BMS150 Student Version Practical Lab Manual Week 4 .pdf

Knee Assessment *What follows is key observations, anatomy palpation, ranges of motion, & special orthopaedic tests* Bony Palpation Medial Aspect • Medial Tibial Plateau • Tibial Tubercle • Medial Femoral Condyle • Adductor Tubercle Lateral Aspect Lateral Tibial Plateau • Lateral Femoral Condyle • H...

Knee Assessment *What follows is key observations, anatomy palpation, ranges of motion, & special orthopaedic tests* Bony Palpation Medial Aspect • Medial Tibial Plateau • Tibial Tubercle • Medial Femoral Condyle • Adductor Tubercle Lateral Aspect Lateral Tibial Plateau • Lateral Femoral Condyle • Head of the Fibula Anterior • Trochlear Groove and Patella Soft Tissue Palpation Anterior Aspect • Quadriceps • Infrapatellar Tendon • Superficial infrapatellar Bursa • Prepatellar Bursa • Pes Anserine Bursa Medial Aspect • Medial meniscus • Medial Collateral Ligament • Sartorius, Gracilis, and Semitendinosis Muscles Lateral Aspect • Lateral Meniscus • Lateral Collateral Ligament • Biceps Femoris Tendon • Ilio<bial Tract • Common Peroneal Nerve Posterior Aspect • Popliteal Fossa • Popliteal Artery • Gastrocnemius Muscle Ranges of Motion of Knee Active ROM (AROM) - Patient copies movement of practitioner or is told to move in particular direction Movements should be done in an order such that expected painful ones are done last and no residual pain is carried over from the previous movement. If very acute, some movements may be left out to avoid exacerbation of symptoms. ACTIVE ROM: • Flexion = 70 - 135 degrees • Patient Seated or standing • Bring heel to butt or squat • Extension = 0 - 15 degrees • Patient seated • Extend leg • Medial Rotation = 20 - 30 degrees • Patient seated • Internally rotate leg • Lateral Rotation = 30 - 40 degrees • Patient seated • Externally rotate leg Passive ROM • Patient seated • Examiner applies an over pressure to the end of each active ROM to assess end feel Resisted ROM • Patients is seated • Examiner resists all of the knee AROM • Assess for weakness Special Orthopaedic Tests Collateral Ligament Stability Test • Support the lower leg or ankle and apply a valgus stress to the knee to test the MCL • Then switch hands and apply a varus stress to the knee to test the LCL • These tests are done first in full extension then in 20- 30 degrees of flexion • Positive = excess movement or pain to the medial or lateral knee being tested • Indicates = Damage to the MCL or LCL Anterior and Posterior Drawer Test • Patient lying supine, flex knee and hip • Dr sits on patients foot, places hands around the knee with thumbs in the eyes of the knee (Medial and Lateral of Patellar Tendon) • Dr applies an anterior force to test for ACL. Repeat 2-3 times • Then Dr applies a posterior force to the tibia on the femur to test for PCL. Repeat 2-3 times • Positive = excessive movement of the tibia on the femur • Indicates = Anterior drawer = anterior cruciate instability, posterior drawer = posterior cruciate ligament instability Lachman Test • Patient supine, with involved leg beside examiner, examiner holds patients knee between full extension and 30 degrees flexion, femur is stabilized with one of examiners hands while proximal aspect of the tibia is moved forward with the other hand • Positive = Mushy or soft end feel when the tibia is moved forward on the femur And the infrapatellar tendon slope disappears • Indicates = Anterior cruciate ligament (especially the posterolateral band), instability test McMurray’s Test • Patient supine and Dr has one hand supporting the patients knee • The other hand externally rotates the tibia while taking the patient out of knee flexion • This procedure is done again but with internal rotation of the knee • Positive = A snap, click or pain to the lateral or medial knee • Indicates = Medial (on external rotation) or lateral (on internal rotation) meniscus damage (tear) Apley’s Distraction Test (Image A) • Stabilizing the patients thigh by placing your knee on it • Pull upwards on the tibia while stabilizing the patients thigh • Rotate the tibia internally and then externally • Positive = Pain in collateral ligaments, excessive motion • Indicates = Collateral ligament sprain Apley’s Compression Test (Image B) • Patient is prone, Dr flexes knee 90 degrees, laterally rotates tibia and pushes down • Next Dr medially rotates tibia and pushes down • Positive = Pain on medial side with lateral rotation or pain on lateral side with medial rotation • Indicates = Medial or lateral meniscus pathology Ober’s Test (Modified) • Patient is side lying, with his involved leg uppermost • Abduct and extend the thigh. While keeping the hip joint in neutral slowly lower the leg towards the table • If the IT band is normal, the thigh should drop to the adducted position • Positive = Thigh remains abducted when the leg is released • Indicates = Contracture of the IT band more than Glutei Med. Ober’s Test (ORIGINAL) • Patient is sidelying, with his involved leg uppermost • Abduct the leg and flex the knee to 90 degrees. While keeping the hip joint in neutral position to relax the IT band • If the IT band is normal, the thigh should drop to the adducted position • Positive = Thigh remains abducted when the leg is released • Indicates = Contracture of the Glute Medius more than IT Band Apprehension Test • Patient stands on the affected knee • Examiner pushes anteriorly and medially on the anterolateral part of the lateral femoral condyle crossing the knee joint • Patient is then asked to slightly flex the knee while examiner pushes with thumb • Positive = Condylar movement and a “giving way” sensation • Indicates = Posterolateral instability Bounce Home Test • Patient lies in the supine position • The heel of the patients foot is cupped in the examiner’s hand • Patients knee is then completely flexed • The knee is then passively allowed to extend • Positive = If extension is not complete or has a rubbery end feel (Springy block) • Indicates = Torn Meniscus Clarks Patellar Grind Test • Patient is supine with legs extended • Examiner presses down slightly proximal to the base of the patella with the web of the hand • Patient is then asked to contract the quadriceps muscles while the examiner pushes down • Positive = Pain or a grinding sensation • Indicates = Patellofemoral dysfunction Thessaly Test • Patient stands flat footed on the affected leg • Examine provides hand for balance • Patient then flexes the knee to 20 Degrees • While maintaining flexion, patient rotates medially and laterally 3 times • Positive = Medial or lateral joint discomfort • Indicates = Meniscus tear