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Special test of the knee

Oleh: dr. Darsuna Mardhiah


Pembimbing: dr. Deta Tanuwidjaja,Sp.KFR
Mc Murray test
• Examine of meniscus tear
• Lie supine, legs flat in neutral
position. One hand hold his heel
and flex his leg fully
• Place free hand on knee joint
• Rotate the leg internally and
externally loosen the knee joint
• Push on lateral side to apply
valgus stress to the medial side of
the joint, at same time , rotating
the leg externally.
• Maintain valgus stress and
external rotation , and extend the
leg slowly as you palpate the
medial joint line
• If palpable or audible “click’
within the joint -> medial
meniscus tear
Reduction click
• Applicable for patients • Position = McMurray
with locked knee due to test
torn, dislocated, or • Flex knee while it is
heaped up meniscus rotated internally &
• To reduce the displaced externally
or torn portion of • Then rotate & extend
meniscus by clicking it leg until you hear
back into place “click”, as meniscus slips
• To unlock a locked knee back to its proper
(by torn meniscus) & position
permit full extension
Mc Murray test
Apley compression test/grinding test
• To aids dx meniscal tear
• patient lie prone with one leg
flexed to 90O
• Gently kneel on the back of his
thigh to stabilize it
• While leaning hard on the heel to
compress medial & lateral
menisci
• Rotate tibia internally &
externally on femur as you
maintain firm compression
• Positive = pain + = meniscal tear
• Pain on medial side = medial
meniscal tear
• Pain on lateral side = lateral
meniscal tear
Apley’s Distraction Test
• To distinguish between meniscal
& ligamentous problem of knee
joint
• Should follow Apley’s
compression test
• Remain in the same position after
Apley’s compression test
• Maintain stabilization of posterior
thigh
• Apply traction to leg
• While rotating tibia internally &
externally on femur
• Positive = pain + = damaged
ligaments
• Negative = pain - = only the
meniscus were torn, ligaments
not damaged
Bounce home test
• To evaluate lack of full knee
extension, secondary by torn
meniscus, loose body within
knee joint, intracapsular joint
swelling
• Patient supine
• Cup his heel on your palm
• Bend his knee into full flexion
• Passively allow knee to extend
• Positive = knee extend
completely/ bounce home
with sharp end point = normal
• Negative = knee falls short,
offering rubbery resistance to
further extension = probably
torn meniscus or other
blockage
Patellar Femoral Grinding Test
• To determine quality of
articulating surfaces of
patella and trochlear
groove of femur
• Patient supine with legs
relaxed in neutral
position
• Push patella distally in
trochlear groove
• Instruct him to tighten his
quadriceps
• Palpate & offer resistance
to patella as it moves
under your fingers
• Negative = patella moves
smooth & gliding
• Positive = pain/
discomfort +
Apprehension Test for Patellar
Dislocation & Subluxation
• To determine whether patella is
prone to lateral dislocation
• If you suspect patient has
recurrent dislocating patella,
attempt to manually dislocate it
while observing his reaction face
• Patient lie supine with legs flat &
quadriceps relaxed
• Press medial border of patella
with your thumb
• Negative = little reaction = normal
• Positive = expression on patients
face becomes one of
apprehension & distress = patella
begins to dislocate
Tinel Sign
• To elicit pain from tapping
for neuromata on the end of
a cut nerve
• To the provocation of pain
on the leading edge of a
regenerating nerve
• tap area around medial side
of tibial tubercle
(infrapatellar branch
saphenous nerve)
• Positive = tenderness over
bulbous end of the severed
nerve if neuroma has
developed.
• In knee surgery, this nerve
frequently cut during
removal of medial meniscus
Test for Major Effusion
• To examine effusion on knee
joint
• When joint distended by large
effusion
• Carefully extend patient’s knee
• Instruct him to relax
quadriceps m.
• Push patella into trochlear
groove & quickly release it

• Positive = ballotable patella;


large amount of fluid under
patella first forced to the joint
sides, then flows back to its
former position, forcing patella
to rebound
Test for Minor Effusion
• Keep patient’s knee
extended
• Milk the fluid from
suprapatellar pouch &
lateral side into medial
side of knee

• Positive = Gently tap the


joint over the fluid, which
will traverse knee to
create fullness on lateral
side
KNEE JOINT EFFUSION TESTS
These tests are designed to document
suspected effusion in the knee joint.
Test for Major Effusion.
• When the joint is
distended by a large
effusion, carefully extend
the patient’s knee
• instruct him to relax the
quadriceps muscles.
• Then, push the patella
into the trochlear groove
and quickly release it.
Test for Minor Effusion
• keep your patient’s knee in extension, and then
“milk” the fluid from the suprapatellar pouch and
lateral side into the medial side of the knee.
• When the fluid has been forced to the medial side,
gently tap the joint over the fluid, which will
traverse the knee to create a fullness on the lateral
side
TERIMA KASIH