physical therapy exam- knee special tests – Flashcards
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lachman's stress test identifies?
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integrity of ACL
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how do you perform lachmans
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Pt supine with knee placed at 20-30 degrees flexed then glide tibia anteriorly while stabilizing femur
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pivot shift (or anterolateral rotary instability) identifies what?
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ACL integrity
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how do you perform a pivot shift test?
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patient supine with testing knee in extension, hip flexed and abducted 30 degrees with slight IR. hold knee with one hand and foot with other hand. place valgus force through knee and flex knee.
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what is a positive finding of this test?
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ligament laxity as indicated by tibia relocating during the test. as knee is flexed, the tibia clunks backward at approximately 30 to 40 degrees. The tibia at beginning of test was subluxed, and then was reduced by pull of IT band as knee was flexed
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posterior sag test indicates what?
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integrity of PCL
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how do you perform a a posterior sag test
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patent supine with testing hip flexed to 45 and knee flexed to 90. observe to see whether tibia sags posteriorly
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what does the reverse lachman indentify
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integrity of PCL
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how do you perform a reverse lachman?
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patient prone with knees flexed to 30. stabilize femur and passively try to glide tibia posterior
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what does McMurray's test identify?
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meniscal tears
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how do you perform the McMurray's test?
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patient supine with testing knee in maximal flexion. passively IR and extend the knee. this tests lateral meniscus. Test medial meniscus with same procedure, except rotate tibia into lateral rotation
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what is a positive McMurray's test
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reproduction of click and/or pain in knee joint
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what does the apley test help differentiate between?
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meniscal tears and ligamentous lesions
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how do you perform the apley test?
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patient prone with testing knee flexed to 90. stabilize patient's thigh to table with your knee. Passively distract the knee joint, then slowly rotate tibia internally and externally. Next, apply a compressive load to knee joint and again slowly rotate tibia internally and externally
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what is a positive apley test?
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pain or decreased motion during compression indicates a meniscal dysfunction. If pain or increased motion occurs during the distraction then it is most likely a ligamentous dysfunction.
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what test identifies dysfunction of the plica?
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hughston's plica test
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how do you perform the hughston's plica test?
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patient is supine and testing knee is flexed with tibia IR. Passively glide the patella medially, while palpating the medial femoral condyle. feel for popping as you passively flex and extend the knee.
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what is a positive hughston's plica test?
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pain and/or popping noted during the test
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what does the patellar apprehension test indicate?
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past history of patella dislocation
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how do you perform a patellar apprehension test?
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patient supine, with patella passively glided laterally
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what is a positive patellar apprehension test?
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patient does not allow and/or does not like patella to move in lateral direction to simulate sublux or dislocation
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what does the clarke's sign identify?
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patellofemoral dysfunction
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how do you perform the clarke's sign?
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patient supine, with knee in extension resting on table. push posterior on superior pole of patella, then ask patient to perform an active contraction of the quads
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what is a positive clarke's sign?
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pain
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what does the ballotable patella (patellar tap test) identify?
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infrapatellar effusion
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how do you perform ballotable patella (patellar tap test)
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patient supine, with knee in extension resting on table. Apply a soft tap over the central patella
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what is a positive ballotable patella (patellar tap test)
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perception of the patella floating (dancing patella)
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what does the fluctuation test identify?
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knee joint effusion
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how do you perform the fluctuation test?
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patient supine, with knee in extension resting on table. Place one hand over suprapatellar pouch and other over anterior aspect of knee joint. alternate pushing down with one hand at a time
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what does the Q-angle measurement identify?
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measurement of angle between the quads and the patellar tendon
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what is a normal Q angle for men and for women?
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men: 13 women: 18
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if the Q angle is less than or greater than normal it may be indicative of what?
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knee dysfunction and/or biomechanical dysfunctions within the lower limb
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what does the noble compression test identify?
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whether distal IT band friction syndrome is present
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how do you perform the noble compression test?
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patient supine with hip flexed to 45 degrees and knee flexed to 90. apply pressure to lateral femoral epicondyle then extend knee
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what is a positive noble compression test?
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reproduces same pain over lateral femoral condyle. patient will complain of pain over lateral femoral epicondyle at approx 30 degrees of flexion
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Tinels sign is done where (knee)? and at what nerve?
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common fibular nerve; where it passes through posterior to fibula head
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what does the neutral subtalar positioning test identify?
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abnormal rearfoot to forefoot positioning
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how do you perform neutral subtalar positioning test?
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patient prone, with foot over edge of table. palpate dorsal aspect of talus on both sides with one hand, and grasp lateral forefoot with other hand. gently dorsiflex foot until resistance is felt, then gently move foot through arc of supination and pronation
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anterior drawer test of the ankle identifies what?
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ligamentous instability (particularly anterior talofibular ligament)
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how do you perform the anterior drawer test of the ankle?
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patient supine with heel just off edge of table in 20 degrees plantar flexion. stabilize lower leg and grasp foot. pull talus anterior
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what does the talar tilt identify?
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ligamentous instability (particularly calcaneofibular ligament)
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how do you perform the talar tilt?
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patient side-lying, with knee slightly flexed and ankle in neutral. Move foot into adduction testing calcaneofibular ligament and into abduction testing deltoid ligament
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what does the thompson's test evaluate?
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integrity of the achilles' tendon
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how do you perform the thompson's test?
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patient prine with foot off edge of table. squeeze calf muscle
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where do you perform the tinel's test in the ankle? and for what nerves?
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posterior tibial nerve: posterior to medial malleolus deep fibular nerve: anterior to talocrural joint
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what two things does a morton's test indentify?
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1. stress fracture 2. neuroma in foot
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how do you perform a morton's test
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patient supine, with foot supported on table. grasp around metatarsal heads and squeeze
