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Msc Manual Therapy The Knee

Msc Manual Therapy The Knee. objective Assessment: Hypothesis testing. Observation. Swelling: Diagnosed by MRI. Self reported swelling and Ballottment test best to identify effusion ( Kasteline , 2009). 62% certainty if negative . Alignment: Q-angle. Anteversion /retroversion.

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Msc Manual Therapy The Knee

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  1. Msc Manual TherapyThe Knee objective Assessment: Hypothesis testing.

  2. Observation Swelling: Diagnosed by MRI. Self reported swelling and Ballottment test best to identify effusion (Kasteline, 2009). 62% certainty if negative. Alignment: Q-angle. Anteversion/retroversion. Valgus/Varus. Patella position. Muscle bulk/tone. Leg length.

  3. Functional test Gait Squat Single leg dip Step up Step down Kneel Hop Functional activity relevant to agg and ease. Differential tests

  4. Active Movements Flexion Extension Medial rotation through range Lateral rotation through range Repeat Sustain Combine movements Speed alteration Differentiate arthrogenic, myogenic, neurogenic.

  5. Passive Movements Flexion Extension Medial rotation Lateral rotation F/Ab and F|Ad quadrant E/Ab and E/Ad quadrant Overpressure Sustained

  6. Muscle function Isometric Isotonic Through range strength PNF Flexibility Core stability

  7. Meniscal Tests Joint effusion, McMurrays and JLT combined may result in superior diagnostic accuracy (Scholtenet al 2001) Good history and several clinical tests may provide greater diagnostic accuracy than a specific physical test. Don't seem to apply to acutely injured knees, or those with degenerative menisci (Callaghan, Best Bet, 2008).

  8. Summary of sensitivity and specificity Meniscus evaluation should include McMurrays and JLT. Thessaly’s test has shown promise but future research is required to define it’s diagnostic accuracy (Chivers, 2009).

  9. ACL tests Lachmans Best acute ACL test Best on field test (+) test is a “mushy” or “empty” end-feel False (-) if tibia is IR or femur is not properly stabilized

  10. Anterior Drawer Test • (+) Test is increased anterior tibial translation over 6 mm • (+) test indicates: • ACL (anteromedial bundle) • posterior lateral capsule • posterior medial capsule • MCL (deep fibers) • ITB • Arcuate complex • False (-) if only ACL is torn • False (-) if there is swelling or hamstring spasm • False (+) if there is a posterior sag sign present

  11. Lateral Pivot Shift Maneuver • Tests for ACL and posterolateral rotary instability • Posterolateral capsule • Arcuate complex • (+) test is the tibia reduces on the femur at 30 to 40 degrees of flexion, subluxation of the tibia on extension

  12. Sensitivity and specificity

  13. PCL tests Posterior Drawer Test Rubenstein, et al 1994 found posterior drawer test 90% sensitive for PCL injury. 58% for Quadriceps Active Test & 26% for Reverse Pivot Shift Test. Clinical exam on whole was 96% effective in detecting PCL dysfunction

  14. Posterior Sag Test • Tests for posterior tibial translation • Tibia “drops back” or sags back on the femur • Medial tibial plateau typically extends 1 cm anteriorly • (+) test is when “step” is lost • (+) Test indicates: • PCL • Arcuate complex • ACL????

  15. MCL Valgus stress test • Assesses medial instability • Must be tested in 0° and 30° • (+) Test in 0° • MCL (superficial and deep) • Posterior oblique ligament • Posterior medial capsule • ACL/PCL • (+) Test in 30° • MCL (superficial) • Posterior oblique ligament • PCL • Posterior medial capsule • Grading Sprains: 1-3

  16. LCL Varus Stress Test • Assesses lateral instability • Must be tested in 0° and 20/30° flexion • (+) Test in 0° • LCL • Posterior Lateral Capsule • Arcuate Complex • PCL/ACL • (+) Test in 30° • LCL • Posterior lateral capsule • Arcuate complex • Grading Sprains

  17. PLC Reverse Lachmans Dial Test Prone, femur fixed. Ant drawer to end point. +vetibtuberosity and fib head move lat. Prone, knees flexed to 90˚. Externally rotate feet. +ve if effected foot moves ?15˚ more.

  18. Valgus Stress Test Hyperextension Full extension. 20˚ flex. If increase in movement think PLC. In standing/walking will have ext/lat thrust. Prone heels over bed: +ve if heel dropped.

  19. Patellofemoral Tests Clarke’s (grind) test No evidence. Many false positives. +ve if reproduces pain or unable to hold contraction.

  20. Compression test Apprehension test Force patella into trochlea. Monitor pain response. Flex knee to 20-30˚. Laterally displace patella.

  21. Accessrory Movements: neutral/through range Tibio femoral Tibio fibular Tibia: Femur: Fibular head:

  22. Patellofemoral Round the clock Rotation

  23. Other joints/structures Lumbar Thoracic SIJ Hip Foot and ankle Neural: PKB +/- slump, SLR +/- peroneal nerve bias

  24. Conclusion Have you confirmed/negated your hypothesis/es? Have you indentified subjective and objective markers for retesting ? What is your clinical impression? What is your prognosis for recovery? Formulate a treatment plan incorporating comparable findings, functional difficulties, patient specific goals and best available evidence. How will you progress treatment to ensure maximum recovery?

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