Noble’s test This tests for hypertonicity of the IT band as a cause of pain on the lateral side of the knee. The client should be in the supine position on the table with their affected hip and knee flexed to 90 degrees. The therapist will grasp the ankle and move the knee back and forth through extension and flexion while applying thumb pressure on the lateral epicondyle of the femur. A feeling of crepitus or the client reporting pain at or above the lateral epicondyle is indicative of IT band syndrome. This may be caused by injury to the IT band at or near the lateral epicondyle, or by the hypertonicity of the TFL muscle. As long as inflammation is not present, cross- fiber friction above, at, and below the lateral epicondyle may be helpful. If hypertonicity of the TFL is suspected, directional massage on the TFL itself or PNF stretches for the hip flexors may be applicable (Manske & Magee, 2018).
Hamstring strain test This tests for the location of a hamstring strain. The client will be in a prone position on the table with their knees flexed to approximately 70 degrees. To assess the medial hamstring muscles, the therapist will bring the affected thigh into flexion, then into medial rotation and knee extension while the client resists the movements at both joints. Deep pain indicates an injury of the semimembranosus muscle while superficial pain indicates an injury to the semitendinosus muscle. To assess the lateral hamstrings, the therapist will bring the client’s thigh into lateral rotation and knee extension while the client resists the movements at both joints. Deep pain indicates an injury to the short head of the biceps femoris while superficial pain indicates an injury to the long head of the biceps femoris. Rest is often the easiest treatment option for strains while the application of ice would be suitable for areas that exhibit inflammation (Manske & Magee, 2018). Anterior and posterior drawer tests for PCL and ACL This tests for the integrity of the knee’s posterior cruciate ligament/PCL. The client should be in the supine position with their hip flexed to 45 degrees and knees flexed to 90 degrees, feet flat on the table for the knee being tested. The therapist places the fingers of both hands behind the knee and their thumbs in front of the knee on the tibial tuberosity. Then the therapist provides a short and sudden knee. The client is asked to stand. The therapist palpates the patella being tested while the client goes into and returns from a squatting position. Patellar pain syndrome is indicated by pain, crepitus, or poor tracking at the patella. Runner’s knee is typically caused by damage to the articulating cartilage underneath the patella or the tendon surrounding the patella. Hypertonicity of the quadriceps may be a factor in this condition but is rarely the source of the chronic pain commonly associated with runner’s knee since the cause is normally on the posterior surface of the patella (Cleland et al., 2020). Patellofemoral pain syndrome compression test This tests for patellofemoral pain syndrome, or runner’s knee. The client should be supine on the table with their legs fully extended. The therapist compresses the top of the affected patella while asking the client to contract their quadriceps. Apprehension, pain, or crepitus indicate patellofemoral pain syndrome. As previously mentioned, this is typically due to damage to the articulating cartilage underneath the patella (Cleland et al., 2020). Major effusion test This tests for increased synovial fluid or blood under the knee cap. The client should be seated at the edge of the table with lower legs hanging. The client is asked to bring their affected leg into full extension at the knee. If client is unable to complete the extension, the therapist will continue to extend the knee to completion. If the patella “pops” onto the femur and then into a floating position— confirmed by palpation—this is a positive sign for fluid beneath the patella and is considered a medical emergency. The client should be referred to a physician immediately (Cleland et al., 2020).
SECTION VI: ORTHOPEDIC TESTS FOR THE KNEE
draw of the leg anteriorly. An injured PCL is indicated by posterior knee pain during the movement or by more than a few millimeters of movement of the tibia as it is drawn forward. This test can be conducted by pushing the leg posteriorly in the same manner with anterior knee pain indicating an injury to the anterior cruciate ligament/ACL (Cleland et al., 2020).
Healthcare Consideration: Due to the simplicity of the knee’s structure, there is potential for a strong therapist to injury a client’s knee during testing. Clients that report knee pain that is sharp prior to testing should be taken gently through any knee test. Any test that elicits sharp knee pain should be stopped immediately and the client referred to a physician or doctor of physical therapy. Also, manual therapies such as those listed in the beginning of this course will be of limited benefit when it is suspected that there are structural issues with the knee (Cleland et al., 2020). Waldron’s test Tests for patellofemoral pain syndrome aka runner’s
Valgus knee stress test This tests for injury to the medial cruciate ligament/MCL or the medial common quadriceps tendon. The client should be in the supine position on the table with their legs in extension. The therapist places one hand on the client’s medial malleolus and their other hand on the lateral side of the affected knee. The therapist applies medially directed stress onto the lateral knee while pulling the ankle laterally. The presence of pain on the medial side of the knee indicates injury to the MCL or the medial common quadriceps tendon (Cleland et al., 2020). Varus knee stress test This tests for injury to the lateral cruciate ligament/LCL or the lateral common quadriceps tendon. The client should be in the supine position on the table with their legs in extension. The therapist places one hand on the client’s lateral malleolus and their other hand on the medial side of the affected knee. The therapist applies laterally directed stress on the medial knee while pushing the ankle medially. The presence of pain on the lateral side of the knee indicates injury to the LCL or the lateral common quadriceps This tests for a patella that is likely to dislocate. The client should be supine on the table with their legs extended and knees bolstered. The therapist laterally directs smooth and continual force against the medial aspect of the patella and observes the client’s reaction. Apprehension on the client’s part or pain surrounding the knee is considered a positive sign for a dislocation risk. Note, however, that pain may also be due to ACL damage or a dysfunction of the common patellar tendon of the quadriceps (Cleland et al., 2020). tendon (Cleland et al., 2020). Patellar apprehension test
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