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TRANSCRIPT
Evidence-‐Based Examination of the Knee and Thigh Practice Session & Skills Check-‐offs
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Evidence-‐Based Examination of the Knee and Thigh Presented by Eric Hegedus, PT, DPT, MHSC, OCS, CSCS Practice Sessions/Skill Check-‐offs Chapter Seven: Special Tests (45 minutes CEU Time)
Skilled Process
Review in
Chapter
Photo Description Check Off
Perform the McMurray’s test
Slide 6
The patient assumes a supine position. The examiner stands to the side of the patient’s involved knee. The examiner grasps the patient‘s heel and flexes the knee to end range with one hand while using the thumb and index finger of the other hand to palpate the medial and lateral tibiofemoral joint line. To test the medial meniscus, the examiner rotates the tibia into external rotation, then slowly extends the knee. To test the lateral meniscus, the examiner reflexes the knee but now internally rotates the pa-‐tient’s tibia and slowly extends the knee. A positive test traditionally is indicated by an audible or palpable “thud” or “click.”
Perform the Thessaly test
Slide 7
The patient stands on one leg facing the examiner and grasps the examiner’s hands. The patient flexes the knee to 20 degrees (partial squat) and rotates his or her body, first to the left and then to the right. Step 2 is repeated three times in each direction.
Evidence-‐Based Examination of the Knee and Thigh Practice Session & Skills Check-‐offs
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A positive test for meniscus tear is indicated by joint-‐line discomfort and possibly a sense of locking or catching.
Perform the Lachman’s test
Slide 10
The patient is supine with the knee flexed to 15 degrees. The examiner stabilizes the distal femur with one hand and grasps behind the proximal tibia with the other hand. The examiner then applies an anterior tibial force to the proximal tibia. A positive test for a torn ACL is indicated by greater anterior tibial displacement on the affected side when compared to the unaffected side.
Perform the Anterior Drawer test
Slide 11
The patient is supine with the knee flexed to 90 degrees so that the foot is flat. The examiner sits on the patient’s foot and grasps behind the proximal tibia with thumbs palpating the tibial plateau and index fingers palpating the tendons of the hamstring muscle group medially and laterally. An anterior tibial force is applied by the examiner. A positive test for a torn ACL is indicated by greater anterior tibial displacement on the affected side when compared to the unaffected side.
Perform the patellar apprehension test
Slide 15
The patient is positioned in supine with a relaxed knee passively flexed to 30 degrees over the side of the examining table, foot resting on the examiner. The examiner presses both
Evidence-‐Based Examination of the Knee and Thigh Practice Session & Skills Check-‐offs
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thumbs on the medial aspect of the patella to exert a lateral force. A positive test occurs when the patient shows signs of apprehension (resists the lateral force and attempts to extend the knee) or pain is reproduced.
Discuss the lack of special tests for ITBS and hamstring strains
Slide 18 How does a clinician know if a patient has these pathologies? Do you need special tests for either of them? Both of them?
Review the best clusters of tests for ACL, meniscus, MCL, patellofemoral dysfunction
Slide 8, 9, 12, 17
Learn the clusters; commit them to memory
Notes: