Tests For Examination Of The Knee Everything You Need To Know Dr Nabil Ebraheim скачать в хорошем качестве

Tests For Examination Of The Knee Everything You Need To Know Dr Nabil Ebraheim

Join and support this channel.    / @nabilebraheim   Knee Examination Tests: McMurray's, Lachman's, Pivot Shift, and Reverse Pivot Shift The McMurray’s test is a knee examination method that detects pain or a painful click as the knee moves from flexion to extension with either internal or external rotation. It utilizes the tibia to trap the meniscus between the femoral condyle and the tibia. During the test, the patient should be lying supine with the knee flexed. The examiner holds the patient’s heel with one hand and positions the other hand over the knee joint. To test the medial meniscus, the knee is fully flexed, and the examiner passively externally rotates the tibia while applying a valgus force. The knee is then extended. For the lateral meniscus, the examiner passively internally rotates the tibia and applies a varus force before extending the knee. A positive McMurray's test is indicated by pain, clicking, or popping within the joint, which may suggest a tear of either the medial or lateral meniscus when the knee is brought from flexion to extension. Lachman’s test is recognized as the most sensitive and accurate test for examining an ACL injury. The patient should be supine and completely relaxed, ensuring that the hip, quadriceps, and hamstring muscles are relaxed. The examiner bends the knee to about 20-30°, stabilizes the femur with one hand, and with the other hand, pulls the tibia anteriorly and posteriorly against the femur. With an intact ACL, the examiner should feel an endpoint as the tibia is pulled forward. However, if the ACL is ruptured, the examination will feel softer, with no distinct endpoint, and the tibia will demonstrate more anterior translation than normal. Both the Lachman’s test and the Pivot Shift test are associated with 20-30° of knee flexion. The Lachman’s test starts at 20-30° of flexion, while in the Pivot Shift test, a clunk can be felt at 20-30° of flexion. This degree of flexion is critical for examining the ACL. During the Pivot Shift test, the patient is supine, and the examiner begins with the knee in full extension, adding a valgus force plus internal rotation of the tibia to increase rotational instability. The test starts with knee extension, and as the knee is taken into flexion, a palpable clunk, indicative of an ACL tear, can be felt. The iliotibial band reduces the tibia, creating the clunk on the outside of the knee. Always compare results with the other side for accuracy. The reverse Pivot Shift test is useful for diagnosing acute or chronic posterolateral knee instability. A significantly positive result indicates that the PCL, LCL, arcuate complex, and popliteofibular ligament are torn. The test begins with the patient in a supine position and the knee flexed to 90°. The examiner applies a valgus stress to the knee combined with an external rotation force and then brings the knee from 90° of flexion to full extension. As the tibia reduces from a posterior subluxed position around 20° of flexion, a shift and reduction of the lateral tibial plateau can be felt as it moves anteriorly from a posteriorly subluxed position, causing a clunk. This test is termed reverse Pivot Shift because the shift of the lateral tibial plateau occurs in the opposite direction to the true Pivot Shift seen in ACL tears. If the tibia is posterolaterally subluxed, the iliotibial band will reduce the knee as it transitions from a flexor to an extensor. It is crucial to compare this test to the contralateral knee. The Pivot Shift test is a hallmark for diagnosing ACL tears. The Posterior Sag test is performed with the patient supine and the knee flexed to 90°. The examiner stabilizes the foot and pushes backward on the tibia, observing if the tibia sags posteriorly, which would indicate a tear of the posterior cruciate ligament (PCL). The extent of translation in relation to the femur is observed, and the test is considered positive if there is excessive posterior translation of the tibia. During the Pivot Shift test, the clunk felt at 20-30° of flexion is most indicative of: A) Meniscus Tear B) ACL Tear C) PCL Tear D) Medial Collateral Ligament Injury Answer: B) ACL Tear