Knee Evaluation: Special Tests
Special tests
• Ligamentous
• Joint play
•
• Vascular
Special tests for fractures
Squeeze test
• Patient: supine
• Examiner: adjacent to injured leg, hands cupped
behind
• Action: gently squeeze the tibia/fibula, progress
towards site of pain
• Positive: pain; crepitus
• Pathology:
Bump test
• Patient: supine
• Examiner: standing in front of involved heel
• Action:
• Positive: pain
• Pathology: stress fracture of talus or leg
Special tests for sprains
Anterior Drawer Test
• Patient:
; Hip flexed to 45º &
knee flexed to 90º
• Examiner: Sits on foot of involved knee
• Thumbs:
• Index fingers:
•
•
•
Action: Tibia is drawn anteriorly
Positive: Increased anterior tibial translation;
lack of firm endpoint
Pathology:
• Notes: Multiple limiting factors
Lachman’s Test
• Patient: Lying supine; knee passively flexed to
20-25º
• Examiner: Lateral to patient
• Hand 1
• Hand 2 grasps femur just proximal to
condyles
• Action: Tibia is drawn anteriorly while posterior
pressure applied to femur
• Positive: ↑ anterior tibial translation; lack of
firm endpoint
• Pathology:
• Notes: Multiple modifications –
examiner specific
Notes
Posterior drawer test
• Patient: Lying supine; Hip flexed to 45º and knee
flexed to 90º
• Examiner: Sitting on foot of involved knee
• Heels of both palms on anterior tibia
• Thumbs on joint line
• Action: Proximal tibia is
• Positive: Increased posterior translation; lack of
firm endpoint
• Pathology:
Valgus stress test
• Patient: Lying supine at edge of table
• Examiner: Standing lateral to patient
• Hand 1 supporting medial distal tibia
(
)
• Hand 2 grasps knee at lateral joint line
• Action: Valgus force applied to knee while distal
tibia is
• Done with knee in full extension and 2030º of flexion
• Positive: Increased laxity; lack of firm endpoint;
pain
• Pathology:
Varus stress test
• Patient: Lying supine at edge of table
• Examiner: Standing lateral to patient
• Hand 1 supporting lateral distal tibia
(near ankle)
• Hand 2 grasps knee at medial joint line
• Action: Varus force applied to knee while distal
tibia is
• Done with knee in full extension and 2030º of flexion
• Positive: Increased laxity; lack of firm endpoint;
pain
• Pathology:
Knee Evaluation: Special Tests
Special tests for other structures
Apley’s compression/distraction
• Patient: Lying prone with
• Examiner: Standing lateral to patient
• Action:
• Compression: Axial load placed
through tibia while
simultaneously internally and externally
rotating the tibia
• Distraction: Distraction of the tibia while
simultaneously internally and externally
rotating the tibia
• Positive:
•
Pathology:
• Notes: Remember differential diagnosis
w/pain during distraction & rotation.
Noble’s compression test
• Patient: Lying supine with knee flexed
• Examiner: Standing lateral to patient
• Hand 1 supporting knee with thumb just
proximal to
• Hand 2 controlling leg
• Action: Knee is passively extended and flexed
while applying pressure to
• Positive: Pain under thumb (typically at 30º)
• Pathology:
• AKA: IT Band Friction Syndrome
Apprehension test
• Patient: Lying supine with knee extended
• Examiner: Standing lateral to patient
• Action: Examiner attempts to
•
•
Positive: Apprehension on patient’s face; forcible
contraction of quadriceps
Pathology:
Clarke’s sign
• Patient: Lying supine with
• Examiner: Standing lateral to patient
• Hand 1 placed proximal to superior
patellar pole applying gentle downward
pressure
• Action: Patient
• Positive: Pain; inability to maintain contraction
• Pathology: Possible
;
many false positives
Notes