Transcript ONE2_14_Knee

Knee Orthopaedic Tests
Anterior Aspect
Anterior Knee Bursa
Medial & Lateral Aspect
Medial Collateral Ligament
Lateral Aspect
TFL and ITB
Posterior Aspect
Meniscus Instability
The menisci are C-shaped discs of fibrocartilage that
are interposed between the condyles of the femur and
tibia.
Primary function is load transmission or weight
bearing.
Secondary function is shock absorption during gait.
Contribute to joint stability and lubrication.
Meniscus Instability
Nerve endings provide proprioceptive feedback for
joint position.
A tear or loss of the menisci, either partial or complete,
hinders their ability to perform.
A twisting injury to the knee with the foot in weight
bearing can injure the menisci.
The outer 20% is vascular – peripheral injuries may
heal.
Meniscus Instability
Clinical Signs and Symptoms
Local medial or lateral joint pain
Limited knee range of motion
Crepitus upon movement
Joint effusion
Knee buckling
Pain on walking up and down stairs
Pain on squatting
Apley’s Compression Test
Procedure: Patient prone. Flex leg to 90 degrees.
Grasp the patient’s ankle and apply downward pressure
while you internally and externally rotate the leg.
Positive Test: Flexing the knee distorts the meniscus.
Downward pressure further stresses the meniscus. Pain
or crepitus on either side indicates a meniscus injury
on that side.
Apley’s Compression Test
McMurray’s Test
Procedure: Patient supine. Flex leg. Externally rotate
the leg as you extend. Internally rotate the leg as you
extend.
Positive Test: Flexion and extension distort the
meniscus. Adding external and internal rotation
further distorts the meniscus. A palpable or audible
click indicates injury of the meniscus.
McMurray’s Test
Ligamentous Instability
The major ligaments of the knee are the anterior and
posterior cruciate and the medial and lateral collateral
ligaments.
Ligament injuries are among the most serious knee
disorders.
Usually due to traumatic stress to the knee while
bearing weight.
Ligaments
Ligamentous Instability
Valgus stress may sprain or tear the medial collateral
ligament.
Varus stress may sprain or tear the lateral collateral
ligament.
Both of these stresses with a rotational force may sprain
or tear the anterior and/or posterior cruciate
ligaments.
Ligamentous Instability
Clinical Signs and Symptoms
Knee pain
Limited range of motion
Difficulty in weight bearing
Joint effusion
Knee giving out; chronic unstable knee
Drawer Sign
Procedure: Patient supine. Flex the leg and place the
foot on the table. Grasp behind the knee and pull and
push on the leg. Hamstring tendons must be relaxed.
Positive Test:
Drawer Sign
Drawer Sign
Drawer Sign
More than 5 mm of tibial movement on the femur
when leg is pulled - injury or tear to one or more of the
following structures is indicated:
Anterior cruciate ligament
Posterolateral capsule
Posteromedial capsule
Medial collateral ligament (more than 1cm movement)
Iliotibial band
Posterior oblique ligament
Arcuate-popliteus complex
Drawer Sign
Drawer Sign
If excessive movement occurs when the leg is pushed,
an injury to one or more of the following structures in
indicated:
Posterior cruciate ligament
Arcuate-popliteus complex
Posterior oblique ligament
Anterior cruciate ligament
Lachman’s Test
Procedure: Patient supine. Knee 30° flexion. Grasp
thigh with one hand to stabilize. Grasp tibia with
opposite hand and pull forward.
Positive Test: Softened feel or anterior translation of
the tibia suggests a possible tear of:
Anterior cruciate ligament
Posterior oblique ligament
Lachman’s Test
Reverse Lachman’s Test
Procedure: Patient prone. Flex leg to 30°. Stabilize
posterior thigh with one hand. Push tibia posterior
with the other hand.
Positive Test: Posterior pressure on the tibia stresses
the posterior cruciate ligament. A soft end feel and
posterior translation of the tibia are positive findings.
Reverse Lachman’s Test
Apley’s Distraction Test
Procedure: Patient prone. Flex leg to 90°. Stabilize
patient’s thigh with your knee. Pull on the ankle while
internally and externally rotating the leg.
Positive Test: Distraction of the knee takes pressure off
the meniscus and puts strain on the medial and lateral
collateral ligaments (non-specific).
Apley’s Distraction Test
Adduction Stress Test
Procedure: Patient supine. Stabilize medial thigh.
Grasp lower leg and push medially.
Positive Test: Excessive movement of the tibia away
from the femur indicates a possible tear of:
Tibial collateral ligament
Posterior meniscofemoral ligament
Posterior medial capsule
Anterior cruciate ligament
Posterior cruciate ligament
Abduction Stress Test
Procedure: Patient supine. Stabilize lateral thigh.
Grasp lower leg and pull it laterally.
Positive Test: Excessive movement of the tibia away
from the femur indicates a possible tear of:
Fibular collateral logaments
Posterolateral capsule
Posterior cruciate ligament
Anterior cruciate ligament
Abduction Stress Test
Medial & Lateral Stability
Rating Scale
Grade 0
No joint Opening
Grade 1+
Less than 0.5 cm joint opening
Grade 2+
0.5 to 1.0 cm joint opening
Grade 3+
More than 1cm joint opening
Patellofemoral Dysfunction
The patella protects the anterior aspect of the knee.
It acts as a fulcrum that increases the mechanical
advantage of the quadriceps.
The patella lies in the trochlear groove. With normal
flexion and extension it tracks smoothly in the groove.
Patellofemoral Dysfunction
Many causes of anterior knee pain involve abnormal
tracking of the patella or direct trauma to the patella.
Patellofemoral injuries include fractures, dislocations,
malalignment syndrome, chondromalacia patellae, and
patellofemoral arthritis.
Patellofemoral Dysfunction
Clinical Signs and Symptoms
Anterior knee joint pain
Knee joint effusion
Popping sensation
Joint crepitus
Discomfort with stair climbing
Knee buckling
Patella Grinding Test
Procedure: Patient supine. Move patella medially and
laterally while pressing down.
Positive Test:
Pain under the patella - chondromalacia patellae,
retropatellar arthritis, or a chondral fracture.
Pain on the patella – osteochondritis.
Pain over the patella – prepatellar bursitis.
Patella Grinding Test
Patella Apprehension Test
Procedure: Patient supine. Manually displace the
patella laterally.
Positive Test: A look of apprehension on the patient’s
face and a contraction of the quadriceps muscle
indicates a chronic tendency to lateral patella
dislocation. Pain is also present with this test.
Patella Apprehension Test
Knee Joint Effusion
Effusion in and around the knee may be caused by
trauma, infection, degenerative joint disease,
rheumatoid arthritis, gout, or pseudogout.
The fluid may contain blood, fat, lymphocytes, and
crystals such as urate, pyrophosphate, and oxalate.
Knee Joint Effusion
Clinical Signs and Symptoms
Knee pain on walking
Anterior knee inflammation
Knee joint warmth to touch
Patella Ballottement Test
Procedure: With one hand, encircle and press down
on the superior aspect of the patella. With the other
hand, push the patella against the femur with your
finger.
Positive Test: If fluid is present in the knee, the patella
will elevate when pressure is applied. When the patella
is pushed down, it will strike the femur with a tap.
Patella Ballottement Test