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). 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 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). Bragard’s sign test This tests for a meniscus tear. The client should be in the supine position with their hips flexed to 45 degrees while knees are bent at 90 degrees and feet are flat on the table. The therapist stabilizes the femur at the knee while moving the lower leg into lateral rotation. Pain or tenderness deep to the patella likely indicates a medial meniscus tear. This procedure can also be conducted with a medial rotation of the lower leg to test for a lateral meniscus tear (Cleland et al., 2020). Apley’s compression test This tests for a meniscus tear. The client should be prone on the table with their affected knee placed in 90 degrees of flexion. The therapist compresses the knee into the table while rotating the leg either laterally or medially. Pain on the medial side of the knee indicates a medial meniscus tear, and pain on the lateral side of the knee indicates a lateral meniscus tear (Cleland et al., 2020). Thompson’s test This tests for a rupture of the calcaneal/Achilles’ tendon. The client should be in the prone position with their feet dangling off the end of the table. The massage therapist squeezes the belly of the posterior calf muscles, the plantar flexors (gastrocnemius and soleus) and looks to see if the client’s ankle goes into plantar flexion. A failure of the heel to rise indicates a ruptured tendon or may signal severe hypertonicity of the ankle’s dorsiflexors, such as tibialis anterior. To treat hypertonicity of the tibialis anterior and the muscles of the anterior compartment of the lower leg, apply directional massage, trigger point therapy, or perform PNF stretches (Cleland et al., 2020). Self-Assessment Quiz Question #4 What structure on the medial side of the ankle is commonly injured? a. The interosseus membrane.
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). 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 Eversion talar tilt test This tests for an injury to the deltoid ligament on the medial side of the ankle inferior to the medial malleolus. The client should be supine on the table with their feet dangling off the end. The therapist will stabilize the tibia proximal to the ankle with one hand while everting/abducting the foot with the other hand. Pain in the area of the deltoid ligament and/or ROM greater than 15-20 degrees during eversion is an indication that the deltoid ligament is injured. Injuries to the ankle’s deltoid ligament are common as it is the only ligamentous structure on the medial side of the ankle. In the absence of inflammation, cross-fiber friction of the area is indicated (Cleland et al., 2020). Inversion talar tilt test tendon (Cleland et al., 2020). Patellar apprehension test This tests for an injury to one of the ligaments on the lateral side of the ankle inferior to the lateral malleolus. The client should be supine on the table with their feet dangling off the end. The therapist will stabilize the tibia proximal to the ankle with one hand while inverting/adducting the foot with the other hand. Pain in the area of the lateral ligaments and/or ROM greater than 20-30 degrees during inversion is an indication that one of the ligaments is injured. In the absence of inflammation, cross-fiber friction of the area is indicated (Cleland et al., 2020).
SECTION VII: ORTHOPEDIC TESTS OF THE ANKLE
b. The medial malleolus. c. The deltoid ligament. d. The plantar fascia.
SECTION VIII: ADDITIONAL ORTHOPEDIC TESTS
Homan’s sign test This tests for the presence of a deep vein thrombosis (DVT) in the leg. The client should be supine on the table with their legs extended and a bolster under their knees. The
therapist then passively places the foot into dorsiflexion. A DVT is indicated by pain during dorsiflexion, tenderness upon palpation of the posterior lower leg, and/or pallor of the skin of the posterior lower leg during the test. Note that
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