Complete the sentence:

You use the Sag Sign to assess the health of the 1) ... cruciate ligament, or else when you perform the 2) ... drawer test you may get a false 3)... for the 4)...  cruciate ligament.

You use the Sag Sign to assess the health of the 1) posterior cruciate ligament, or else when you perform the 2) anterior drawer test you may get a false 3) positive for the 4) anterior cruciate ligament.

Which meniscus are you assessing with McMurrays test when you put the knee into:

> External rotation?

> Which pressure accompanies this rotation?

> External rotation: assesses the medial meniscus

* heel in, push in = medial meniscus*

> Pressure is valgus

moderate to significant = fluctuation test

* significant to gross = patellar tap test*

Which two structures are you assessing when performing the Valgus stress test?

Valgus stress test assesses:

> MCL/medial collateral ligament

> posteromedial capsule

*tautest at 30^o and commonly injured 1^st*

*valgus stress test is with the knee in an extended position; this allows the knee to be taken into its maximal congruency and therefore enables one to assess the posteromedial capsule*

> gastrocnemius

> semitendinosus

> semimembranosus

> biceps femoris

Structures tested:

> LCL/lateral collateral ligament

> posterolateral capsule

*knee extended = knee is in its maximal congruency=enables to test LCL + posterolat. capsule*

*knee flexes= assesses LCL & sometimes ITB*

True or false?

Appley's distraction enables to differentiate between LCL and MCL pain.

False: With Appley's distraction, you are not able to differentiate between the LCL and MCL

*positive sign = pain in either ligament*

> Sag sign : rule out false positive

> Palpate hamstrings: rule out false negative

*positive sign: pain/↑ movement compared to the unaffected leg*

Flexio

semitendinosus, semimembranosus, biceps femoris, gastrocnemius

*injury to prime movers*

*1^o n. root: L5, S1-S2*

Extension

Rectus femoris, vastus medialis, vastus lateralis, vastus intermedius

* injury to the prime movers*

*1^o n root: L2, L3, L4*

Which muscles may have pain/limitation with interal rotation of the knee, in active resisted?

Internal rotation

Semitendinosus, semimembranosus, gracilis

* caused injury to the prime movers*

*1^o n. root: L5, S1, S2*

External rotation

biceps femoris

*caused by injury to the prime mover*

*1^o n. root: L5, S1, S2*

Extension = 1^o n root L2, L3, L4

*Flexion + Internal rotation + External rotation = 1^o n root L5, S1, S2*

Lachman's test: assess integrity of the anterior cruciate ligament/ACL

*positive sign: pain/↑ movement or soft mushy end feel in comparison to the unaffected leg*

Appley's compression assesses both menisci simultaneously

*positive sign: pain, possibly a click*

Bounce home test

Positive sign: when knee stops short or a rubbery resistance to full extension is felt

*this may be an indication of joint mice or meniscus flat (broken meniscus and hanging loose)*

Clarke's sign: assesses for chondromalacia patellae

*softness of the articular cartilage*

*positive sign: pain/palpable crepitus while client contracts quads mm (forces patella under your web space)*

Assess: Patellofemoral Pain Syndrome

*test quality of articular cartilage between posterior aspect of patella and femoral condyles*

> 30^o, 60^o, and 90^o of flexion

* MOI: wear and tear, off-tracking*

Patellar apprehension sign/test assesses for patella dislocation/subluxations

* + sign: client shows signs of apprehension or/and contracts quadriceps to bring patella back into alignment*

* more movement medially vs movement laterally of patella*

Noble compression test: assess for ITB Friction Syndrome/Runner's knee

> positive sign: usually at 30^o flexion, and point specific (same time of activity), proximal to lateral femoral condyle

*tx: stretch TFL, glut med + MFR on ITB*

*LCL can also be injured while running = do varus stress test to rule out*

Complete this sentence that is true to menisci:

Menisci possess ... nerves and the inner ... is avascular.

Menisci possess no nerves and the inner 2/3^rd is avascular.

True or false?

The anterior cruciate ligament prevents posterior translation of the femur from the tibia.

True

ACL:

> checks posterior translation of femur on tibia

> check anterior translation of the tibia from the femur

pain descending but not with climbing = PCL

*PCL prevents femur from translating forward but mostly from tracking with patella*

PCL

> prevents posterior translation of the tibia from the femur

> prevents anterior translation of the femur from the tibia

loose-packed = 25-30^o knee flexion

*allow for maximal area for swelling within knee*
*capsular pattern: flexion limited more than extension*

Brush/Stroke/Wipe test/ minor effusion test: assess for minimal swelling

*positive sign: swelling appearing inferomedial to the patella (of pulsative appereance)*

* swelling moving quickly = synovial fluid*

*swelling moving slowly = contains blood = refer out to MD*