Download Palpation and Special Tests

Orthopedic Evaluation of the
Knee- Palpation and Special
Tests
Any knee injuries?
Evaluation Lab
Palpation
Bony Landmarks

Medial Aspect
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Medial Tibial Plateau
Med. Femoral Condyle
Medial Joint line

Lateral Aspect
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Lateral Tibial Plateau
Lat. Femoral Condyle
Head of Fibula
Gerdy’s Tubercle
Bony Landmarks (cont.)

Anterior Aspect
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Tibial Tubercle

Patella
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Superior Patellar
Border
Inferior Patellar Border
Around Periphery w/
knee relaxed
Around Periphery w/
knee in full extension
Soft-Tissue Palpation

Anterior Aspect
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Rectus Femoris
Vastus Lateralis
Vastus Medialis Obl.
Quadriceps Tendon
Pre-patella Bursa
Patellar Tendon
Tibial Tubercle
Medial Soft Tissue

Medial Aspect
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–
MCL
Pes Anserinus
Insertion (Sartorius,
Gracilis,
Semitendinosus)
Medial Plica
Soft-Tissue Palpation (cont.)

Posterior Aspect
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Baker’s Cyst
Popliteus
Medial and Lateral
Heads of
Gastrocnemius

Lateral Aspect
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LCL
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Iliotibial Band
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Fibular Head
Typical Pain Sites of the Knee
Special Tests
Patella Tests
Brush
Test
Ballottement
Clarke’s Test
Apprehension
Brush Test

Pt in supine with knee
supported on the table and
slightly flexed. PT places one
hand below the joint line on the
medial surface of the patella
and strokes proximally with the
palm and fingers as far as the
suprapatellar pouch. The other
hand then strokes down the
lateral surface of the patella. (+)
wave of fluid just below the
medial distal border of the
patella. Indicates knee effusion.
Ballotable Patella

Pt in supine with the
knee extended on
table. PT applies a
slight tap over the
center of the patella.
(+) patella appears to
be floating ("dancing
patella" sign).
Indicates retro-patellar
effusion.
Clarke’s Test

Pt in supine with knee
extended on table. PT
applies slight posterior
pressure with the web
space of their hand over
the superior pole of the
patella while PT instructs
the pt to contract the
quadriceps muscle. (+)
pain upon contraction.
Indicates patello-femoral
dysfunction.
Patella Apprehension Test

Pt in supine with the knees
extended on table. PT
places both thumbs on the
medial border of the
patella and passively
glides patella in lateral
direction. (+) look of
apprehension or an
attempt to contract the
quadriceps in an effort to
avoid subluxation.
Indicates (hx of) patella
subluxation or dislocation.
Ligamentous Tests
Valgus stress at 0 degrees = Capsule/MCL
 Valgus stress at 20-30 degrees =MCL
 Varus stress at 0 degrees = Capsule/LCL
 Valgus stress at 20-30 degree = LCL
 Anterior drawer = ACL
 Posterior drawer = PCL
 Lachman test = ACL
 Modified Lachman = ACL
 Posterior Sag = PCL
 Lateral Pivot Shift

Ligamentous Instability
Anterior Drawer Test

Pt in supine with the knee
flexed to 90 degrees and the hip
flexed to 45 degrees. PT
stabilizes the lower leg by
sitting on the forefoot and
grasps the patient's proximal
tibia with both hands placing
the thumbs on the tibial plateau.
PT administers an anterior
directed force to the tibia on the
femur. (+) excessive anterior
translation of the tibia on the
femur with a diminished or
absent end-point. Indicates
ACL injury.
Posterior Drawer Test

Pt in supine with the knee
flexed to 90 degrees and the hip
flexed to 45 degrees. PT
stabilizes the lower leg by
sitting on the forefoot and
grasps the patient's proximal
tibia with both hands placing
the thumbs on the tibial plateau.
PT administers an posterior
directed force to the tibia on the
femur. (+) excessive posterior
translation of the tibia on the
femur with a diminished or
absent end-point. Indicates PCL
injury.
Lachman Test

Pt in supine with knee
flexed to 20-30 degrees.
PT stabilizes distal femur
with one hand and places
other hand on proximal
tibia. PT applies anterior
directed force to tibia on
femur. (+) excess anterior
translation of tibia on
femur with
diminished/absent endpoint. Indicates ACL
injury.
Modified Lachman Test

Pt. is supine with hip at
45 degrees and knee at
30 degrees. PT places
bent knee under pt’s
knee. PT uses one hand
to stabilize femur and
other to draw tibia
forward. + if tibia
translates forward with
excess laxity and no
endpoint.
Lateral Pivot Shift Test

Pt in supine with knee
extended, hip flexed and ABD
to 30 degrees with slight IR. PT
grasps leg with one hand and
places other hand over lateral
surface of prox. tibia. PT IR
tibia and applies valgus force to
knee while knee slowly flexes.
(+) palpable shift/clunk
occurring between 20-40 deg.
flexion (resulting from
reduction of tibia on femur).
Indicates anterolateral rotary
instability/ACL integrity.
Posterior Sag Sign

pt in supine with
knee flexed 90 deg.
& hip flexed 45 deg.
PT observes position.
(+) tibia "sags"
posterior. Indicates
PCL injury.
Valgus Stress Test
Pt in supine with entire LE
supported and knee flexed to
20-30 deg. PT places one hand
on medial surface of ankle and
other hand on lateral surface of
knee. PT applies valgus force to
the knee with distal hand. (+)
excess valgus movement and/or
pain. Indicates MCL sprain.
Note: a (+) test with knee in full
extension may be indicative of
damage to MCL, PCL,
posterior oblique ligament,
posteromedial capsule
Varus Stress Test

pt in supine with entire LE
supported and knee flexed 2030 deg. PT places one hand on
lateral surface of ankle and
other hand on medial surface of
knee. PT applies varus force to
knee with distal hand. (+)
excess varus movement and/or
pain. Indicates LCL sprain.
NOTE: a (+) test with knee in
full extension may be indicative
of damage to LCL, PCL,
poterolateral capsule
Meniscal Tests
 McMurray’s
test-IR of the tibia
with knee extension = torn
lateral meniscus and vice-versa.
 Apley’s Compression
Meniscal Pathology
Apley’s Compression Test

Pt in prone with knee flexed 90
deg. PT stabilizes femur with
PT's hand. PT passively
distracts the knee joint then
slowly rotates tibia internally
and externally then apply a
compressive force through tibia
while continuing the rotation of
the tibia. (+) pain/clicking or
decreased motion during
compression indicates meniscal
dysfunction. (+) pain/clicking
or decreased motion during
distraction indicates
ligamentous dysfunction.
McMurray Test

Pt in supine with knee in full
extension. PT grasps distal
leg with one hand and
palpates knee joint line with
other. PT medially rotates
tibia and extends knee.
Repeat same while laterally
rotating tibia. (+) pain &/or
click over joint line.
Indicates dysfunction in
lateral meniscus with passive
IR of tibia and medial
meniscus with ER of tibia
Modified meniscal grind test
Flexion & extension of the knee with a
valgus stress = compression of the lateral
meniscus
 Flexion & extension of the knee with a
varus stress = compression of the medial
meniscus
 Pain with end-range flexion may = posterior
horn.
 Pain with end-range extension may =
anterior horn

Paul’s Meniscal Grind Test

Pt. is supine. PT
places a valgus stress
to the knee while
passively flexing and
extending the knee.
Pain in the lateral joint
is indicative of lateral
meniscal pathology.
Vice-versa for medial
meniscus.
Other Tests
Noble Compression Test
 Ober’s Test
 Q-angle
 Functional Squat- Look for:

-Ankle DF

-Knee Valgus

-Hip Varus

-Inability to keep back straight

•
IT Band Friction Syndrome
Noble Compression
Test
Pt in supine with the hip flexed

45 deg and the knee flexed 90
deg. PT places the thumb of one
hand over the lateral epicondyle
of the femur and the other hand
around the pt's ankle. PT
maintains pressure over the
lateral epicondyle while pt is
instructed to slowly extend the
knee. (+) pain over the lateral
femoral epicondyle at approx
30 deg of knee flexion.
Indicates iliotibial band friction
syndrome.
Q angle Measurement

Measurement of angle
b/w the quadriceps
muscle and the patellar
tendon. Normal is 13
deg for men & 18 deg
for women.
Landmarks for
measurement are the
ASIS, mid patella and
tibial tubercle.
Ober’s Test
Functional Squat
Selective tissue tension tests

Must differentiate between contractile and
non-contractile tissue (I.e. popliteus mm.
Vs. posterior horn of lateral meniscus)