lOMoAR cPSD| 60399657
NURS 612 Final Exam GYT
Comprehensive Knee & Ankle
Examination Techniques With Verified
Answers
• Knee examination techniques – o ACL (Anterior cruciate ligament):
Ballottement Tests: “Tap Test” for effusion
• POSITIVE: Patella floats or bounces back after tapping = effusion
• NEGATIVE: No movement (minimal)
Anterior Drawer Test: With patient supine, flex hip to 45 degrees and knee to
90 degrees. Sit on dorsum of the foot, wrap hands around hamstrings, then pull
and push the proximal part of the leg. Perform in 3 positions Neutral, 30
degrees external rotation, 30 degrees internal rotation.
• POSITIVE: Pain, laxity
• NEGATIVE: Solid, no pain
Lachman Test: With patient supine, leg slightly externally rotated and flexed at
examiner’s side, stabilize the femur with 1 hand and apply pressure to BACK of
the knee with other hand, with thumb on the joint line.
• TESTS SIDE OF THE KNEE
• POSITIVE: A positive test reveals increased laxity – often without a
definite end-point. Can be uncomfortable too if positive.
• NEGATIVE: Firm movement
Pivot Shift Test: Fully extend the knee and rotate the foot internally, apply a
valgus (ABDUCTION) force while progressively flexing the knee.
• POSITIVE: “clunking, pain” imitating feeling of ACL rupture
• NEGATIVE: No discomfort
o PCL (Posterior cruciate ligament):
Posterior drawer test: Patient should be supine on exam table with knees flexed to
90 degrees, assess for posterior displacement of the tibia (“sag” sign). Fix the
patient’s foot in a neutral rotation by sitting on the foot, position thumbs on the
tibial tubercle, place fingers at the posterior calf. Push posteriorly and assess for
• POSITIVIE: Posterior displacement of the tibia/laxity
• NEGATIVE: Firm resistance
Gravity “sag” sign near extension test: Resting position with the distal femur on
a 15 cm support and the heel resting on the exam table (20 degrees of flexion).
, lOMoAR cPSD| 60399657
POSITIVE: The unsupported proximal tibia displays a concave anterior
contour (“dip” below the knee when knee bent at rest)
Active Reduction “Quad Activation” of Posterior Tibial Subluxation: When
the patient raises the heel 2-3 cm, a normal anterior contour is restored. o
Meniscal:
Joint-Line Tenderness: Palpate medially or laterally along the knee to the joint
line between the femur and tibial condyles.
McMurray: Flex the hip and knee maximally. Apply a valgus (abduction) force
to the knee while externally rotating the foot and passively extending the knee.
• POSITIVE: An audible or palpable snap or click/pop with pain during
extension suggests a tear of the medial meniscus.
• Lateral meniscus – apply a varus (adduction) stress during internal
rotation of the foot and passive extension of the knee.
Thessaly Test: Hold patient’s outstretched hands while the patient stands flat
footed on the floor, internally and externally rotating the affected leg three times
with the knee flexed 20 degrees. The unaffected leg should be flexed to avoid
contact with the floor.
• POSITIVE: Patient reported pain at the medial or lateral joint line
• Ankle examination
Test Description
Anterior The examiner stabilizes the anterior distal leg with one hand & grasps the patient's
Drawer Test calcaneus and rear foot with their second hand. The examiner then places the patient's
foot into 10-15 degrees of plantar flexion and translates the rear foot anteriorly. A
positive test results if the talus translates forward.
Calf The examiner gently squeezes the calf. A positive test is considered when the ankle Squeeze
Test remains still or there is significantly less plantar flexion than the contralateral side.
(Thompson)
Squeeze Test The examiner grasps the patient's leg midway up the calf and performs a compress and
release motion. A positive test is considered if the patient experiences pain in the area
of the syndesmosis.
Tarsal The examiner maximally dorsiflexes the ankle, everts the foot, and extends all of the
Tunnel toes. Next, the examiner maintains this position for 5-10 seconds while tapping over
Syndrome the tarsal tunnel (just posterior to the medial malleolus). A positive test is complaints of
localized nerve tenderness and/or a positive Tinel's Sign.
Navicular First, mark the navicular tuberosity. Next, measure the height of the navicular bone
Drop Test with the subtalar joint in neutral and the patient bearing most of the weight on the
contralateral limb. Finally, have the patient assume equal weight on both feet and
remeasure the height of the navicular. The difference between the first and second
measurement is the navicular drop. A difference of >10 mm is considered significant
excessive foot pronation.
Talar Tilt The examiner stabilizes the distal leg in a neutral position and inverts the ankle. The
Test examiner then determines how much inversion is present. The amount present is
graded on a 4 point scale of 0-3, with 0 being no laxity and 3 being gross laxity. Flynn
describes an alternate method of grading as <5 degrees, 5-15 degrees, or >15 degrees.
, lOMoAR cPSD| 60399657
Under anesthesia, >15 degrees was associated with complete rupture of both the
anterior talofibular ligament and calcaneofibular ligament.
External The examiner maintains ankle dorsiflexion and externally rotates the foot on a
Rotation stabilized leg. A positive test occurs when pain in recreated in the area over the Test
interosseous membrane (syndesmosis region).
Metatarsal The examiner grasps the metatarsal of the suspected fracture and pushes it toward the
Loading Test calcaneus, providing an axial loading force. A positive test is reproduction of the
patient's symptoms.
Tap or The patient should not be wearing shoes. The examiner then strikes the heel of the
Percussion patient. A positive test is reproduction of the patient's worst pain. Test
Vibration The examiner places a tuning fork on the suspected site of the stress fracture.
Test
Impingemen Grasp the patient's calcaneus with one hand and the forefoot of the patient with a t
Sign second hand to bring the patient's foot into a position of plantarflexion. The examiner then
places his/her thumb over the anterolateral aspect of the ankle and brings the foot into dorsiflexion
and eversion. A positive test results when the patient experiences pain with pressure over the
anterolateral ankle and when the pain response is greater
with the ankle in dorsiflexion and eversion than in plantar flexion.
Test for Grasp the metatarsal bones of the two metatarsal between which is the suspected
Interdigital neuroma. Next, the examiner moves the metatarsal back and forth while compressing
Neuroma them. A positive test is reproduction of the patient's symptoms. Often these symptoms
are described as shooting, burning, or tingling pains.
Windlass Part 1: In sitting, the examiner stabilizes the ankle in neutral with 1 hand just
Mechanism proximal to the 1st metatarsal head. Next, the examiner extends the first phalange
Test while allowing the IP joint to flex. A positive test is considered if passive extension is continued to
end range or until the patient's pain is reproduced.
Part 2: The patient stands on a stool with the metatarsal heads just off the edge of the
stool. The patient is instructed to place equal weight on both feet. Again, the examiner
passively extends the first phalange while allowing the IP to flex. A positive test is
considered if passive extension is continued to end range or until the patient's pain is
reproduced.
• Musculoskeletal Exam o History!!
o Inspection, palpation, ROM, strength, joint-specific tests
• Muscle strength
• Casting education
NURS 612 Final Exam GYT
Comprehensive Knee & Ankle
Examination Techniques With Verified
Answers
• Knee examination techniques – o ACL (Anterior cruciate ligament):
Ballottement Tests: “Tap Test” for effusion
• POSITIVE: Patella floats or bounces back after tapping = effusion
• NEGATIVE: No movement (minimal)
Anterior Drawer Test: With patient supine, flex hip to 45 degrees and knee to
90 degrees. Sit on dorsum of the foot, wrap hands around hamstrings, then pull
and push the proximal part of the leg. Perform in 3 positions Neutral, 30
degrees external rotation, 30 degrees internal rotation.
• POSITIVE: Pain, laxity
• NEGATIVE: Solid, no pain
Lachman Test: With patient supine, leg slightly externally rotated and flexed at
examiner’s side, stabilize the femur with 1 hand and apply pressure to BACK of
the knee with other hand, with thumb on the joint line.
• TESTS SIDE OF THE KNEE
• POSITIVE: A positive test reveals increased laxity – often without a
definite end-point. Can be uncomfortable too if positive.
• NEGATIVE: Firm movement
Pivot Shift Test: Fully extend the knee and rotate the foot internally, apply a
valgus (ABDUCTION) force while progressively flexing the knee.
• POSITIVE: “clunking, pain” imitating feeling of ACL rupture
• NEGATIVE: No discomfort
o PCL (Posterior cruciate ligament):
Posterior drawer test: Patient should be supine on exam table with knees flexed to
90 degrees, assess for posterior displacement of the tibia (“sag” sign). Fix the
patient’s foot in a neutral rotation by sitting on the foot, position thumbs on the
tibial tubercle, place fingers at the posterior calf. Push posteriorly and assess for
• POSITIVIE: Posterior displacement of the tibia/laxity
• NEGATIVE: Firm resistance
Gravity “sag” sign near extension test: Resting position with the distal femur on
a 15 cm support and the heel resting on the exam table (20 degrees of flexion).
, lOMoAR cPSD| 60399657
POSITIVE: The unsupported proximal tibia displays a concave anterior
contour (“dip” below the knee when knee bent at rest)
Active Reduction “Quad Activation” of Posterior Tibial Subluxation: When
the patient raises the heel 2-3 cm, a normal anterior contour is restored. o
Meniscal:
Joint-Line Tenderness: Palpate medially or laterally along the knee to the joint
line between the femur and tibial condyles.
McMurray: Flex the hip and knee maximally. Apply a valgus (abduction) force
to the knee while externally rotating the foot and passively extending the knee.
• POSITIVE: An audible or palpable snap or click/pop with pain during
extension suggests a tear of the medial meniscus.
• Lateral meniscus – apply a varus (adduction) stress during internal
rotation of the foot and passive extension of the knee.
Thessaly Test: Hold patient’s outstretched hands while the patient stands flat
footed on the floor, internally and externally rotating the affected leg three times
with the knee flexed 20 degrees. The unaffected leg should be flexed to avoid
contact with the floor.
• POSITIVE: Patient reported pain at the medial or lateral joint line
• Ankle examination
Test Description
Anterior The examiner stabilizes the anterior distal leg with one hand & grasps the patient's
Drawer Test calcaneus and rear foot with their second hand. The examiner then places the patient's
foot into 10-15 degrees of plantar flexion and translates the rear foot anteriorly. A
positive test results if the talus translates forward.
Calf The examiner gently squeezes the calf. A positive test is considered when the ankle Squeeze
Test remains still or there is significantly less plantar flexion than the contralateral side.
(Thompson)
Squeeze Test The examiner grasps the patient's leg midway up the calf and performs a compress and
release motion. A positive test is considered if the patient experiences pain in the area
of the syndesmosis.
Tarsal The examiner maximally dorsiflexes the ankle, everts the foot, and extends all of the
Tunnel toes. Next, the examiner maintains this position for 5-10 seconds while tapping over
Syndrome the tarsal tunnel (just posterior to the medial malleolus). A positive test is complaints of
localized nerve tenderness and/or a positive Tinel's Sign.
Navicular First, mark the navicular tuberosity. Next, measure the height of the navicular bone
Drop Test with the subtalar joint in neutral and the patient bearing most of the weight on the
contralateral limb. Finally, have the patient assume equal weight on both feet and
remeasure the height of the navicular. The difference between the first and second
measurement is the navicular drop. A difference of >10 mm is considered significant
excessive foot pronation.
Talar Tilt The examiner stabilizes the distal leg in a neutral position and inverts the ankle. The
Test examiner then determines how much inversion is present. The amount present is
graded on a 4 point scale of 0-3, with 0 being no laxity and 3 being gross laxity. Flynn
describes an alternate method of grading as <5 degrees, 5-15 degrees, or >15 degrees.
, lOMoAR cPSD| 60399657
Under anesthesia, >15 degrees was associated with complete rupture of both the
anterior talofibular ligament and calcaneofibular ligament.
External The examiner maintains ankle dorsiflexion and externally rotates the foot on a
Rotation stabilized leg. A positive test occurs when pain in recreated in the area over the Test
interosseous membrane (syndesmosis region).
Metatarsal The examiner grasps the metatarsal of the suspected fracture and pushes it toward the
Loading Test calcaneus, providing an axial loading force. A positive test is reproduction of the
patient's symptoms.
Tap or The patient should not be wearing shoes. The examiner then strikes the heel of the
Percussion patient. A positive test is reproduction of the patient's worst pain. Test
Vibration The examiner places a tuning fork on the suspected site of the stress fracture.
Test
Impingemen Grasp the patient's calcaneus with one hand and the forefoot of the patient with a t
Sign second hand to bring the patient's foot into a position of plantarflexion. The examiner then
places his/her thumb over the anterolateral aspect of the ankle and brings the foot into dorsiflexion
and eversion. A positive test results when the patient experiences pain with pressure over the
anterolateral ankle and when the pain response is greater
with the ankle in dorsiflexion and eversion than in plantar flexion.
Test for Grasp the metatarsal bones of the two metatarsal between which is the suspected
Interdigital neuroma. Next, the examiner moves the metatarsal back and forth while compressing
Neuroma them. A positive test is reproduction of the patient's symptoms. Often these symptoms
are described as shooting, burning, or tingling pains.
Windlass Part 1: In sitting, the examiner stabilizes the ankle in neutral with 1 hand just
Mechanism proximal to the 1st metatarsal head. Next, the examiner extends the first phalange
Test while allowing the IP joint to flex. A positive test is considered if passive extension is continued to
end range or until the patient's pain is reproduced.
Part 2: The patient stands on a stool with the metatarsal heads just off the edge of the
stool. The patient is instructed to place equal weight on both feet. Again, the examiner
passively extends the first phalange while allowing the IP to flex. A positive test is
considered if passive extension is continued to end range or until the patient's pain is
reproduced.
• Musculoskeletal Exam o History!!
o Inspection, palpation, ROM, strength, joint-specific tests
• Muscle strength
• Casting education
