Purpose of the knee special tests

Valgus Stress Test at 30°

Patient is supine & their leg is in 30o of flexion. A valgus force is then applied using caudad and cephalad hands. Physician's caudad hand is applying an abductive force at the distal leg, while the cephalad hand is applying an adductive force to the thigh. A positive test is one that increases the valgus position of the knee, due to increased joint movement; there is also the absence of a firm end-feel

Varus Stress Test at 30°

Patient is supine & their leg is in 30o of flexion. A varus force is then applied using caudad and cephalad hands. Physician's caudad hand is applying an adductive force at the distal leg, while the cephalad hand is applying an abductive force to the thigh. A positive test is one that increases the varus position of the knee due to increased joint movement; there is also the absence of a firm end-feel

Posterior Drawer Test

Patient is supine. Patient's thigh is flexed to 45o and leg is flexed to 90o. Physician is seated at the patients feet (so the flexed knee will not slide). Physician, with both hands, grasps the proximal tibia (anteriorly, posteriorly, laterally & medially). The tibia is then translated posteriorly relative to the femur. A positive test is one where the tibia translates posteriorly excessively or there is not a firm stop or so called "end- feel" (compare to other knee if possible)

Patellar Compression Test

Patient is supine. Physician takes hold of the patella and compresses it posteriorly. With the patella compressed inferior, superior, medial and lateral motions are tested. Pain or crepitus elicited in any of these directions is a positive test.

McMurray Lateral Meniscus Test

Patient is supine. Physician's caudad hand is placed on the patient's heel and the cephalad hand is placed over the knee, monitoring the lateral joint space. The patient's thigh and leg are hyperflexed, a varus force (adduction of the leg) is introduced, the foot is internally rotated and the thigh and leg are extended. A positive test would be pain or a palpable and/or audible click upon thigh/leg extension.

McMurray Medial Meniscus Test

Patient is supine. Physician's caudad hand is placed on the patient's heel and the cephalad hand is placed over the knee, monitoring the medial joint space. The patient's thigh and leg are hyperflexed, a valgus force (abduction of the leg) is introduced, the foot is externally rotated and the thigh and leg are extended. A positive test would be pain or a palpable and/or audible click upon thigh/leg extension

Patellar Apprehension (Dislocation) Test ) Patellofemoral Mechanism

Patient is supine. Physician's cephalad hand brings the patient's knee into 30o of flexion (to relax the quadriceps muscle). Physician's caudad hand then attempts to dislocate the patella in medial and lateral directions. Positive test is significant pain associated with this motion or verbal/non-verbal apprehension (in anticipation of dislocation or pain)

Is there fluid in the knee joint? Palpate/observe to determine if there is fluid (effusion) in the knee joint. These tests don't tell you why there is fluid in the knee joint.

1) Ballottement of patella 2) Bulge sign

Anterior Drawer Test

ACL Patient is supine. Patient's thigh is flexed to 45o and leg is flexed to 90o. Physician is seated at the patients feet (so the flexed knee will not slide). Physician, with both hands, holds the proximal tibia (anteriorly, posteriorly, medially, and laterally). The tibia is then translated anteriorly relative to the femur. A positive test is one where the tibia translates anteriorly excessively or there is not a firm stop or so called "end-feel" (compare to other knee if possible)

4 ligaments of the knee

ACL, PCL, MCL, LCL

Bulge sign

Occurs with very small amounts of effusion, 4-8 ml, from fluid flowing across the joint within the suprapatellar pouch. Assessed by firmly stroking up the medial aspect of the knee 2-3 times to displace any fluid, tapping the lateral aspect, and watching the medial side in the hollow for a distinct bulge from a fluid wave Patient is supine. The idea with this test is we are moving fluid from the anterior compartment of the distal thigh to the knee region. Then we are applying a force on the medial side of the knee, which will move the fluid to the lateral aspect of the knee. A lateral to medial pressure is then applied to the lateral aspect of the knee. A positive sign is one where you see a "fluid ripple" on the medial side of the knee with lateral to medial pressure. A false negative can be present if there is significant tension with the effusion.

Apley Compression Test

Patient is prone and their leg is flexed to 90o. A compressive force is applied longitudinally along the tibia, followed by internal and external rotation of the tibia. A positive test would illicit pain at the medial and/or lateral joint space of the knee.

Apley Distraction Test

Patient is prone and their leg is flexed to 90o. A distractive force is applied longitudinally along the tibia (stabilize with hand), followed by internal and external rotation of the tibia. A positive test would illicit pain at the medial and/or lateral joint space of the knee.

Patellar Grind/Crepitus Test

Patient is supine. Physician's cephalad hand contacts the thigh a few inches above the knee and exerts a sliding posteroinferior force towards the patella. After this motion is repeated a few times the physician then contacts the patella with thumb and index finger around its superior border (again with cephalad hand). A posterior force is applied to the patella (against the femur) and patient is asked to contract their quadriceps. Pain, crepitus, or grinding at the patella is a positive test.

Lachman Test

Similar to anterior drawer test, however patient's leg is kept in 20-30o of flexion. Important to stabilize the distal femur More sensitive and specific than the anterior drawer test!

Anterior Fibular Head Dysfunction

The fibular head moves anterolaterally during pronation of the foot (dorsiflexion, eversion, and external rotation). Where is the restriction in an anterior fibular head dysfunction?

Posterior Fibular Head Dysfunction

The fibular head moves posteromedially during supination of the foot (plantarflexion, inversion, and internal rotation). Where is the restriction in a posterior fibular head dysfunction?

The Sag Sign

The tibia is shifted posteriorly (by gravity) due to possible posterior cruciate ligament injury.

ballottement of patella

if fluid has collected, tap on the patella will be heard against femoral condyle Patient is supine. Physician's cephalad hand contacts the patella and a posterior motion is utilized. A positive ballottement test is where you "feel the patella swimming in space."