SECTION VI: ORTHOPEDIC TESTS FOR THE KNEE
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 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). Waldron’s test Tests for patellofemoral pain syndrome aka runner’s 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 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 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 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 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 Patellar apprehension test 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 Helfet’s test This tests for a possible torn meniscus or a muscular imbalance. The client should be seated at the end of the table with their legs draped off the end, hanging. The therapist slowly and fully extends the client’s knee while observing the movement of the tibial tuberosity just below the knee. The absence of a slight lateral motion of the
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). 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). 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). “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). 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). 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 tendon (Cleland et al., 2020). 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). tibial tuberosity compared to the midline of the patella may indicate a torn meniscus or muscular imbalance of the quadriceps. If hypertonicity of any of the four quadriceps is suspected, apply directional massage, PNF stretches, myofascial release, or trigger point therapy (Cleland et al., 2020).
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Book Code: MPA0825
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