BIOMEDICINE: Muscular System | Orthopedic Tests for the Knee

Patient supine with involved knee flexed to 30° and supported by a pillow. Examiner places thumbs on medial side of patella and pushes it laterally. What is the test? a. Patellar Apprehension Test b. Dial test c. Posterior Sag Sign d. Patella Grind Test

Patellar Apprehension Test POSITIVE: patient feels patella is dislocating and expresses apprehension or contracts the quadriceps which is an indication of patella dislocation

Patient supine. Examiner supports both the ankle and slightly flexed knee. Remove support from the knee, allowing it to fall into extension. What is the test? a. Bounce Home test b. Balloon sign c. McMurray's sign d. Thessaly test

a. Bounce Home test POSITIVE: rubbery end feel on full extension or cannot extend the knee fully indicates meniscus injury

Patient seated w/ leg fully extended. Place left hand above knee and apply pressure on the suprapatellar pouch, "milking" fluid downward. Stroke downward on the medial aspect of the knee with one hand and apply pressure to force fluid into the lateral area. With the other hand, tap the knee just behind the lateral margin of the patella. What is the test? a. Bulge sign b. Lachman's test c. Balloon sign d. Patella Grind Test

a. Bulge sign POSITIVE: fluid wave or bulge on medial side of patella and the femur indicates minor knee effusion (excess fluid in knee)

Patient supine, you cup the patient's heels and lift their legs to 90 of flexion in hips and knees comparing the anterior profiles of both knees. What is the test? a. Godfrey test b. Dial test c. Patella Grind Test d. Waldron's (or Unilateral Squat) test

a. Godfrey test POSITIVE: Normal alignment of tibia is 10mm in front of femur. If displaced this indicates PCL insufficency

Patient supine. Grasp the heel and flex the knee. Cup the other hand over the joint w/ fingers and thumb along the medial joint line. MCL - apply a valgus (abduction) force to the knee while externally rotating the foot and passively extending the knee. LCL - apply a varus (adduction) stress during internal rotation of the foot and passive extension of the knee. What is the test? a. McMurray's sign b. Pivot Shift test c. Balloon sign d. Thessaly test

a. McMurray's sign POSITIVE: audible or palpable snap during extension indicates meniscal tear

The Posterior Drawer test assesses for a. PCL tear b. LCL tear c. MCL tear d. meniscus injury

a. PCL tear

The Posterior Sag sign assesses for a. PCL tear b. LCL tear c. MCL tear d. meniscus injury

a. PCL tear

The Thessaly test assesses for a. meniscal tear b. LCL tear c. tear in subscapularis tendon or subscapularis tendonitis d. PCL tear

a. meniscal tear

The Pivot Shift test assesses for a. PCL tear b. ACL or LCL injury c. MCL tear d. meniscus injury

b. ACL or LCL injury

Anterior Drawer test assesses for a. LCL tear b. ACL sprain (or instability) c. meniscus injury d. PCL tear

b. ACL sprain (or instability)

The Anterior Drawer test assesses for a. LCL tear b. ACL tear c. meniscus injury d. PCL injury

b. ACL tear

Slocum's test assesses for a. LCL tear b. ACL, LCL MCL instability c. meniscus injury d. PCL tear

b. ACL, LCL MCL instability

Patient supine w/ hips flexed and knees flexed to 90°. Cup your hands around the knee w/ thumbs on medial and lateral joint line and fingers on medial and lateral insertions of the hamstrings. Draw the tibia forward. What is the test? a. Slocum test b. Anterior Drawer test c. Pivot Shift test d. Lachman's test

b. Anterior Drawer test (or Slocum) POSITIVE: tibia slides forward (like a drawer) from under the femur indicates ACL tear

Patient prone w/ knee flexed to 90°. Grasp patient's ankle and place downward pressure while internally and externally rotating the flexed leg. What is the test? a. Thessaly test b. Apley's Compression test c. McMurray's sign d. Lachman's test

b. Apley's Compression test POSITIVE: pain on either side of the knee indicates meniscus injury

Patient prone w/ knee flexed to 90°. Grasp patient's ankle and pull up (distraction) while internally and externally rotating the leg. What is the test? a. Pivot Shift test b. Apley's Distraction test c. Apley's Compression test d. Lachman's test

b. Apley's Distraction test POSITIVE: pain on either side of the knee indicates ligament injury

Patient seated w/ leg fully extended. Place thumb and index finger of the right hand on each side of patella; with the left hand, compress the suprapatellar pouch against the femur. Feel for fluid entering the spaces next to the patella under your right thumb and index finger. What is the test? a. Patella Grind Test b. Balloon sign c. McMurray's sign d. Slocum test

b. Balloon sign POSITIVE: palpable fluid wave indicates major knee effusion (excess fluid in knee)

Patient seated w/ leg fully extended. Compress the suprapatellar pouch and push the patella sharply against the femur. What is the test? a. Apley's Compression test b. Balloting Patella test c. Balloon sign d. Pivot Shift test

b. Balloting Patella test POSITIVE: fluid returns to supra patellar pouch indicates major knee effusion (excess fluid in knee)

Patient prone, you flex the knees to 30° and externally rotate the legs; compare the extent of rotation of both limbs. You then flex the knees to 90° and repeat the external rotation and comparison of both limbs. What is the test? a. Godfrey test b. Dial test c. Patella Grind Test d. Waldron's (or Unilateral Squat) test

b. Dial test POSITIVE: an increase in external rotation at 90 of flexion and not at 30 indicates PCL

The Varus Stress (Adduction) test assesses for a. MCL tear b. LCL tear c. PCL tear d. meniscus injury

b. LCL tear

Patient supine w/ knee flexed to 15°. Stabilize the distal femur with one hand and grasps the proximal tibia in the other hand. Simultaneously pull the tibia forward and the femur back. What is the test? a. Patella Grind Test b. Lachman's test c. Apley's Compression test d. Posterior Drawer test

b. Lachman's test POSITIVE: lack of a clear end point indicates ACL injury

The Knee Abduction (valgus) Stress test assesses for a. ACL tear b. MCL tear c. PCL tear d. LCL tear

b. MCL tear

Patient supine w/ hips flexed and knees flexed to 90°. Cup your hands around the knee w/ thumbs on medial and lateral joint line and fingers on medial and lateral insertions of the hamstrings. Draw the tibia posteriorly. What is the test? a. Thessaly test b. Posterior Drawer test c. Patella Grind Test d. Slocum test

b. Posterior Drawer test POSITIVE: tibia slides backward (like a drawer) from under the femur indicates PCL tear

McMurray's sign assesses for a. MCL tear b. meniscal tear c. chondromalacia patella, chondral fracture, osteochondritis, prepatellar bursitis d. ligament injury

b. meniscal tear

Apley's Compression test assesses for a. tear in subscapularis tendon or subscapularis tendonitis b. meniscus injury c. major knee effusion d. ligament injury

b. meniscus injury

The Bulge sign assesses for a. tear in subscapularis tendon or subscapularis tendonitis b. minor knee effusion c. PCL injury d. LCL tear

b. minor knee effusion

Lachman's test assesses for a. LCL tear b. PCL tear c. ACL injury d. meniscus injury

c. ACL injury

The Dial test assesses for a. ACL tear b. major knee effusion c. PCL instability d. patellofemoral dysfunction | chondromalacia patellae

c. PCL instability

The Godfrey test assesses for a. ACL tear b. major knee effusion c. PCL instability d. patellofemoral dysfunction | chondromalacia patellae

c. PCL instability

Patient supine. Move the patella medially and laterally while pressing down. a. Slocum test b. Posterior Drawer test c. Patella Grind Test d. Balloon sign

c. Patella Grind Test POSITIVE: pain in patellofemoral joint indicates patellofemoral dysfunction (patellar chondromalacia - "runner's knee")

Patient supine with w/ hips flexed to 45° and knees flexed to 90°. This test can best be observed from the side by comparing the involved leg to the normal side. What is the test? a. Patellar Apprehension Test b. Dial test c. Posterior Sag Sign d. Patella Grind Test

c. Posterior Sag Sign POSITIVE: tibia "sags" posteriorly causing an indentation which indicates a PCL tear

Patient supine and knee slightly flexed. Move the thigh 30° laterally. Place one hand against the medial surface of knee and the other around the lateral ankle. Push laterally against the knee and pull medially at the ankle. What is the test? a. Thessaly test b. Pivot Shift test c. Knee Adduction (varus) Stress test d. Lachman's test

c. Varus Stress (Adduction) test POSITIVE: pain or gap in medial joint line indicates LCL tear

The Balloon sign assesses for a. tear in subscapularis tendon or subscapularis tendonitis b. ligament injury c. major knee effusion d. meniscus injury

c. major knee effusion

Bounce Home test assesses for a. LCL injury b. PCL tear c. meniscus injury d. ACL tear

c. meniscus injury

Patient supine. Fully extend the knee and rotate the foot internally. Apply a valgus (abduction) force while progressively flexing the knee. What is the test? a. Slocum test b. Apley's Compression test c. Posterior Drawer test d. Pivot Shift test

d. Pivot Shift test POSITIVE: clunk heard when performing maneuver indicates ACL or LCL injury

Patient stands on one leg while examiner provides his/her hands for balance. Patient flexes knee to 20° and rotates the femur on the tibia medially and laterally three times while maintaining 20° flexion. What is the test? a. McMurray's sign b. Pivot Shift test c. Patella Grind Test d. Thessaly test

d. Thessaly test POSITIVE: joint pain or sense of locking or catching in the knee indicates meniscal tear

Patient supine and knee slightly flexed. Move the thigh 30° laterally. Place one hand against the lateral knee and the other around the medial ankle. Push medially against the knee and pull laterally at the ankle. What is the test? a. Lachman's test b. Slocum test c. McMurray's sign d. Knee Abduction (valgus) Stress test

d. Valgus Stress (Abduction) test POSITIVE: pain or gap in medial joint line indicates MCL tear

Patient standing with feet separated approximately 12". You palpate the patella as they perform several slow deep squats (to about 90° if possible). What is the test? a. Godfrey test b. Dial test c. Patella Grind Test d. Waldron's (or Unilateral Squat) test

d. Waldron's (or Unilateral Squat) test POSITIVE:

Apley's Distraction test assesses for a. tear in subscapularis tendon or subscapularis tendonitis b. major knee effusion c. meniscus injury d. ligament injury

d. ligament injury

The Balloting Patella test a. tear in subscapularis tendon or subscapularis tendonitis b. meniscus injury c. LCL tear d. major knee effusion

d. major knee effusion

The Waldron's (or Unilateral Squat) test assesses for a. ACL tear b. major knee effusion c. PCL instability d. patellofemoral dysfunction | chondromalacia patellae

d. patellofemoral dysfunction | chondromalacia patellae

The Patella Grind Test assesses for a. tear in subscapularis tendon or subscapularis tendonitis b. ligament injury c. meniscus injury d. patellofemoral dysfunction (patellar chondromalacia)

d. patellofemoral dysfunction | chondromalacia patellae *NOTE* chondromalacia patella - aka "runner's knee" - cartilage on the undersurface of the patella deteriorates and softens