Knee Exam for dummies
Noble's Test
Testing: Assess the Iliotibial Band (IT Band) How: Patient is supine with knee flexed to approx 90 degrees. Examiner then applies pressure to the lateral femoral condyle or 1-2 cm proximal to it as the patient's knee is passively extended Positive Test: Patient complains of tenderness over the lateral femoral condyle at approx 30 degrees of flexion
Ober's Test
Testing: Assesses the Tensor fascia lata and iliotibial band tightness How: Patient lies on unaffected side with the unaffected knee and hip flexed. Examiner then places the affected knee to 90 degrees of flexion and then abducts and hyperextends the ipsilateral hip while stabilizing the pelvis then slowly lowers the thigh as far as possible Positive Test: Inability of the extremity to drop below horizontal to the level of the table indicates tightness in the fascia and IT band
McMurray Test
Testing: Meniscus tear in knee How: Pt supine with examiner at side of pt. One hand on heel while other is palpating joint line. - External rotation, valgus stress & slowing extending leg = Medial meniscus. - Internal rotation, varus stress and slowing extending knee = Lateral Meniscus. Positive Test: pop with associated pain
Pivot Shift Test
Testing: Used to assess dysfunction of the ACL-Usually with more severe Grade II or Grade III tears How: placing the knee in full extension and then slowly flexing the knee while the examiner applies a valgus stress and internal rotation. (Generally done under anesthesia) Positive Test:A subluxation will occur at 20-40o flexion
Anterior Drawer test
Testing: anterior collateral lig How: sit on foot with pt knee&hip flexed, pull on leg below knee Positive Test: laxity (compared to other leg)
Lachman Test
Testing: anterior collateral ligament (MOST SENSITIVE TEST FOR ACL) How: pt supine knee slightly flexed; hand under femur above knee and other hand on tibia, pull tibia forward Positive Test: Increased anterior translation of the tibia indicates a partial or complete tear of the ACL
Balloon Sign
Testing: joint effusion (minor) How: pt supine, leg extended; compress superpatellar pouch, feel for excess fluid Positive Test: excess fluid
Patella Ballottement
Testing: joint effusion (minor) How: pt supine, leg extended; compress superpatellar pouch, press patella and relase quickly Positive Test: rapid rebound
Bulge Sign
Testing: joint effusion (minor) How: push fluid superior on medial knee; then push fluid inferior on lateral knee Positive Sign: bulge appear on medial knee
Varus Stress Test (Adduction)
Testing: lateral collateral lig How: palpate LCL, slight flexion at knee with other hand in joint line posterior pushes knee laterally Positive Test: laxity (compared to other leg)
Valgus Stress Test (Abduction)
Testing: medial collateral lig How: palpate MCL, slight flexion at knee with other hand in joint line posterior pushes knee medially Positive Test: laxity (compared to other leg)
Patellar Grind Test (Clarke Sign)
Testing: patellofemoral syndrome (Chondromalacia) How: Patient supine and the knee is fully extended. Place one hand superior to the patella and gently push the patella inferiorly as you instruct the patient to contract the quadricep Positive Test: Pain with this is considered a positive test. Grinding or clicking is indicative of Chondromalacia
Patellar Apprehension Sign
Testing: patellofemoral syndrome, patellar subluxation,patellar dislocation How: Patient lies supine with knee relaxed in approx 30 deg. flexion - May put roller under knee to support it. Displace the patella laterally by applying medial pressure Positive Test: If patient contracts the quadriceps or is apprehensive due to pain, this is a positive test
Posterior Drawer test
Testing: posterior collateral lig How: sit on foot with pt knee&hip flexed, push on leg below knee Positive Test: tibia sag posteriorly
