachman's Test
ACL (gold standard test, pathoneumonic)
102
Patello-femoral tests (7)
1. medial/lateral glides 2. cephalic/caudal glides 3. medial/lateral tilts 4. passive tracking 5. active tracking OKC 6. active tracking CKC 7. moving patellar apprehension test
103
# implications Ballotment Test
Intra articular effusion
104
# test category Dynamic McMurray's Test
Meniscus
105
# indications Lachman's Test
1. History of macrotrauma including twisting, deceleration MOI \* 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn't let quads fire normally \* Not always due to a ligament instability issue \* Can also be related to arthritis 3. Hear a 'pop' during MOI 4. Intra articular effusion \* ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
106
# implications Medial/Lateral patellar glides
Medial/Lateral retinaculum (superficial fibers)
107
# indications Moving Patellar Apprehension test.
all patients
108
# How to perform McMurray's Test
pt supine \* Flex hip to 90 degrees \* GENTLY flex knee fully (depends on how much ROM they have due to pain and swelling) \* Palpating over joint line \*internally and externally rotate tibia on femur 3 times in each directions
109
# implications Medial/Lateral tilts
Medial/Lateral retinaculum (deep fibers)
110
# indications Active Tracking CKC
all patients
111
# indications Jerk test
1. History of macrotrauma including twisting, deceleration MOI\* 80% or more of ACL injuries are non-contact2. Giving way-could be effusion creating an arthrogenic inhibition that doesn't let quads fire normally\* Not always due to a ligament instability issue\* Can also be related to arthritis3. Hear a 'pop' during MOI4. Intra articular effusion\* ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
112
# test category PMRI
ACL - Rotary Instabillities
113
# How to perform PMRI
pt supine: knee flexed \< 90 degrees (80-70 good) Same as Posterior drawer, except tibia is ER
114
# test category ALRI
ACL - Rotary Instabillities
115
# response Moving Patellar Apprehension test.
Part 1: + Test: oral apprehension or quad apprehensive activation Only do part 2 if part one is + Part 2: + is No apprehension allowin full ROM
116
# How to perform Steinman's test
pt supine\* Flex hip to 90 degrees\* GENTLY flex knee fully (depends on how much ROM they have due to pain and swelling)\* Palpating over joint line\* 3 gentle overpressures-looking for replication of symptoms
117
# indications Posterior Drawer
1. \*History of macrotrauma 2. \*Hyperextension injury 3. \*Fall on anterior tibia with ankle in plantarflexion 4. \*Intra articular effusion 5. \*Suspected ACL
118
Collateral Ligament tests (3 general)
1. Valgus stress (at 0 and 30 degrees) 2. Varus stress (at 0 and 30 degrees) 3. Apley's Distraction and Apley's Dynamic Distraction (DDV)
119
# How to perform Dial Test
pt position supine. Part 1: \* Flex patients knees to less than 80\* (helps if someone can hold them but you don't really need that) \* have pt keep heels together and let feet ER. One more than the other implicates that side Part 2: (often times when there is a posterior lateral corner injury, you also have a concomitant PCL injury) hen need to test for PCL o Restest with knees at 90\* With the knees at 90\*, the PCL is tightened o If the same side goes further into ER, not only does that implicate posterior lateral corner and arcuate ligament complex but PCL as well
120
# indications ALRI
(PCL must be intact to perform the test) 1. History of macrotrauma including twisting, deceleration MOI \* 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn't let quads fire normally \* Not always due to a ligament instability issue \* Can also be related to arthritis 3. Hear a 'pop' during MOI 4. Intra articular effusion \* ACL supplied by genicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
121
# implications Cephalic/Caudal glides
infrapatellar tendon. Quadriceps tendon
122
# test category Lachman's Test
ACL
123
# indications Passive Tracking
all patients
124
# response Sag Test
If PCL torn, tibia will sag posteriorly due to gravity. will see a concavity from inferior pole of patella to tibial tuberosity
125
# How to perform fluid wave test
pt supine, knee in 30 degrees of flexion. Keep hand in place after last milking test. And sweep fingers of other hand over spot on each side of the knee cap, alternating sides.
126
Meniscus Tests (4 general)
1. Recuratum 2. Steinman's test 3. McMurray's and Dynamic McMurray's 4. Apley's Compression and Apley's Dynamic Compression (DDV)
127
# implications Anterior drawer
ACL (Anterior medial bundle - AMB)
128
# indications Ballotment Test (4)
1. History of macro trauma, 2. patient complains of stiffness, 3. observation of swelling, 4. increased anthropometric measurements ## Footnote (Effusion indications)
129
# response Clancy step-up test
distal end of femur should feel 10mm away from plateau of tibia (should be a 10mm step up of the tibia toward you relative to the distal end of femur)
130
# implications Valgus stress
0 degrees is MCL,ACL,PCL, PMOL 30 degrees is just MCL (0 degrees-57%) (30 degrees-78%)
131
# How to perform PLRI
pt supine: knee flexed \< 90 degrees (80-70 good) Same as Posterior drawer, except tibia is IR
132
# test category AMRI
ACL - Rotary Instabillities
133
# test category Anterior drawer
ACL
134
# How to perform Anterior drawer
Pt supine Flex knee s an ACL tear
135
# response PLRI
abnormal: posterior subluxation of the lateral side of tibia
136
# implications Dynamic McMurray's Test
entire meniscus from posterior horn, to middle, to anterior horn
137
# test category Recurvatum for Meniscus
Meniscus
138
# indications Flexion Rotation Drawer (FRD)
1. History of macrotrauma including twisting, deceleration MOI \* 80% or more of ACL injuries are non-contact 2. Giving way-could be effusion creating an arthrogenic inhibition that doesn't let quads fire normally \* Not always due to a ligament instability issue \* Can also be related to arthritis 3. Hear a 'pop' during MOI 4. Intra articular effusion \* ACL supplied by ganicular artery so if you tear it mid-substance it bleeds like mad and get effusion within 24 hours-hemarthrosis
139
# implications Posterior Drawer
PCL Acute PCL tears are often missed because people don't do first 3 tests and tibia is already sagged back so it doesn't move during the posterior drawer test \* Chronic PCL tears-secondary restraints (capsule) become loose so, even though the tibia is already sagged back, as you push back there will be more give in the joint
140
# response Steinman's test
reproduction of symptoms: clicking/clunking, psudocatching/locking
141
# implications Dial Test
Post 1/3 lat cap., Arcuate complex Part 2: PCL too
142
# response Recurvatum for Meniscus
reproduction of symptoms?: clicking/clunking, psudocatching/locking pain?
143
# test category Medial/Lateral tilts
Patello-Femoral
144
# response Cephalic/Caudal glides
only cephalic has norm: 10mm.
145
# indications Valgus stress
1. \*MOI-macrotraumatic injury with twisting 2. \*MOI-history of frontal plane macrotrauma 3. \*Localized edema without intra articular effusion 4. \*Localized pain over collateral ligaments
146
# How to perform Medial/Lateral patellar glides
pt position, supine, knee flexed to 30 degrees. Place hands superior and inferior to patella. Use thumbs to produce medial glide and fingers to produce lateral glide (perform 3 times)
147
Rotary Instability Tests (5)
1. ALRI 2. PLRI 3. AMRI 4. PMRI 5. Dial
148
# indications Varus stress
1. \*MOI-macrotraumatic injury with twisting 2. \*MOI-history of frontal plane macrotrauma 3. \*Localized edema without intra articular effusion 4. \*Localized pain over collateral ligaments
149
# indications Apley's Distraciton test and Apleys Dynamic Distraction Test (DDV)
(perform this test if other tests for collateral ligaments are equivocal) 1. \*MOI-macrotraumatic injury with twisting 2. \*MOI-history of frontal plane macrotrauma 3. \*Localized edema without intra articular effusion 4. \*Localized pain over collateral ligaments
150
# How to perform Active Tracking OKC
pt in dependant position. Watch patella movement as pt extends/flexes knee through ROM. Stay at eye level and watch only one spot.
151
# implications Steinman's test
posterior horns of meniscus (most common problem)
152
# How to perform Cephalic/Caudal glides
pt supine, knee flexed to 30 degrees. Use thumb web to puch knee cap distally three times, then the opposite hand to push it proximally. KEEP ELBOW DOWN on leg: you could hurt the infrapatellar fat pad or something above the knee cap
153
# How to perform Milking test
pt position: supine, knee in 30 degrees of flexion. Use wrist crease to find edge of superior joint capsule. Gently sweep hand down to knee cap (like you are milking fluid down) three times.
154
# How to perform Ballotment Test
pt supine, knee in 30 degrees of flexion. Use two fingers to push on the patella straight towards the table, then release pressure. Do not take fingers off of the patella even when releasing pressure or you will not feel quality of spring back.
155
# test category PLRI
ACL - Rotary Instabillities
156
# How to perform Dynamic McMurray's Test
pt supine \* Start with hip and knee flexed to 90 degrees for both parts Part 1: \* Keep hand on heel, forearm on medial side of foot to externally rotate tibia \* Give valgus force with palm of one hand on lateral femoral epicondyle-fingers toward ceiling-and take knee from flexion to extension - Don't internally rotate hip - Rotate proximal hand as you bring them into extension to catch the leg - DO NOT let it clunk back to extension-that's a different test called clunk/bounce home Part 2: \* Opposite of part 1 \* Hand on heel, forearm on lateral side of foot to internally rotate tibia \* Give varus force to medial side of knee - Don't want to abduct the hip
157
# indications Steinman's test
1. \*History of macrotrauma 2. \*Twisting MOI 3. \*Delayed effusion (over 12 hours) 4. \*Reproducible click/clunk 5. \*Pseudo locking 6. \*Joint line pain
158
# indications Sag Test
1. \*History of macrotrauma 2. \*Hyperextension injury 3. \*Fall on anterior tibia with ankle in plantarflexion 4. \*Intra articular effusion 5. \*Suspected ACL
159
What order are the four main rotational instability tests usually positive in?
o ALRI- 1st most common o PLRI- 2nd most common o AMRI- 3rd most common o PMRI- least common
160
# How to perform Posterior Drawer
Pt supine Flex knee s a PCL tear
161
# implications ALRI
ACL Mid-1/3 lat. Cap.
162
# test category Varus stress
Collateral Ligaments
163
# response PMRI
abnormal: posterior subluxation of the medial side of tibia
164
# response fluid wave test
Pressure on one side will produce outpoutching on onther side if effusion is present.
165
# response Varus stress
repod of symptoms? Pain, gapping??
166
# test category Dial Test
Rotational Instabilities
167
# test category Clancy step-up test
PCL
168
# response ALRI
abnormal: anterior subluxation of the lateral side of tibia
169
# How to perform Active Tracking CKC
Instruct pt to do squat to assess weight bearing active tracking. Make sure they step away from table. Do not specify how, just however they decide to do a squat and observe how they do it:( 1st squat: looking to see what entire kinetic chain is doing 2nd squat, check for true chondral involvement - put finger right over patella to feel for crunching/grinding if there is chondral damage, you want to avoid that area in rehab by doing short arc exercises? 3rd squat, make diamond over patella (palpate peri-patella soft tissue )
170
# implications Flexion Rotation Drawer (FRD)
): ACL, middle 1/3 of lateral capsule
171
# implications McMurray's Test
posterior horns of meniscus (most common problem)
172
TF: Meniscus tear could happen just from ADLs?
true. Especially in older folks.
173
# test category Passive Tracking
Patello-Femoral
174
# response Posterior Drawer
If tibia subluxates back, you know it's a PCL \* Acute PCL tears are often missed because people don't do first 3 tests and tibia is already sagged back so it doesn't move during the posterior drawer test Chronic PCL tears-secondary restraints (capsule) become loose so, even though the tibia is already sagged back, as you push back there will be more give in the joint
175
what is the gold standardr ACL special test?
Lachman's
176
# response Ballotment Test
can tell if there is effusion based on the feel of the bounce back
177
8 Rules of Rotary instability test interpretation
1. PCL is intact and serves as the axis of rotation 2. Properly position the knee into IR or ER to selectively bias the tissues 3. Force is applied in a straight sagittal plane 4. Direction of applied force 5. Which tibial plateau translates in the direction of the applied force 6. Names the rotary instability 7. Anterior rotary instabilities are actually named opposite of the true rotation 8. Posterior rotary instabilities are actually named same as the true rotation
178
# indications Recurvatum, not for meniscus (5)
1. History of macrotrauma 2. Hyperextension injury 3. Fall on anterior tibia with ankle in plantarflexion 4. Intra articular effusion 5. Suspected ACL ## Footnote (PCL indications)

PHTH 7232 Ortho (21 decks)

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