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Clinical Assessment
Clinical Assessment - The knee
35
Other
Not Applicable
10/27/2011

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Cards

Term

Complete the sentence:

You use the Sag Sign to assess the health of the 1) ... cruciate ligament, or else when you perform the 2) ... drawer test you may get a false 3)... for the 4)...  cruciate ligament.

Definition

You use the Sag Sign to assess the health of the 1) posterior cruciate ligament, or else when you perform the 2) anterior drawer test you may get a false 3) positive for the 4) anterior cruciate ligament.

 

Term

Which meniscus are you assessing with McMurrays test when you put the knee into:

 

> External rotation?

> Which pressure accompanies this rotation?

 

Definition

> External rotation: assesses the medial meniscus

* heel in, push in = medial meniscus*

 

> Pressure is valgus

Term
What special test would you perform if you were testing for moderate knee swelling?
Definition

moderate to significant = fluctuation test

 

* significant to gross = patellar tap test*

Term

Which two structures are you assessing when performing the Valgus stress test?

 

Definition

Valgus stress test assesses:

> MCL/medial collateral ligament

> posteromedial capsule

*tautest at 30o and commonly injured 1st*

*valgus stress test is with the knee in an extended position; this allows the knee to be taken into its maximal congruency and therefore enables one to assess the posteromedial capsule*

Term
Your client has pain with active free knee flexion.  List 4 knee flexors that may be the cause of this pain/limitation.
Definition

> gastrocnemius

> semitendinosus

> semimembranosus

> biceps femoris

Term
A positive sign for the Bounce home test is.....
Definition
Positive sign: leg stopping from extension + bouncing
Term
Which stuctures are being assessed with the Varus stress test? Why is the leg being tested in extension?
Definition

Structures tested:

> LCL/lateral collateral ligament

> posterolateral capsule

 

*knee extended = knee is in its maximal congruency=enables to test LCL + posterolat. capsule*

*knee flexes= assesses LCL & sometimes ITB*

Term

True or false?

 

Appley's distraction enables to differentiate between LCL and MCL pain.

Definition

False: With Appley's distraction, you are not able to differentiate between the LCL and MCL

 

*positive sign = pain in either ligament*

Term
What should you always perform prior to doing an Anterior Drawer test?
Definition

> Sag sign : rule out false positive

> Palpate hamstrings: rule out false negative

 

*positive sign: pain/↑ movement compared to the unaffected leg*

Term
Which muscles may cause pain/limitation with the knee in flexion, in active resisted?
Definition

Flexio

semitendinosus, semimembranosus, biceps femoris, gastrocnemius

*injury to prime movers*

 

*1o n. root: L5, S1-S2*

Term
Which muscles may cause pain/limitation with the knee extended, in active resisted?
Definition

Extension

Rectus femoris, vastus medialis, vastus lateralis, vastus intermedius

 

* injury to the prime movers*

*1o n root: L2, L3, L4*

Term

Which muscles may have pain/limitation with interal rotation of the knee, in active resisted?

 

Definition

Internal rotation

Semitendinosus, semimembranosus, gracilis

 

* caused injury to the prime movers*

 

*1o n. root: L5, S1, S2*

Term
Which muscles may have pain/ limitation with external rotation of the knee, in active resisted?
Definition

External rotation

biceps femoris

 

*caused by injury to the prime mover*

*1o n. root: L5, S1, S2*

Term
All movements of the knee share the same innervation except for knee extensors.  Please identify the primary nerve root for knee extensors.
Definition

Extension = 1o n root L2, L3, L4

 

*Flexion + Internal rotation + External rotation = 1o n root L5, S1, S2*

 

 

Term
Which structure of the knee is being assessed with the Lachman's test?
Definition

Lachman's test: assess integrity of the anterior cruciate ligament/ACL

 

*positive sign: pain/↑ movement or soft mushy end feel in comparison to the unaffected leg*

Term
What is being assessed with Appley's compression?
Definition

Appley's compression assesses both menisci simultaneously

 

*positive sign: pain, possibly a click*

Term
What is a positive sign for Bounce home test?
Definition

Bounce home test

Positive sign: when knee stops short or a rubbery resistance to full extension is felt

 

*this may be an indication of joint mice or meniscus flat (broken meniscus and hanging loose)*

Term
What is being assessed in the Clarke's sign?
Definition

Clarke's sign: assesses for chondromalacia patellae

*softness of the articular cartilage*

*positive sign: pain/palpable crepitus while client contracts quads mm (forces patella under your web space)*

Term
Name the structures being assessed wtih the Patella femoral compression test as well as varying degrees in angles of flexion.
Definition

Assess: Patellofemoral Pain Syndrome

*test quality of articular cartilage between posterior aspect of patella and femoral condyles*

 

> 30o, 60o, and 90o of flexion

* MOI: wear and tear, off-tracking*

Term
What is being tested with the Patellar apprehension sign/test?
Definition

Patellar apprehension sign/test assesses for patella dislocation/subluxations

 

* + sign: client shows signs of apprehension or/and contracts quadriceps to bring patella back into alignment*

* more movement medially vs movement laterally of patella*

Term
What is being assessed with Noble compression test?  What will be a positive sign?
Definition

Noble compression test: assess for ITB Friction Syndrome/Runner's knee

> positive sign: usually at 30o flexion, and point specific (same time of activity), proximal to lateral femoral condyle

 

*tx: stretch TFL, glut med + MFR on ITB*

*LCL can also be injured while running = do varus stress test to rule out*

Term
What is the main function of menisci?
Definition
Medial and lateral menisci both provide congruency between the femur and the tibia.
Term

Complete this sentence that is true to menisci:

Menisci possess ... nerves and the inner ... is avascular.

Definition

Menisci possess no nerves and the inner 2/3rd is avascular.

 

 

Term

True or false?

 

The anterior cruciate ligament prevents posterior translation of the femur from the tibia.

Definition

True

ACL:

> checks posterior translation of femur on tibia

> check anterior translation of the tibia from the femur

 

 

Term
Pain ascending stairs, without any pain descending stairs usually pertains to which ligament of the knee?
Definition
ACL
Term
Pain descending stairs without any pain ascending stairs usually talks to which ligament of the knee?
Definition

pain descending but not with climbing = PCL

 

*PCL prevents femur from translating forward but mostly from tracking with patella*

Term
Which ligament prevents posterior translation of the tibia from the femur?
Definition

PCL

> prevents posterior translation of the tibia from the femur

> prevents anterior translation of the femur from the tibia

Term
What is the closed-packed position of the knee?
Definition
closed-packed = knee in full extension
Term
What is the loose-packed position of the knee?
Definition

loose-packed = 25-30o knee flexion

 

*allow for maximal area for swelling within knee*
*capsular pattern: flexion limited more than extension*

Term
What is another word for hyperextension of the knee?
Definition
Knee hyperextended = genu recurvatum
Term
Which joints do you rule out with a knee assessment?
Definition
Rule out: Ankle + Hip
Term
If neurological s/s are present, what would you rule out?
Definition
Neurological s/s = rule out lumbar spine
Term
Which test assesses for minimal swelling?
Definition

Brush/Stroke/Wipe test/ minor effusion test: assess for minimal swelling

 

*positive sign: swelling appearing inferomedial to the patella (of pulsative appereance)*

* swelling moving quickly = synovial fluid*

*swelling moving slowly = contains blood = refer out to MD*

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