Knee Special Tests and Mobilizations questions and answers 100% correct

Knee Special Tests and Mobilizations questions and answers 100% correct Which Special Tests are used to diagnose an ACL tear? 1.) Lachman's Test 2.) Anterior Drawer Test 3.) Pivot Shift Test How do you perform the Anterior Drawer test for the knee? 1.) Pt supine with both knees flexed to 90 degrees. Check for PCL integrity using the posterior sag sign 3.) Sit on patient's foot. 4.) Hands around tibia and draw forward. What is a positive Anterior Drawer test and how to you interpret the findings? Excessive translation of the tibia is a positive test and indicates that multiple structures are damaged. Normal translation is about 6 mm. If only the ACL is damaged, the test is typically negative because other structures limit movement (like the posterior capsule). Also, if the PCL is damaged, the knee will start in a posterior direction (not neutral) which will give you a false positive on the anterior drawer. What are the psychometric properties of the Anterior Drawer test? Sensitivity = 41-91% Specificity = 86-100% Pooled specificity of 92% in a meta-analysis of 1,420 patients with both acute and chronic ACL tears. This means that if you get a positive you can rule in an ACL tear with a high degree of accuracy. When would you use a Lachman's Test? You would use it early on to try to rule out an ACL tear because the test has a high sensitivity. How do you perform a Lachman's Test? 1.) Hold knee in resting position (25 degrees of knee flexion). Can also place thigh under their leg. 2.) Stabilize the femur with one hand, tug the tibia anteriorly with the other. 3.) Can also perform the test sitting EOB with their leg resting on your leg at 25 degrees flexion. How do you interpret a Lachman's Test? A mushy/soft end-feel is indicative of an ACL injury but this test is more useful if it is negative. When would you use a Pivot Shift Test? When you want to rule in an ACL tear because it has a high specificity. What were the findings of the systematic review by Scholten in 2003 regarding the ACL tests? 1.) The Anterior Drawer is not recommended because it has an unacceptably low sensitivity and specificity leading to many false negatives. 2.) The Pivot Shift test has a favorable positive predictive value. 3.) The Lachman test has good negative predictive value. How do you perform a Pivot Shift test? 1.) Pt supine. Hip in 30 flexion, knee in 30 flexion. 2.) Grasp the bottom of the foot and place other hand at the knee. 3.) IR the tibia (the "pivot"). 4.) Extend the knee causing the tibia to sublux anteriorly. 5.) Apply a valgus force to the knee while maintaining IR torque on the tibia. 6.) Knee is now flexed and at 30-40 degrees the tibia will reduce backwards. ("the shift") This reduction/shift is indicative of an ACL tear. What causes the reduction of the tibia during the pivot shift test? The IT band switches from an extensor to a flexor at about 30 degrees of flexion Which test is used to identify a PCL tear? Posterior Drawer Test 00:03 01:39 Which test is used to identify an MCL tear? Valgus Stress Test Which test is used to identify an LCL tear? Varus Stress Test What is a positive test on the Collateral Ligament Stress Test? Laxity is a positive test, not pain. What are the psychometric properties of the collateral ligament stress tests? They have a high sensitivity of 96% so they are most helpful if they are negative to rule out an MCL or LCL tear. What is the significance of finding a positive test at the collateral ligament stress tests when the knee is held at 0 degrees? At 0 degrees the knee is in a position of maximal stability so if you get a positive test at 0 degrees then other ligaments are involved (like the cruciate ligaments). Which Special Tests help diagnose a meniscal tear? 1.) Apley Test 2.) Bounce Home Test 3.) McMurray Test 4.) Thessaly Test What is the significance of an Apley test with compression? Significant for a meniscal lesion What is the significance of an Apley test with distraction? Significant for a ligamentous lesion. What is a positive Bounce Home test? Springy block end feel or lack of complete passive knee extension How do you perform the McMurray Test? 1.) Pt supine. Flex the knee to 90 degree. 2.) Fully rotate the tibia. (IR to test the lateral meniscus. ER to test the medial meniscus). 3.) Passively extend the knee while palpating the knee joint line. 4.) The same maneuver is performed in gradually increasing degrees of knee flexion to progressively load more posterior segments of the meniscus. What is a positive McMurray Test? Palpable thud or click; pain does not make a positive test. What is the significance of a positive McMurray Test? Detects flap tears in the posterior portion of the medial and lateral meniscus. You can get a false positive from inflamed place under the patella (not at the joint space) during a medial McMurray test. How do you perform a Thessaly test? 1.) Pt stands barefoot on one leg with the knee flexed to 20 degrees and holding the PT's hands. 2.) Rotates medially and laterally. What is a positive Thessaly test? Medial or lateral joint line discomfort or clicking/catching. What are the psychometric properties of the Thessaly test? High Specificity and High Sensitivity