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Minnesota State University, Mankato

Minnesota State University, Mankato
Athletic Training

Special Tests

Page address: http://ahn.mnsu.edu/athletictraining/spata/kneemodule/specialtests.html/

Brush/Sweep/Wipe Test

Steps
Patient is supine with his/her legs extended & relaxed
Examiner uses one hand just below the joint line on the medial side & strokes proximally toward the patient's hip 2–3 times
Examiner uses the other hand to stroke down the lateral side of the patella
Examiner observes for a fluid wave bulge just below the medial distal portion or patellar border
Positive Test
Fluid wave bulge just below the medial distal portion or patellar border
Positive Test Implications
Intracapsular effusion/swelling
See Test

Ballotable Patella Test

Steps
Patient lies supine while the examiner "milks" the knee capsule
Examiner ends by placeing proximal hand over the suprapatellar pouch and the distal hand (mainly the thumb and index finger of the distal hand) over the patella
Examiner compresses the suprapatellar pouch with the proximal hand and then compresses the patella into the femur
Positive Test
Patella moves downwardly and then rebounds once the pressure on the patella is removed; appearance of a floating or ballotable patella
Positive Test Implications
Indicative of moderate to severe effusion (depending on the amount of movement compared bilaterally)
See Test

NOTE: If a ballotable patella is present, the examiner should take joint line, proximal and distal girth measurements.

False positive – prepatellar bursitis may present with swelling in the same general area, however, the test is negative if the patella does not depress & rebound with pressure.

Valgus Stress Test (full extension)

Steps
Patient is supine with the involved leg close to the edge of the table and the knee in full extension
Examiner supports the medial portion of the distal tibia with one hand while the other hand grasps the knee along the lateral joint line
Examiner applies a medial (valgus) force to the knee & the distal tibia is moved laterally while the knee is in complete extension
Positive Test
Increased laxity, pain, and guarding
Positive Test Implications
Injury to the MCL, medial joint capsule; probable ACL/PCL involvement if there is no endpoint
See Test

Valgus Stress Test (25–30 degrees of flexion)

Steps
Patient is supine with the involved leg close to the edge of the table and the knee is flexed ~ 25–30 degrees
Examiner supports the medial portion of the distal tibia with one hand while the other hand grasps the knee along the lateral joint line
Examiner applies a medial (valgus) force to the knee & the distal tibia is moved laterally while the knee is in 25–30 degrees of flexion
Positive Test
Increased laxity, pain, guarding
Positive Test Implications
Injury to the MCL; No end point indicates a Grade 3 injury; solid end point with no laxity but pain indicates a Grade 1 injury
See Test

Varus Stress Test (full extension)

Steps
Patient is supine with the involved leg close to the edge of the table and the knee is in full extension
Examiner supports the lateral portion of the distal tibia with one hand while the other hand grasps the knee along the medial joint line
Examiner applies a lateral (varus) force to the knee & the distal tibia is moved medially while the knee is in complete extension
Positive Test
Increased laxity, pain, and guarding
Positive Test Implications
Injury to the LCL, lateral joint capsule, & arcuate ligament; probable PCL (& maybe ACL) involvement if there is no endpoint
See Test

Varus Stress Test (25–30 degrees of flexion)

Steps
Patient is supine with the involved leg close to the edge of the table and the knee is flexed ~ 25–30 degrees
Examiner supports the lateral portion of the distal tibia with one hand while the other hand grasps the knee along the medial joint line
Examiner applies a lateral (varus) force to the knee & the distal tibia is moved medially while the knee is in 25–30 degrees of flexion
Positive Test
Increased laxity, pain, and guarding
Positive Test Implications
Injury to the LCL; No end point indicates a Grade 3 injury; solid end point with no laxity but pain indicates a Grade 1 injury
See Test

Lachman's Test

Steps
Patient is supine with his/her knee passively flexed to approximately 20 degrees & hands crossed across his/her chest
Examiner's thumb of the same–side hand as the knee to be examined is placed at the anterior medial tibial plateau/joint line, while digits 2–5 are positioned posterior, slighty distal to the popliteal fossa
Examiner's contralateral hand is placed laterally around the distal femur, just proximal to the patella with the thumb anterior & the digits 2–5 are positioned posteriorly
Examiner sets the tibia by pushing posterior (to make sure the PCL is in tact)
Examiner provides an anterior force to the tibia while applying posterior pressure to the femur; repeats the process 2–3 times
Positive Test
Increased anterior tibial translation, pain
Positive Test Implications
ACL tear (primary posterolateral bundle but also the anteromedial bundle)
See Test

NOTE: The student may also use the Thigh Bolster modification to stabilize the femur.

Posterior Lachman's Test

Steps
Patient is supine with his/her knee passively flexed to approximately 20 degrees & hands crossed across his/her chest
Examiner's thumb of the same–side hand as the knee to be examined is placed at the anterior medial tibial plateau/joint line, while digits 2–5 are positioned posterior, slighty distal to the popliteal fossa
Examiner's contralateral hand is placed laterally around the distal femur, just proximal to the patella with the thumb anterior & the digits 2–5 are positioned posteriorly
Examiner sets the tibia by pushing anterior (to make sure the ACL is in tact)
Examiner provides a posterior force to the tibia while applying anterior pressure to the femur; repeats the process 2–3 times
Positive Test
Increased posterior tibial translation, pain
Positive Test Implications
PCL tear
See Test

NOTE: The student may also use the Thigh Bolster modification to stabilize the femur.

Anterior Drawer Test

Steps
Patient is lying supine with his/her hip flexed 45 degrees & knee flexed 90 degrees
Examiner sits on the patient's foot & grasps the tibia just below the joint line
Examiner's thumbs are placed along the joint line on either side of the patellar tendon & the index fingers are used to palpate the hamstring tendons
Examiner ensures that the patient is relaxed, esp. the hamstring tendons
Examiner draws the tibia straight forward (no rotation)
Positive Test
Increased anterior tibial translation, pain
Positive Test Implications
ACL tear (mainly the anteromedial bundle because the posterolateral bundle is basically laxed in this position)
See Test

Posterior Drawer Test

Steps
Patient is lying supine with his/her hip flexed to 45 degrees & knee flexed to 90 degrees
Examiner sits on the patient's foot & grasps the tibia just below the joint line
Examiner's thumbs are placed along the joint line on either side of the patellar tendon
Examiner ensures that the patient is relaxed, esp. the quadriceps
Examiner pushes the tibia posteriorly
Positive Test
Increased posterior tibial translation, pain
Positive Test Implications
PCL tear
See Test

Posterior Tibial Sag Test

Steps
Patient is lying supine with his/her hip flexed to 45 degrees & knee flexed to 90 degrees
Examiner sits on the patient's foot & grasps the tibia just below the joint line
Examiner's thumbs are placed along the joint line on either side of the patellar tendon
Examiner ensures that the patient is relaxed, esp. the quadriceps
Examiner pushes the tibia posteriorly
Positive Test
Increased posterior tibial translation, pain
Positive Test Implications
PCL tear
See Test

Quad Activating Test

Steps
Patient is lying supine with his/her hip flexed to 45 degrees & knee flexed to 90 degrees
Examiner observes the tibial tubercles for presence of a posterior sag
Examiner holds the patient's feet down against the table
Examiner instructs the patient to contract his/her quadriceps as if trying to straighten his/her knees
Examiner observes the tibial tubercle for anterior shifting upon quadriceps contraction
Positive Test
Anterior shift of the tibia upon quadriceps contraction
Positive Test Implications
ACL injury (if no posterior sag is present); PCL injury (if posterior sag is present)
See Test

Slocum Drawer Test (ALRI)

Steps
Patient is lying supine with his/her hip flexed to 45 degrees & knee flexed to 90 degrees
Examiner internally rotates the tibia 25 degrees
Examiner ensures that the patient is relaxed, esp. the hamstrings
Examiner sits on the patient's foot & draws the tibia anteriorly
Positive Test
Increased amount of anterior tibial translation with tibial internal rotation
Positive Test Implications
Sprain of the lateral joint capsule, ACL, and LCL(int. rotation) (plus other possible lateral structures)
See Test

Slocum Drawer Test (AMRI)

Steps
Patient lying supine with hip flexed to 45 degrees & knee flexed to 90 degrees
Examiner externally rotates the tibia 15 degrees to test for AMRI
Examiner ensures that the patient is relaxed, esp. the hamstrings
Examiner sits on the patient's foot & draws the tibia anteriorly
Positive Test
Increased amount of anterior tibial translation with tibial external rotation
Positive Test Implications
Sprain of the MCL, anteromedial capsule, & ACL (ext. rotation) (plus other possible medial structures)
See Test

Lateral Pivot Shift Test (ALRI)

Steps
Patient is supine with his/her hip passively flexed to 30–45 degrees and slightly abducted
Examiner grasps the distal lower leg and/or ankle & maintains ~20 degrees of tibial internal rotation
While maintaining internal rotation, examiner applies a valgus force to the knee while slowly flexing & extending
Positive Test
A palpable "clunk" occurs as the tibia's position on the femur reduces as the leg is flexed between 30–40 degrees & anteriorly subluxes during extension
Positive Test Implications
Sprain of the lateral joint capsule, ACL, and LCL(int. rotation) (plus other possible lateral structures)
See Test

Hughston External Rotation Recurvatum Test (PLRI)

Steps
Patient lies supine with the lower limbs relaxed
Examiner grasps the 1 st MT of each foot & lifts both feet off of the examining table
Examiner instructs the patient to keep his/her quadriceps relaxed & observes the tibial tuberosities
Positive Test
Affected knee goes into relative hyperextension on the lateral side with the tibia & tibial tuberosity rotating laterally
Positive Test Implications
Sprain of the lateral joint capsule, PCL, and can involve the LCL (plus other possible lateral structures)
See Test

McMurry's Test

Steps
Patient is supine
Examiner stands lateral & distal to the involved knee with one hand supporting the lower leg
Examiner positions thumb & index finger of the opposite hand in the anteromedial & anterolateral joint lines on either side of the patellar tendon
Examiner keeps the tibia in the neutral position, applies a valgus stress through knee flexion & varus stress through knee extension
Examiner internally rotates the tibia & applies a valgus stress through knee flexion & a varus stress through knee extension
Examiner externally rotates the tibia & applies a valgus stress through knee flexion & a varus stress through knee extension
Positive Test
Popping, clicking, or locking of the knee; pain from within the joint
Positive Test Implications
Possible meniscus tear
See Test

Bounced Home Test

Steps
Patient lies supine on the table
Examiner cups the patient's heel in his/her hand
Examiner flexes the patient's knee & allows the knee to passively extend
Positive Test
Knee extension is not complete or has a rubbery ("springy block") end feel; pain & guarding
Positive Test Implications
Possible meniscus tear (pain & springy block)
Possible posterior capsular sprain (pain & guarding but no springy block
See Test

Apley's Compression Test

Steps
Patient is prone with his/her knee flexed to 90 degrees
Examiner applies pressure to the plantar aspect of the heel, applying an axial load to the tibia while simultaneously internally & externally rotating the tibia
Positive Test
Pain; possible clicking
Positive Test Implications
Possible meniscus tear
See Test

Apley's Distraction Test

Steps
Patient is prone with his/her knee flexed to 90 degrees
Examiner grasps the lower leg & stabilizes the knee proximal to the femoral condyles
Examiner distracts the tibia away from the femur while internally & externally rotating the tibia
Positive Test
Pain from Apley's compression is reduced and/or eliminated during distraction
Pain occurs with distraction & rotation
Positive Test Implications
Possible meniscus tear with decreased pain // joint capsule or ligament sprain with increased pain
See Test

Wilson Sign Test

Steps
Patient is sitting with the knee flexed 90 degrees
Patient is instructed to internally rotate the knee and to maintain that position while extending the knee
Patient is instructed to stop knee extension at a point of pain, hold the knee at that point of motion, and then instructed to externally rotate the lower leg
Positive Test
Pain with internal rotation but a decrease in pain with external rotation
Positive Test Implications
Possible chondral or osteochondral defect of the joint
See Test

Ober's Test

Steps
Patient is lying on the side opposite that being tested
Examiner stabilizes the pelvis with one hand and the lateral side of the examiner's hip against the patient's pelvis
Examiner grasps the femur above the knee with the other hand & abducts & extends the hip
Examiner allows the hip to passively adduct to the table with the knee straight
Positive Test
Leg does not adduct past parallel
Positive Test Implications
IT Band tightness
See Test

Noble Compression Test

Steps
Patient is supine with the knee flexed
Examiner is positioned lateral to the patient on the involved side
Examiner supports the knee above the joint line with the thumb over or just superior to the lateral femoral condyle
Examiner applies pressure over the lateral femoral condyle, while the knee is passively extended & flexed
Positive Test
Pain underneath the thumb as the knee approaches 90 deg
Positive Test Implications
IT Band inflammation
See Test

Patellar Apprehension Test

Steps
Patient lies supine with his/her quadriceps fully relaxed
Examiner attempts to move the patient's patella laterally as far as possible with the patient's legs fully extended
Examiner flexes the knee ~ 30 degrees & attempts to move the patient's patella laterally as far as possible
Positive Test
Patient forcefully contracts quadriceps and/or demonstrates apprehension, c/o pain
Positive Test Implications
Patellar subluxation/medial patellar retinaculum sprain
See Test

Q Angle Test

Steps
Patient is lying supine with the knee fully extended
Examiner identifies & marks the ASIS, midpoint of patella & tibial tuberosity
Examiner places a goniometer so that: (a) Axis is located over the patellar midpoint; (b) The center of the stationary arm is over the line from the ASIS to the patella; (c) Moving arm is placed over the line from the patella to the tibial tuberosity
Positive Test
Q angle > 13 degrees (men) / 18 degrees (women)
Positive Test Implications
Increased lateral forces at the patellofemoral joint
See Test

Medial–Lateral Patellar Glide Test

Steps
Patient is supine & fully relaxed with the involved knee placed on a bolster so that it is flexed ~ 30 deg
Examiner glides the patella medially & laterally, taking care to avoid tilting
Positive Test
Hypomobile patella (< 1 quadrant); hypermobile patella (> 3 quadrants)
Positive Test Implications
Lateral or medial patellofemoral joint laxity depending on which side is stressed

Clark's Sign Test

Steps
Patient is lying supine with the knee in 30 degrees of flexion
Examiner places one hand on top of the patella & applies gentle downward pressure
Examiner asks patient to contract the quadriceps muscle while applying a downward pressure on the patella
Examiner repeats this test but with the knee flexed to 60 degrees
Positive Test
Patient experiences patellofemoral pain & cannot hold the contraction
Positive Test Implications
Chondromalacia patella
See Test

Stutter Test

Steps
Patient is sitting with his/her knee flexed over the edge of the table
Examiner stands lateral to the involved side, lightly cupping one hand over the patella
Examiner has the patient slowly extend his/her knee
Positive Test
Irregular patellar motion / stuttering between 40–60 deg
Positive Test Implications
Symptomatic medial synovial plica
See Test

Hughston Plica Test

Steps
Patient is supine with his/her knee flexed to 90 degrees
Examiner internally rotates the tibia & passively moves the patella medially while palpating the anteromedial capsule
Examiner flexes & extends the knee from 90 degrees to 0 degrees while the tibia is internally rotated
Positive Test
Pain and/or palpable clicking
Positive Test Implications
Symptomatic medial synovial plica
See Test