Apley’s Distraction Test
- pt is prone
- flexes the knee to 90 degrees/ stabilizes the patient’s thigh with your knee
- Doctor pulls on the pt’s ankle while internally and externally rotating the leg
- Bilaterally performed
- unaffected side first
Positive finding(s): Pain on distraction or relief of pain
-Indication(s): Pain=nonspecific ligamentous injury or instability (MCL or LCL)
Relief of pain = meniscus tear
Drawer’s Sign (Ant/Post)
- pt is supine
- Doctor flexes the leg and places the foot on the table (can sit on foot to stabilize)
- Doctor grasps behind the flexed knee and pulls and pushes on the leg
- Bilaterally performed
- unaffected side first
Positive finding(s): Over 5 mm of tibial movement on the femur when leg is pulled OR excessive movement when leg is pushed
-Indication(s): > 5 mm when leg is PULLED= injury or tear of some degree to any of the following structures: ACL,(MCL if more than 1 cm of movement), (Posterolateral capsule,
Posteromedial capsule, iliotibial band,
posterior oblique ligament)
-Excessive movement when leg is PUSHED=injury to 1 of the following structures: PCL (arcuate-politeus complex, posterior oblique ligament, anterior cruciate ligament
)
Posterior Sag Sign (Gravity Drawer Test)
- pt is supine
- Doctor brings both hips to45 or to 90 degrees and knees to 90 degrees
- Doctor lines up legs and observe for tibia to sag
Positive finding(s): tibia plateau sags posterior relative to femur
Indication(s): chronic PCL sprain
Slochum Test
- pt is supine
-Prior to performance of test, Dr. asks
pt to inform if pain or symptoms are produced
-knee is flexed betw 45 & 90 degrees (thigh & calf or not approximated), dr stabilizes pt’s foot with knee
-Doctor places foot in approximately
30 degrees of internal rotation
-Doctor grasps prox tibia with both hands, palpating jt line
-From neutral position dr PULLS the proximal tibia from P-A
-Bilaterally performed
-Unaffected side first
Positive finding(s): 5 mm of tibial movement in either direction -Indication(s):sprain or instability of ACL, posterolateral capsule, LCL or ITB
Hughston’s Drawer Test
-pt is supine
-Hip is is flexed 45 degrees knee is flexed to 90 degrees /Doctor places foot in approximately 30 degrees of internal/medial
rotation, sits on foot to stabilize it
-Doctor grasps prox tibia with both hands, palpating jt line/From neutral position dr
PUSHES the proximal tibia posterior
Doctor places foot in approximately
30 degrees of external/lateral rotation, sits on foot to stabilize it
-From neutral position dr PUSHES the proximal tibia posterior
- Bilaterally performed
- Unaffected side first
Positive finding(s): Posteromedial Instability= PCL, MCL
Posterolateral Instability= PCL, LCL, APC
Indication(s):ligamentous injury or dysfunction to either the pcl,mcl,lcl or apc
Lachman’s Test
- Instructions prior to performance: pt is supine/ Doctor flexes the pt’s knee approx 30 degrees
- Prior to performance of test , Dr. asks pt to inform if pain or symptoms are produced
- Doctor stabilizes the femur w/1 hand while the other grabs the proximal tibia
- Doctor tries to PULL the tibia forward
- Bilaterally performed
- Unaffected side first
Positive finding(s): soft end feel and ant translation of the tibia on the femur)
-Indication(s): ACL sprain or possible posterior oblique ligament sprain)
Reverse Lachman’s Test
- pt is prone
-Doctor flexes patient’s hip knee to 30 degrees
-Prior to performance of test, Dr. asks pt to inform if pain or symptoms are produced - Doctor stabilizes posterior thigh with one hand
- Doctor grasps tibia with other hand and
presses from anterior to posterior
-Bilaterally performed - Unaffected side first
Positive finding(s): Pain with A-P pressure OR soft end feel with excessive posterior translation
Indication(s): PCL dysfunction (torn or injured)
Lateral Pivot Shift Maneuver (Test of MacIntosh)
- pt is supine
-leg relaxed, doctor raises leg to 20’ hip flexion/Doctor internally rotate tibia (maximize rotational instability) - Doctor applies a valgus stress on knee
while flexing knee - Bilaterally performed
-Unaffected side first
Positive finding(s): At ~30 degrees of knee flexion patient will experience a “GIVING AWAY” feeling
Indication(s): ACL, posterior capsule or LCL tear
Adduction Stress (Varus)
- pt is supine
- Prior to performance of test, Dr. asks pt to inform if pain or symptoms are produced
- Doctor contacts med jt line w/1 hand & the other hand palpates lat jt line / Doctor creates a varus stress- pushes proximal tibia medial to lateral (gently at first than creating adequate stress to r/in or r/out) with knee in extension
- Doctor performs the same movement while passively flexes knee 20-30 degrees (if no pain in extension)
- Bilaterally performed
- Unaffected side first
Positive finding(s): Gaping along the lateral tibiofemoral joint line, with knee in extension and/or when flexed 20-30 degrees
-Indication(s): Sprain of the LCL in flexion; extension: sprain of the LCL &/or capsule
(Flexion isolates MCL better) when in extension
: tear of any of the following: fibular collater
al ligament, posterior lateral capsule, ACL, PCL, ITB When in flexion-instability of the fibular collateral ligament (LCL), posterolateral capsule, ITB
Abduction Stress (Valgus)
-Instructions prior to performance: pt is supine
-Prior to performance of test, Dr. asks pt to inform if pain or symptoms are produced
-Doctor contacts lat jt line w/1 hand & the other hand palpatesmed jt line / Doctor
creates a valgus stress-pushes proximal tibia lateral to medial (gently at first than creating adequate stress to r/in or r/out) with knee in extension
- Doctor performs the same movement while passively flexes knee 20-30 degrees (if no pain in extension)
-Bilaterally performed
- Unaffected side first
Positive finding(s): Gaping along the medial tibiofemoral joint line, with knee in extension or when flexed 20-30 degrees
Indication(s): Sprain of the MCL in flexion;
extension: sprain of the MCL &/or Posteromedial capsule, PCL, ACL.
When in flexion-instability of the tibial collateral ligament (MCL), Posteromedial capsule
Patella Ballottement Test
- pt is supine
- With one hand, dr. encircles and presses down on the superior aspect of the patella.
- With the other hand, dr. pushes the patella against the femur with finger
- Bilaterally performed
- Unaffected side first
Positive finding(s): patella elevates up when pressure is applied, when pushed down, strikes the femur with a palpable tap
Indication(s): fluid present in the knee
(knee joint effusion) (infection, trauma etc.)
Noble’s Compression Test
- pt is supine
- Pt’s knee is flexed to 90 degrees (accompanied by hip flexion)
- Doctor uses thumb to apply pressure to lateral condyle or w/in 1-2 cm of it
- Doctor passively extends the knee
- Bilaterally performed
- Unaffected side first
Positive finding(s): Pain underneath finger at lateral femoral condyle (at ~30 degrees of flexion)(CC, pt states it is the same pain that occurs with activity)
Indication(s): Iliotibial band friction syndrome
Thessaly Test
- pt is standing
- Doctor grasps the patient’s hands
- Doctor instructs the patient to flex the knee to 5 degree and rotate his/her body to the right and leg and repeat three times
- Doctor instructs the patient to flex the knee to 20 degree and rotate his/her body to the right and leg and repeat three times
- Bilaterally performed
- unaffected side first
Positive finding(s): Pain or discomfort at the joint line OR a sense of locking or catching
Indication(s): Torn meniscus on the side corresponding to the location of the pain/locking
Modified Helfet’s Test
- pt is seated, knees flexed 90 degrees
- Doctor notes position of tibial tuberosity relative to midline at 90 degrees knee flexion
- Doctor passively extends patient’s knee, again notes location of tibial tuberosity compared to patella
Positive finding(s): tibial tuberosity remains at midline with patella with knee extension (Normal, tibial tuberosity will move inline with lateral boarder of patella with extension) (Abnormal: rotation of tibia is blocked due to torn meniscus)
Indication(s): meniscus dysfunction (torn or injured)
Bounce Home Test
- pt is supine
- Doctor INSTRUCTS pt to flex the leg
- When leg is flexed, dr. cups hand around pt’s heel and instructs pt to relax his muscles and allow the knee to drop
- Bilaterally performed
- unaffected side first
Positive finding(s): Unable to extend the knee fully or rubbery end feel on full extension
Indication(s):Torn meniscus
McMurray’s Test
- pt is supine
-Doctor fully flexes knee & adds int. rotation
then extends knee while palpating & listening at lat jt line
-Doctor fully flexes knee & adds ext. rotation
then extends knee while palpating & listening at med jt line
-Bilaterally performed
-unaffected side first
Positive finding(s): Palpable or audible clicking along the medial &/or lateral joint line
Indication(s): Medial &/or lateral meniscus dysfunction (torn or injured)
Steinman’s Tenderness Displacement Test
- pt is supine
- Doctor flexes patient’s hip and knee to 90 degrees
- Doctor places thumb and index finger on medial and lateral knee joint lines
- Doctor grasps pt’s ankle and passively flexes and extends knee while palpating both joint lines
- Bilaterally performed
- unaffected side first
Positive finding(s): Pain seems to move anterior when knee extended OR posterior when knee flexed
Indication(s): meniscus dysfunction (torn or injured) rationale: when knee is extended
-meniscus will move ant/when flexed -Meniscus moves post
Apley’s Compression
- pt is prone
-Doctor flexes knee to 90 degrees/Doctor
stabilizes pt’s thigh down on table with their knee
- Doctor places downward pressure on heel (or distal ankle) while internally & externally rotating tibia
- Bilaterally performed
- unaffected side first
Positive finding(s): Pain or crepitus on either side of the knee
Indication(s):Torn meniscus on the painful side
Dreyer’s Test
- pt is supine
- Doctor instructs pt to raise leg actively
- If pt. cannot raise leg, stabilize the quadriceps tendon just above the knee (by compressing it w/ both thumbs/hands)/ Doctor instructs the patient to raise leg again
- Bilaterally performed
- Unaffected side first
Positive finding(s): can raise leg with stabilization but not without
Indication(s): Traumatic fracture of the patella
(if FX’d, quad tendon is not stabilized
Patellar Grinding Test
- pt is supine
-Doctor Moves patella medially and laterally
while pressing down
-Bilaterally performed
-Unaffected side first
Positive finding(s): Pain under the patella
Indication(s): Chondromalacia patella, retropatellar arthritis, chondral
fracture, prepatellar bursitis
Fairbank’s Apprehension Test
Patellar Apprehension Test: no flexion, just
extension
- pt is supine
- Quad relaxed, knee flexed to 30 degrees
- Doctor carefully and slowly pushes patella laterally
- Bilaterally performed
- Unaffected side first
Positive finding(s): contraction of quadriceps and apprehensive look and pain (If pt feels the patella will dislocate pt will contract the quadriceps muscle to bring the patella “back into line”)
Indication(s): Dislocation of the patella
Clarke’s Sign (Patellar Grind Test)
- pt is supine
-pt’s knee is extended; dr. uses web contact just superior to the superior pole of the patella and doctor points to or asks pt to
slowly contract quads (without using the term quadriceps) while the dr pushes down (gradual pressure)
-Doctor repeats procedure at 30, 60, & 90 degrees (if no pain was produced in previous position)
- Bilaterally performed
- Unaffected side first
Positive finding(s): Retropatellar pain and patient cannot hold contraction
Indication(s): Chondromalacia patella
Mediopatellar Plica Test -pt is supine -Affected knee flexed to 30 degrees resting on a support or the dr.s arm -Doctor pushes the patella medially with the thumb - Bilaterally performed -Unaffected side first
Positive finding(s): pain or click, Pinching of the edge of the plica between the med. Femoral condyle and the patella
Indication(s): Mediopatellar plica is inflamed
or adhered to patella
Hughston’s Plica Test
-pt is supine
-Doctor flexes the knee and medially rotates the tibia with one hand
-Doctor then presses the patella medially with the heel of the other hand
-Doctor then palpates the medial femoral condyle with the fingers of the same hand
-Doctor passively flexes and extends
the pt.s knee while feeling for popping of the plica band under the fingers
-Bilaterally performed
- Unaffected side first
Positive finding(s): “popping”
Indication(s): Suprapatellar plica is inflamed or adhered to patella
