Knee- ankle- foot Lab Flashcards Preview

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Flashcards in Knee- ankle- foot Lab Deck (76)
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1

Patellar tap test

Purpose: to assess knee swelling

Patient: supine with leg extended
Look for temp, color
- PT puts pressure on the proximal side of the knee in an effort to squeeze the fluid out of the suprapatellar pouch. the fluid can be moved under the patella while maintaining the pressure on the suprapatellar pouch.. PT can add additional pressure to medial and lateral joint line forcing the fluid under the patella. tap down the patella with the index finger.

Pos test- palpable click as the patella hits the underlying femur

neg test- the femur and the patella are already in contact. the test can be false positive; therefore, we must always test both sides to compare

2

Bulge, wipe, or stroke test/ fluid displacement test

purpose: to assess knee swelling
Patient: supine with leg extended
- PT strokes upwards with the edge of the hand on the medial side of the knee to "milk" the fluid 10 cm proximal of the patella into the lateral compartment. PT continues pushing the fluid downwards on the lateral side. the test is pos if the PT sees fluid moving towards the medial side of the knee

3

knee flexion with OP

Purpose: to assess joint mobility and rule out associated joint problems
Patient: supine, head on pillow
-Patient is asked to actively flex their knee as far as they can. PT holds the patients foot at the dorsum and places other hand on patient' anterior thigh right above the knee. PT adds flexion pressure to the patient's knee. PT asks the patient if they have any pain at each progression into deeper flexion, ex "any pain, any pain, any pain"

4

knee flexion abduction with overpressure

Purpose: to assess joint mobility and rule out associated joint problems

-PT holds the patients foot at the dorsum and places their other hand on the patient's thigh slightly superior to the knee. PT points the patients calcaneus laterally, away from the center of the patient's body. PT gives aan abduction force to the foot while knee is taken into deep flexion. PT asks the patient if they have any pain at each progression into deeper flex/abduction, ex "any pain, any pain, any pain"

5

knee flexion adduction with OP

Purpose: to assess joint mobility and rule out associated joint problems

- PT holds the patinet's foot at the dorsum and places their other hand on the patient's thigh slightly superior to the knee. PT points the patient's calcaneus medially , toward the center of the patient's body. PT gives an adduction force to the foot while knee is taken into deep flexion. PT asks the patient if they have any pain at each progression nto deeper flexion/adduction ex "any pain x3"

6

Knee extension with OP

Purpose: to assess joint mobility and rule out associated joint problems

-Patient is asked to actively extend their knee. PT holds the patients leg at the ankle and places their other hand on patient's tibial tuberosity. PT gives a posterior force to the patients above the knee and an anterior force at the ankle. PT asks the patient if they have any pain at each progression

7

knee extension abduction with OP

Purpose: assess joint mobility and rule out associated joint problems
. Patient is supine heel facing out
-PT holds the patients leg at the ankle and place other hand on patient's anterior thigh slightly below the knee. PT takes the patient's leg into IR. PT then gives a post force to the patient below the knee and a anterior force at the ankle. therapist asks if they have any pain at each progression

8

extension add with OP

Purpose: knee clearing
-Patient is supine with tibia ER. heel facing in
- Patient is asked to relax. place cephalad hand on prox tibia and caudad hand under medial side of distal tibia/fibula. stabilize prox tibia with cephalad hand. gently pull up on distal tibia with caudad hand in three increments of OP. asks patient if they feel any pain with each increase in force

9

Tibiofemoral anterior and posterior glides

Purpose: knee clearing
patient is supine with knee flexed to 25 deg
- Patient is asked to relax. PT places both hands on the tibia and grasps the tibia. PT stabilizes the patient's foot by sitting on foot. therapist pulls anteriorly and pushes posteriorly. assess for joint accessory mobility and pain reproduction.

10

Tibial IR and ER

Purpose: knee clearing
Supine with hip and knee flexed to 90 deg
- Patient is asked to relax.lock leg under medial arm and support medial side of tibia/fibula with hand under calcaneus. place lateral hand around forefoot and lock ankle into DF (close pack). rotate tibia through foot with lateral hand. assess motion as you rotate foot internally and externally

11

Tibial torsion

Purpose: measure tibial torsion
sitting at edge of table
- PT places the goniometer at the heel of the foot. stationary arm is lined up with an imaginary line through the femoral condyles. Moving arm is lined up with an imaginary line through the malleoli. normal is 12-18 deg

12

Superior tibia-fibula mobility assessment

Purpose: assess mobility and treatment of superior tibia-fibula
-patient is supine and relaxed. knee is flexed to 90 deg. push gastroc head out. grasp the fibular head. assess the mobility of the fibular head in a posterior/medial and anterior/lateral direction.
(+) test = decreased mobility or reproduction of symptoms

13

eccentric step test

purpose: quality of movement. provocative test for patella femoral pain
- Patient stands on top of 8 in platform or step. subject asked to step forward and down toward the floor. the descending limb brushed the floor with the heel and then is brought back up to the step. that is one rep. make sure each rep such that the step limb is not used to accelerate back onto the step. the number of reps the subject performs in 30 sec is recorded. both limbs are tested. (+) test is pain reproduction

14

grind scour test

Purpose: provocative test for patellofemoral pain

-apply a compression load to the patella. apply a rotational grinding force. (+) test is reproduction of the patient's patellofemoral pain

15

Clarke's sign

Purpose: provocative test for patellofemoral pain
- Patient is supine with knees extended. PT applies pressure distal with the web space of their hand over the superior pole of the patella. PT asks the patient to contract the quadriceps muscle while maintaining pressure on the patella. (+) is failure to complete contraction because of pain; my indicate patellofemoral pain syndrome

16

Patellar lateral tilt test

Purpose: provocative test for patellofemoral pain, knee pain with mobility deficit
- Patient is supine. stabilize ankle in neutral rotation. lift lateral edge of patella from the lateral femoral condyle , using thumb and index finger on both hands
(+) if patella moves out of the trochlear groove
(+) for hypomobility if the patella cannot tilt >15 deg from the neutral plane

17

medial patellar plica test

Purpose: special test for medial patellar plica

-supine fully flex the knee
- internally rotate the tiia with the grasping hand at the ankle. add a medial glide to the patella. then extend the knee
(+) Popping or clicking or reproduction of symptoms

18

Gerdy's tubercle palpation

-Purpose: identify irritation or tenderness of iliotibial band

identify and palpate tibial tuberosity. identify and palpate head of the fibula. between tibial tuberosity and head of fibula, below the joint line, palpate for gerdy's tubercle. palpate for gerdy's tubercle for symptoms reproduction

19

Thessaly's test

Purpose: provocative test for meniscus pathology

have patient stand on one leg and flex knee to about 20 deg. PT supports patient by holding patient's outstretched hand. while holding take patient through 3 full rotations. (+) with medial or lateral joint line discomfort; may have a sense of locking or catching

20

McMurray's Test

Purpose: Provocative test for meniscus pathology
1. Examiner stands to the side of the patient’s involved knee 2. Examiner grasps the patient’s heel and flexes the knee to end range with one hand while using the thumb and index finger of the other hand to palpate the medial and lateral tibiofemoral joint line 3. To test medial meniscus, examiner rotates the tibia into external rotation, then slowly extends the knee with a varus stress 4. To test the lateral meniscus, examiner flexes the knee again, internally rotates the tibia and slowly extends the knee while applying a valgus stress 5. (+) Test is indicated by an audible or palpable “thud” or “click”

21

Apley's Compression

Purpose: Provocative test for meniscus pathology
1. Therapist stabilizes patient’s femur with one hand and grasps heel with other hand 2. Therapist medial and laterally rotates tibia with compressive force 3. (+) Test = pain/clicking; may indicate meniscal lesion

22

Lachman's test

Purpose: Provocative test for ACL pathology
1. Flex patient’s knee to 15 degrees 2. Examiner stabilizes the distal femur with one hand and grasps behind the proximal tibia with the other hand 3. Examiner then applies an anterior tibial force to the proximal tibia 4. Assess for joint displacement with thumbs on the joint line 5. (+) Test is indicated by greater anterior tibial displacement on the affected side when compared to the unaffected side

23

Anterior Drawer Test

Purpose: Provocative test for ACL pathology
1. Knee is flexed between 60 degrees and 90 degrees with the foot on examination table 2. Examiner draws tibia anteriorly 3. (+) Test indicated by greater anterior tibial displacement on the affected side when compared to the unaffected side

24

Posterior Sag Test

Purpose: Identify PCL pathology
1. Patient is supine with knee flexed to 90 degrees and hips at 45 degrees flexion 2. (+) Test = tibia sagging back on femur and may indicate posterior cruciate ligament injury

25

Posterior Drawer Test

Purpose: Provocative test for PCL pathology
1. Patient is supine with knees flexed to 90° and the hip flexed to 45° 2. Therapist stabilizes the lower leg by sitting on the forefoot 3. Therapist grasps patient’s proximal tibia with both hands, thumbs on tibial plateaus, and administers posterior force 4. (+) Test = excessive posterior translation, diminished, or absent end point.; may indicate PCL injury

26

Varus stress Test

Purpose: Provocative test for LCL pathology
1. Patient is supine with knee flexed 20-30° 2. Therapist places one hand on lateral ankle and the other hand on medial knee 3. A varus force is applied with distal hand 4. (+) Test = excessive varus movement, may indicate LCL ligament sprain

27

Valgus Stress test

Purpose: Provocative test for MCL pathology
1. Patient is supine with knee flexed 20-30° 2. Therapist places one hand on medial ankle and the other hand on lateral knee 3. A valgus force is applied with distal hand 4. (+) Test = excessive valgus movement, may indicate MCL ligament sprain

28

Apley's Distraction

Purpose: Provocative test for ligamentous pathology
1. Therapist stabilizes patient’s femur with 1 hand and grasps heel with other hand 2. Therapist medial and laterally rotates tibia with distractive force 3. (+) Test = pain or laxity may indicate collateral ligament lesion

29

Anterior- Posterior Glide with Distraction

Purpose: To increase extension or flexion
1. Therapist applies a distraction force to the ankle with a mobilization belt or with the therapist’s knees 2. An anterior glide mobilization or posterior glide mobilization force is applied on proximal tibia

30

Anterior Glide Tibial Mobilization

Purpose: To increase extension
1. Patient is positioned at end of table with femur stabilized on a towel 2. The uninvolved limb stabilized with a mobilization belt 3. The therapist grasps the involved ankle 4. Apply anterior glide force to the proximal tibia