Anteromedial/lateral instability

posteromedial/lateral instability

Quadrant Drawer Test

tests anterior rotary instability

Slocum's Test

Posterior rotary instability

Hughston's Test

PT stands on 1 leg in slight knee flex and rotates L and R

(+) pain with rotation and feeling of instability

(+) if pain is at joint lint (Merke's Sign)

tests rotary instability and meniscus

Disco test

Start with knee flexed at 30°, support foot and allow knee to “drop” into ext.

-Rubbery or springy rebound (something blocking ext) – usually torn meniscus

Tests Meniscus

Bounce Home

In supine, take knee from fully flex à ext:

Medial – add varus stress & lat tibial rotation

Lateral – add valgus stress & medial tibial rotation

Tests Meniscus

McMurray

With pt in prone, knee flex to 90 med and lat rotate tibia with rotation (menisci) and distraction (ligamentous tissue – prob coronary ligs)

*Can perform in varying degrees of flex – use towel above the patella

Tests Meniscus and Ligamentous tissue

Apley's Compression and Distraction

Pt side lying, tested hip passively abd and ext (examiner stabs pelvis) – slowly lower leg to plinth

-+ = leg does not add but IR to plinth

-Do with knee flex/ext

tests TFL and IT band

Ober's test

Pt side lying (or supine) with knee flex to 90. Maintain pressure on ITT while pt actively ext knee

-Painful response occurs as ITT crosses over lat epicondyle

tests IT band

Noble's Test

Pt prone with knee flex to 90, palpate greater trochanter, rotate thigh until trochanter is “horizontal” – measure angle: should have 8-15° IR

tests femoral anteversion

Craigs test

Pt relaxed in 20-30 flex, slowly push patella lat

-Pt will contract quads to prevent subluxation

tests PFJ

Patellar Apprehension Test

(Fairbank's)

Compress suprapatellar pouch – pt performs quad contraction with maintained pressure on base of patella

-Pain

tests PFJ

Clarke's Test

provocative

Pull patella distally, pt contracts quads

-Pain

tests PFJ

Zohlers test

provocative

Percuss patella in various degrees of knee flex

-Pain

tests PFJ

Frunds test

provocative

Palpate b/t patella and med femoral condyle while knee is flex & ext (0-90) – look for painful “popping”

-Add med tib glide of patella (~ 30°)

-Add med glide & med tib rotation (Hughston’s) while passively flex/ext knee

tests Plica

Plica Test

tests for stress fracture 

(+) increased pain

Anterior talofibular ligament (gen’l anterior instability)

Excessive anterior motion when pulling talus forward on a fixed mortise (or pushing mortise backwards on a fixed foot    

PF – anterior fibers

Neutral – middle fibers

DF – posterior fibers

(+) Excessive motion or pain when inverting/everting calcaneus and/or talus on a fixed mortise

tests Calcaneofibular ligament

Pain or stress when talus is abd/add on a fixed mortise

tests Deltoid ligament

Ant/Post tibiofibular ligs

-Med pain/if talus displaces

-Pain in the “high”ankle

syndesmosis (inferior tib/fib ligament)

(+) Pain with compression of tibia and fibula just distal to calf (can repeat distally)

tests mortise integrity 

Fix tibia, perform A – P glides of fibula.

-Hold head of fibula back and repeat inversion

Mortise integrity/ syndesmosis

Hold distal tib/fib and attempt to glide talus medial/lateral

Mortise integrity/ syndesmosis

Forceful passive DF of foot with lower leg stab’d

Mortise integrity/ syndesmosis

WB DF with & w/o compression of malleoli

tests Achilles tendon

No plantar flexion with squeeze

tests DVT

pain with abrupt passive dorsiflexion

tests Tarsal tunnel syndrome – posterior tibial nerve

tests MLA/spring ligament

measure malleoli to navicular then to 1st MT head

(+) more than 10mm drom of navicular

Tests knee swelling 

Observe indentation lat to patellar tendon with knee ext in supine – as pt flexes knee observe if indentation stays on normal side

tests knee Temp & swelling

Stroke fluid prox on med side of patella & down on superolat side – watch for wave of fluid on med side

tests knee Temp & swelling

One hand over suprapatellar pouch, other with fingers and thumb around patella – alt pressure feeling for fluctuation of fluid with other hand

Tests MCL, LCL

Do in 0 & 30° flex:

Varus stress – LCL

Valgus stress – MCL

Slight flex isolates collaterals

tests ACL

Pulling anterior on tibia while knee is in 90° - excessive translation (normal is 5-6 mm)

Tests ACL

Position pt in 20-30° knee flex – ant glide of tibia while femur is stabilized. Looking for loss of infrapatellar slope, soft end feel, excessive tibial motion (norm 2-3 mm)

Lachman

(6 variations)

Tests ACL

Passively move knee from full ext to 60° flex while maintaining tibial rotation & valgus stress on prox tibia

-Knee will sublux/reduce 20-40° - pt will report “giving way” feeling

tests PCL

Knee flexed to 90, watch for post “sagging” of tib on one side (can also do with hips flexed to 90 and tib horiz)

tests PCL

Pushing posterior on tibia while knee is in 90° - excessive translation (normal is 5-6 mm)

tests PCL

Prone post tibial glide – classically knee flexed to 30, more displacement in 90