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SPECIAL TESTS FOR
THE KNEE

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

POSITION:

APPLICATION:

POSITIVE SIGN:

Q-Angle
Q-angle is defined as the angle between the quadriceps muscles and the
patellar tendon
...
The therapist is standing next to
the patient
...
The foot should be placed in a neutral position relative to
supination and pronation and the hip in a neutral position relative to medial and
lateral rotation
...
The angle formed by the
crossing of these two lines is called the Q-angle
...
Abnormal is a Q-angle less than 13 degrees or greater than 18
degrees
...
A Q-angle greater that 18 degrees indicates chondromalacia or a
subluxated patella
...
The normal measurement in this position is 0 degrees
...
p
...
p
...
800
...
6128

KNE • 73

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:
POSITION:

APPLICATION:

POSITIVE SIGN:
REFERENCE:

KNE • 74

Patellar Ballotment Test
Large amount of swelling in the knee joint
...
The therapist is standing next to the patient with the web
space of one hand placed approximately 15 cm
...

The examiner squeezes fluid out of the suprapatellar pouch in a distal direction
...

A tap or floating of the patella may be felt
...
p
...
p
...
p
...
800
...
6128

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:
POSITION:

APPLICATION:

POSITIVE SIGN:
REFERENCE:

Fluctuation Test
Significant joint effusion
...

The therapist is standing next to the patient with the palm of one hand
placed over the suprapatellar pouch and the palm of the opposite hand just
below the patella with the thumb and index finger just beyond the margins of the
patella
...

Fluctuation of synovial fluid
...
p
...
p
...
800
...
6128

KNE • 75

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

POSITION:

Fluid Displacement Test
Effusion of the knee joint
...
of synovial fluid
...
extra fluid within the knee
...
The therapist is standing next to
the patient with one hand placed about 15 cm above the patella
...
Maintain pressure proximally and
stroke on the medial side of the knee with the fingers of the opposite hand in a
proximal direction
...
Then stroke with the fingers
of the same hand on the lateral side in a proximal direction
...


POSITIVE SIGN:

A wave of fluid, if present, will pass to the medial side of the joint and bulge just
below the medial distal border of the patella
...


REFERENCE:

KNE • 76

A
...
498-499
B
...
196 (minor effusion)
C
...
417-418 (Brush-Stroke Wipe Test)

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is supine with the knee extended
...

While applying gentle pressure down onto the patella the patient is asked to
perform an active quadriceps contraction
...

Retropatellar pain and inability to maintain contraction
...
p
...
p
...
419 (Zohler’s Sign)

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is supine with the knee extended
...

Force the patella into the patellar groove with strong pressure and then grind it
medially and laterally
...

Pain with patellar compression and movement
...
p
...
800
...
6128

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

Berman’s Test
Articular cartilage of the patella
...
The therapist is standing with the stabilizing hand on the patella and the
operating hand distal on lower leg
...


POSITIVE SIGN:
REFERENCE:

Crepitus of patella
...
p
...
800
...
6128

KNE • 79

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

POSITION:

Stutter Test
Patellofemoral joint and patellar tracking
...
)
The patient is seated on the edge of the examining table with both knees flexed to
90 degrees
...
Place a finger on the patella to
palpate during movement
...


POSITIVE SIGN:

The patella will stutter or jump somewhere between 60 and 45 degrees of knee
flexion
...
p
...
p
...
800
...
6128

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

Passive Lateral Patellar Tilts
Lateral retinaculum
...

The therapist is standing next to the patient with the fingers on the medial
patellar pole and the thumb of the same hand underneath the lateral patellar
pole
...

The patella should remain in the femoral trochlea and should not be pushed
medially or laterally
...
Patients with angles
less than this are prone to chondromalacia
...
p
...
800
...
6128

KNE • 81

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

Valgus Stress, Medial Gap
In full extension the following structures may have been injured to some degree:
medial collateral ligament (superficial and deep fibers), posterior oblique
ligament, posteromedial capsule, anterior cruciate ligament, posterior cruciate
ligament, medial quadriceps expansion, semimembranosus muscle/ tendon
...


POSITION:

APPLICATION:

POSITIVE SIGN:

REFERENCE:

KNE • 82

The patient is supine with the knee relaxed in full extension
...
The therapist is standing next to the patient, supporting the patient’s
lower limb
...

Perform a valgus stress and medial gapping
...

Excessive gapping of the medial joint space
...

A
...
572-573
C
...
396

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

In 20 to 30 degrees flexion the following structures may have been injured to
some degree: lateral collateral ligament, posterolateral capsule, arcuatepopliteus complex, iliotibial band, biceps femoris tendon
...
The therapist is standing next to the patient or seated on the
table between the patient's lower limbs, facing the medial side of the involved
knee, supporting the patient’s lower limb
...


APPLICATION:

Perform varus stress and lateral gapping
...


POSITIVE SIGN:

Excessive gapping of the lateral joint space
...


REFERENCE:

A
...
574-575
C
...
396-397

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is supine with the knee flexed to 20 degrees
...
One hand grasps the medial tibia just below the tibial
tubercle
...


APPLICATION:

Pull the tibia firmly forward without allowing external rotation to occur
...


REFERENCE:

KNE • 84

A
...
536-537
C
...
397-400

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...


POSITION:

The patient is supine with the hip flexed to 45 degrees and the knee flexed to 90
degrees
...
The therapist is seated on the table and the patient’s
forefoot
...
Palpate the hamstrings for relaxation
...

Excessive forward movement of the tibia and lack of definite end-point
...

Differentiate between straight anterior instability: no rotation occurs;
anteromedial rotatory instability: medial tibial condyle subluxes anteriorly and
rotates laterally; anterolateral instability: lateral tibial condyle subluxes
anteriorly and rotates medially
...


REFERENCE:

A
...
488-489
B
...
186-187
C
...
400-401

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

B: Medial collateral ligament, posterior oblique ligament, posteromedial capsule,
anterior cruciate ligament
...
The foot is first placed in 30 degrees internal rotation (figure A)
...
The therapist is seated on the table and the patient’s forefoot
...


APPLICATION:

POSITIVE SIGN:

REFERENCE:

Figure A

KNE • 86

A
...

B
...

A
...

B
...

- Grade I: <1 mm; Grade II: 1-2 mm; Grade III: >2 mm
...
p
...
p
...
800
...
6128

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

POSITION:

Slocum’s “ALRI” Test (Lateral Pivot Shift Maneuver)
Anterior cruciate ligament, posterolateral capsule, arcuate-popliteus complex,
lateral collateral ligament, iliotibial band
...
The
uninvolved extremity is flexed 90 degrees at the hip and knee
...
The weight of the uppermost extremity is
supported by the inner aspect of the foot and heel of the uninvolved lower
extremity, creating a valgus stress and internal rotation of the tibia of the involved
extremity
...
The therapist is standing next to the patient, grasping the distal thigh
with one hand and the proximal tibia with the opposite hand
...


APPLICATION:

Gently push the knee into flexion, creating reduction of the tibia on the femur at
approximately 30 to 40 degrees flexion
...
The iliotibial band must be intact for the test to
work
...
p
...
800
...
6128

KNE • 87

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

POSITION:

APPLICATION:

POSITIVE SIGN:

REFERENCE:

Figure A

KNE • 88

Macintosh’s Test (Lateral Pivot Shift Test)
Anterior cruciate ligament, posterolateral capsule, arcuate-popliteus complex,
lateral collateral ligament, iliotibial band
...
The therapist is standing next to the patient
...
The palm
of the opposite hand is placed on the posterolateral aspect of the proximal tibia
with the thumb pointing down
...

Flex the patient’s knee gradually while forcing the knee into a valgus position,
and rotate the tibia internally (figure B)
...

A
...
540-541
C
...
404-405 ( Lateral Pivot Shift Maneuver)

Figure B

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is supine
...
Flex the knee to 90 degrees
...

Apply a valgus stress to the knee and internally rotate the tibia
...

Anterior subluxation of the lateral tibia with a jerk at about 30 degrees flexion,
with spontaneous reduction as extension is continued, indicating anterolateral
instability
...
p
...
p
...
800
...
6128

KNE • 89

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:
POSITION:

APPLICATION:

POSITIVE SIGN:

REFERENCE:

KNE • 90

Jerk Test (modified)
Anterior Cruciate Ligament
The patient is supine close to the edge of the table with the knee placed in 50-60
degrees of flexion
...

The therapist's hands apply a valgus stress to the knee and internal rotation of
tibia
...

Lateral tibial plateau subluxes with knee flexion, then relocates with a jerk as
extension is continued
...
p
...
p
...
p
...
p
...
800
...
6128

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

POSITION:

APPLICATION:

POSITIVE SIGN:

REFERENCE:

Figure A

Losee Test
Anterior cruciate ligament, posterolateral capsule, arcuate-popliteus complex,
lateral collateral ligament, iliotibial band
...
The therapist is standing next
to the patient
...
The knee is flexed to 30 degrees
...

Apply a valgus stress to the lateral joint space
...
Allow for medial rotation of the
foot by loosening the grip around the ankle
...

A
...
538-539
C
...
406-407

Figure B

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is supine with the hips flexed to 45 degrees and the knees flexed to
90 degrees
...

Observe the position of the tibia from the side and compare left with right
...

A
...
562-563
C
...
402-403

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is supine with the knee flexed to 90 degrees and the hip flexed to 45
degrees
...
rotation
...
Both hands are placed on
either side of the patient’s upper tibia with the thumbs parallel on either side of
the patellar tendon
...

Excessive movement of tibia of femur in posterior directions and lack of definite
end point
...

* Straight instability: no rotation occurs
...

* Posterolateral rotatory instability: lateral tibial condyle subluxes
posteriorly
...
p
...
p
...
800
...
6128

KNE • 93

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

POSITION:

APPLICATION:
POSITIVE SIGN:
REFERENCE:

KNE • 94

Posteromedial Drawer Test (Hughston)
Posterior cruciate ligament, posterior oblique ligament, medial collateral
(superficial and deep fibers), semimembranosus muscle, posteromedial
capsule, anterior cruciate ligament
...
The foot is resting on the table in 20 degrees medial rotation
...
Both hands are placed on
either side of the patient’s upper tibia with the thumbs parallel on either side of
the patellar tendon
...

Posterior subluxation or rotation of the tibia on femur
...
p
...
p
...
800
...
6128

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

POSITION:

APPLICATION:
POSITIVE SIGN:
REFERENCE:

Posterolateral Drawer Test (Hughston)
Posterior cruciate ligament, arcuate-popliteus complex, lateral collateral
ligament, biceps femoris tendon, posterolateral capsule, anterior cruciate
ligament, posterior oblique ligament, medial collateral (superficial and deep
fibers), semimembranosus muscle, posteromedial capsule
...
The foot is resting on the table in 15 degrees lateral rotation
...
Both hands are placed on
either side of the patient’s upper tibia with the thumbs parallel on either side of
the patellar tendon
...

Posterior subluxation or rotation of the tibia on femur
...
p
...
p
...
800
...
6128

KNE • 95

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:

Jacob’s Test (Reverse Pivot Shift Test)

STRUCTURE:

Posterior cruciate ligament, arcuate-popliteus complex, lateral collateral ligament,
biceps femoris tendon, posterolateral capsule, anterior cruciate ligament
...
The therapist faces the
patient
...
The opposite hand is placed
against the lateral side of the calf with the palm on the proximal fibula (figure A)
...
Extend the knee slowly while a valgus
force to the proximal tibia (figure B)
...


REFERENCE:

Figure A

KNE • 96

A
...
528-529
C
...
410-411

Figure B

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is supine with the knee flexed and quadriceps relaxed
...
The opposite hand supports the knee underneath
...

Limited knee extension with a “springy” or “rubbery” end feel
...
p
...
p
...
p
...
800
...
6128

KNE • 97

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:

POSITION:

APPLICATION:

POSITIVE SIGN:
REFERENCE:

Figure A

KNE • 98

McMurray’s Test
A
...

B
...

The patient is supine
...
Flex the knee maximally
...
Rotate the tibia into external rotation and gradually extend the knee (figure A)
to test the medial meniscus (posterior horn)
...
Rotate the tibia into internal rotation and gradually extend the knee (figure B)
to test the lateral meniscus (posterior horn)
...

A
...
542-543
B
...
191-192
C
...
413

Figure B

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is supine
...
Flex the knee maximally
...

If a “click” can be palpated and/ or pain is experienced
...
p
...
800
...
6128

KNE • 99

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:
POSITION:

APPLICATION:

Knee Quadrant Meniscus Test
Medial and lateral meniscus
...
The therapist is standing, with one hand cupping the anterior
knee and the other hand grasping around the distal lower leg, (distal tibia and
fibula just above the ankle) of the extremity to be tested
...
The joint line will be palpated for any
clicking or grinding
...
This will test the posterior quadrant of the medial meniscus
...
The joint line will be palpated for any
clicking or grinding
...
This will test the posterior quadrant of the lateral meniscus
...
The joint line will be palpated for
any clicking or grinding
...
This will test the anterior quadrant of the lateral meniscus
...
The joint line will be palpated for
any clicking or grinding
...
This will test the anterior quadrant of the medial meniscus
...


Phase I: Flexion / Internal rotation: Clicking due to meniscus trauma occurs in
the posterior medial quadrant
...

Phase II: Flexion / External rotation: Clicking due to meniscus trauma occurs in
the posterior lateral quadrant
...
Sometimes pain occurs from the same source, or
from the tension on the posterior horn collagen on the posterior medial side
...
Sometimes pain occurs from the same source, or
from the tension on the posterior horn collagen on the posterior lateral side
...
800
...
6128

SPECIAL TESTS FOR THE KNEE

Phase 1

Phase 2

Phase 3

Phase 4

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is prone
...

Maximally flex the knee
...

The patient experiences a painful “click”
...
p
...
800
...
6128

SPECIAL TESTS FOR THE KNEE
SPECIAL TEST:
STRUCTURE:
POSITION:

APPLICATION:

POSITIVE SIGN:

REFERENCE:

Apley’s Compression Test
Medial and lateral meniscus
...

The therapist is standing next to the patient with one hand on the plantar
aspect of the heel and foot
...

Perform a knee joint compression in varying degrees of flexion, combining
flexion with internal and external rotation
...
Less
flexion stresses the anterior meniscal horns
...

A
...
490-491
B
...
191-192
C
...
413

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is prone with the knee flexed to 90 degrees
...
The therapist's knee is placed on the distal thigh
...

Apply a distraction force in distal direction
...

A
...
490-491
B
...
191-192
C
...
413

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is supine with the uninvolved knee and hip extended
...

With the hip passively flexed at 90 degrees, extend the knee
...

A
...
350-351
B
...
256
C
...
267-268

Figure B

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is supine close to the edge of the table
...

With the patient’s knee extended, the therapist performs passive dorsiflexion of
the ankle (figure A)
...

Decreased flexibility in the gastrocnemius with the knee extended is noted
...

B
...
234

Figure B

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...
Ober originally described the
test with the knee flexed
...

The patient is side lying with the lower leg flexed at the knee and hip for stability
...

Flex the knee to 90 degrees
...

From this position, the therapist slowly lowers the leg, allowing it to drop
towards the table
...

A
...
470-471
B
...
167
C
...
354-355

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is prone
...

1) The patient actively flexes the knee (figure A)
...
If still negative, the therapist
passively extends the patient’s hip (figure C)
...

A
...
450-451
C
...
354

Figure B

Figure C
KNE • 108

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...

The patient is supine
...

Tap the medial aspect of tibial tubercle at the location of the saphenous nerve
...

B
...
195

Copyright © 1998 by The Ola Grimsby Institute • 1
...
646
...
800
...
6128



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