Knee Special Tests Flashcards Preview

PHTH 7232 Ortho > Knee Special Tests > Flashcards

Flashcards in Knee Special Tests Deck (178):
1

Anterior drawer

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

 

2

Passive Tracking

Noncontractile tissue, patellar groove

3

Medial/Lateral patellar glides

all patients

4

Flexion Rotation Drawer (FRD)

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

5

Anterior drawer

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

6

Recurvatum

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

7

Apley's Compression and Dynamic Compression (DDV)

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

8

What test is for meniscus and PCL?

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

9

Recurvatum for Meniscus

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

10

PMRI

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

11

Recurvatum

10_ is normal amount of recurvatum

12

Active Tracking OKC

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

13

Medial/Lateral patellar glides

Patello-Femoral

14

Lachman's Test

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

15

fluid wave test

Effusion (intra-articular swelling)

16

Flexion Rotation Drawer (FRD)

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

17

Moving Patellar Apprehension test.

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

18

ALRI

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

19

Medial/Lateral tilts

all patients

20

Recurvatum

PCL

21

Pivot shift

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

22

Jerk test

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

23

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

* 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

24

Sag Test

PCL

25

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

McMurray's Test

Meniscus

27

Valgus stress

Collateral Ligaments

28

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

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

Apley's Compression and Dynamic Compression (DDV)

Compression without dynamic component: Meniscus-post. horns Dynamic Compression: Meniscus-entire

31

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

Posterior Drawer

PCL

33

Clancy step-up test

PCL

34

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

AMRI

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

36

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

Apley's Compression and Dynamic Compression (DDV)

Meniscus

38

Milking test

Effusion (intra-articular swelling)

39

Milking test

Intra articular effusion

40

Recurvatum for Meniscus

Meniscus-ant. Horns (much less common than posterior horns, but you don't want to miss it)

41

AMRI

Mid 1/3 med. Cap.

42

Moving Patellar Apprehension test.

Noncontractile tissue, patellar groove patellar dislocation or instability

43

Moving Patellar Apprehension test.

Patello-Femoral

44

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

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

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

Jerk test

ACL, middle 1/3 of lateral capsule

48

Flexion Rotation Drawer (FRD)

ACL

49

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

Reproduction of Symptoms? MCL (+ with Internal rotation) LCL (+ with external rotation)

50

fluid wave test

Intra articular effusion

51

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

Ballotment Test

Effusion (intra-articular swelling)

53

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

Medial/Lateral patellar glides

Normal is moving two quadrants, more is hypermobile, less is hypomobile.

55

Cephalic/Caudal glides

all patients

56

Effusion Tests (3)

 

  1. Milking
  2. Fluid Wave
  3. Ballotment

 

57

Cephalic/Caudal glides

Patello-Femoral

58

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

Apley's Compression and Dynamic Compression (DDV)

* Looking for replication of joint line pain, maybe some snapping, cracking, clicking, clunking, pseudocatching, locking

61

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

Passive Tracking

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

63

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

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

Collateral Ligaments

66

Jerk test

ACL

67

Active Tracking OKC

Patello-Femoral

68

Milking test

History of macro trauma, patient complains of stiffness, observation of swelling, increased anthropometric measurements

69

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

Recurvatum

PCL/Posterior capsule

71

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

AMRI

abnormal: anterior subluxation of the medial side of tibia

74

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

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

Clancy step-up test

Pt supine Flex knee

77

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

Pivot shift

ACL, middle 1/3 of lateral capsule

79

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

Valgus stress

reproduction of symptoms, pain, gapping??

81

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

Sag Test

Pt supine Flex knee

84

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

Pivot shift

ACL

86

fluid wave test

History of macro trauma, patient complains of stiffness, observation of swelling, increased anthropometric measurements

87

FRD

Flexion Rotation Drawer Test

88

Active Tracking OKC

all patients

89

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

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

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

MCL (+ with Internal rotation) LCL (+ with external rotation)

92

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

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

PLRI

Post 1/3 lat cap., Arcuate complex

97

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

Active Tracking OKC

Contractile tissue, patellar groove

99

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

Medial/Lateral tilts

normal is about 15 degrees of tilt (referenced to the table)

101

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

Ballotment Test

Intra articular effusion

104

Dynamic McMurray's Test

Meniscus

105

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

Medial/Lateral patellar glides

Medial/Lateral retinaculum (superficial fibers)

107

Moving Patellar Apprehension test.

all patients

108

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

Medial/Lateral tilts

Medial/Lateral retinaculum (deep fibers)

110

Active Tracking CKC

all patients

111

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

PMRI

ACL - Rotary Instabillities

113

PMRI

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

114

ALRI

ACL - Rotary Instabillities

115

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

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

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

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

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

Cephalic/Caudal glides

infrapatellar tendon. Quadriceps tendon

122

Lachman's Test

ACL

123

Passive Tracking

all patients

124

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

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

Anterior drawer

ACL (Anterior medial bundle - AMB)

128

Ballotment Test (4)

  1. History of macro trauma,
  2. patient complains of stiffness,
  3. observation of swelling,
  4. increased anthropometric measurements

(Effusion indications)

129

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

Valgus stress

0 degrees is MCL,ACL,PCL, PMOL 30 degrees is just MCL (0 degrees-57%) (30 degrees-78%)

131

PLRI

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

132

AMRI

ACL - Rotary Instabillities

133

Anterior drawer

ACL

134

Anterior drawer

Pt supine Flex knee s an ACL tear

135

PLRI

abnormal: posterior subluxation of the lateral side of tibia

136

Dynamic McMurray's Test

entire meniscus from posterior horn, to middle, to anterior horn

137

Recurvatum for Meniscus

Meniscus

138

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

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

Steinman's test

reproduction of symptoms: clicking/clunking, psudocatching/locking

141

Dial Test

Post 1/3 lat cap., Arcuate complex Part 2: PCL too

142

Recurvatum for Meniscus

reproduction of symptoms?: clicking/clunking, psudocatching/locking pain?

143

Medial/Lateral tilts

Patello-Femoral

144

Cephalic/Caudal glides

only cephalic has norm: 10mm.

145

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

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

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

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

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

Steinman's test

posterior horns of meniscus (most common problem)

152

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

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

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

PLRI

ACL - Rotary Instabillities

156

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

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

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

Posterior Drawer

Pt supine Flex knee s a PCL tear

161

ALRI

ACL Mid-1/3 lat. Cap.

162

Varus stress

Collateral Ligaments

163

PMRI

abnormal: posterior subluxation of the medial side of tibia

164

fluid wave test

Pressure on one side will produce outpoutching on onther side if effusion is present.

165

Varus stress

repod of symptoms? Pain, gapping??

166

Dial Test

Rotational Instabilities

167

Clancy step-up test

PCL

168

ALRI

abnormal: anterior subluxation of the lateral side of tibia

169

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

Flexion Rotation Drawer (FRD)

): ACL, middle 1/3 of lateral capsule

171

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

Passive Tracking

Patello-Femoral

174

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

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

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

(PCL indications)