Clinical Chiropractic Handbook - NIKITA VIZNIAK

(KNEE PATELLAR TESTS )CHAPTER 3 Step-up Bench Test • Dr. palpates patella • PI. step up on bench (+) Pain &/or crepitis 7 arthritis, DJD, sprain/strain Patella Facet Pinch Test • Dr. moves patella medially & laterally palpate facets (+) Facet tenderness 7 chondromalacia patella Patellar Aperp hension That makes me feel (Fairbanks) Test apprehensive doctor!!! • Dr. moves patella laterally, observe pI. for verbal & nonverbal signs of apprehension (+) Apprehension 7 patellar instability & potential dislocation Note: Humor - PI. shows apprehension, not Dr. © Adapted, with permission, from N M S Lab b y M A Carnes, D C . WSCC. 2001. � = may indicate/suggests, (+) = positive, (0) = negative, Pt. = patient, , DJD = degenerative joint disease UMNL = u er motor neuron lesion, LMNL = lower motor neuron lesion 114 CLINICAL CH IROPRACTIC HANDBOOK ©2003 NtKITAVIZNtAK

Apley's Compression • PI. prone wi knee flexed 90° • Dr. pushes down on foot & rotates internally & externally (+) Pain compression relieves by distraction -7 meniscal lesion Apley's Distraction • PI. prone wi knee flexed 90° • Dr. puts shin on posterior of pt.'s thigh, pull up on foot, & rotates internally & externally (+) Pain wi distraction -7 capsulelligament lesion Hyperflexion Test Same as Apley's compression, except pI. leg flexed to 130°-150°, may find posterior horn tears missed by Apley's compression Adapted, with permission, from NMS Lab by MA Carnes, DC. WSCC. 2001. -7 = may indicate/suggests, (+) = positive, (-) = negative, Pt. = patient, , DJD = degenerative joint disease UMNL = u er motor neuron lesion, LMNL = lowermotor neuron lesion ©2003NIKITAVIZNIAK CLINICAL CHIROPRACTIC HANDBOOK 1 15

(KNEE MENlseAL TESTS )CHAPTER ' Wilson's Test • PI. wi knees flexed 900 hanging over end of table, pI. actively extends leg: 1\" with tibia intemally rotated, then repeat 2'\" with tibia externally rotated • Dr. palpates popliteal fossa (+) Pain or apprehension � meniscal lesion or Osteochondritis '-.-':= Dessicans (0.0.) Steinman's Test/Sign • PI. supine leg up knee bent-90° • Dr, palpates around knee joint line & flexeslextends leg (+) Pain -7 rneniscal lesion, 0.0. McMurray's Tests • Dr. rotates tibia internally (with varus stress) & externally (with valgus stress) while applying long axis compression (+) Pain -7 meniscal lesion or plica Lateral meniscus ­ valgus wi exl. rol. Medial meniscus ­ varus wi inl. rol. Adapted, with permission, from NMS Lab by MA Carnes, DC. WSCC. 2001. � = may indicate/suggests, (+) = positive, (-) = negative, PI. = patient, , DJD = degenerative joint disease UMNL = u er motor neuron lesion, LMNL = lower motor neuron lesion 116 CLINICAL CHIROPRACTIC HANDBOOK ©2003NIKITAVIZNIAK

( CHAPTER 3 HIP) Allis' Leg Length Check Rectus Femoris Contracture PI. supine knees bent 90°. Observe knee heighl. Test (+) Uneven knee height -7 long/short femur/tibia, PI. supine same as Thomas test (+) Opposite leg extends -7 contracture of rectus pelvic misalignment, poor technique femoris Anvil Test Scour Test PI. supine w/ knees locked in extension, lift leg Same as IRAC except w/ long axis pressure -10° and heel is struck with increasing force applied to femur. 3 times Thomas Test (+) Pain in ipsilateral hip -7 DJD or inflammation of joint PI. supine, pull knee to chest (+) Opposite hip flexes -7 hip flexor contracture Bragrag d's PRONE TESTS SLR with dorsiflexion of at ankle (+) 'Electrical' 'shooting' pain down back of leg or Ely's Test thigh PI. prone, Dr. flexes knee- heel to opposite buttock Gaenslen's Test Hibb's Test PI. supine or side lying, pulls knee to chest, test is intended to provoke SI disorders, but may Flex knee and intemally rotate leg provoke femoral nerve or iliopsoas (+) SI pain -7 may be due to hip or SI pathology Internal Rotation Adicdut on Nachlas' Test Circumduction Test tlRAC) (Femoral nerve stretch test) pI. prone, Dr. flexes knee- heel to buttock PI. supine w/ knee & hip flexed, Dr. moves pI. leg (+) Pain in groin, upper thigh & buttock -7 hip (+) Pain or tightness of quadriceps, or femoral neuralgia or L2-L4 radiculopathy pathology [SCFE, arthritis, transient synovitis] Ober's Test (+) crepitus -7 arthritis PI. side posture, inferior leg flexed, lifts straight leg Laguerre's Test & passively adducts posteriorly 'FABER in the air' (+) .J. Adduction -7 ITB contracture Patrick's (FABER) Test Yeoman's Test PI. ends up with leg in figure four position PI. prone, knee flexed to 90°, Dr. lifts bent leg to (+) Pain/.J.ROM -7 pathology in hip (arthritis, put SI into extension contracture, etc) (+) Pain -7 SI, femoral nerve or iliopsoas contracture For pictures refer to the general orthopedics section of this chapter � = may indicate/suggests, (+) = positive, (-) = negative, PI. = patient, , DJD = degenerative joint disease I UMNL = upper motor neuron lesion, LMNL = lower motor neuron lesion 117) (©2003 NIKITAVIZNIAK CLINICAL CHIROPRACTIC HANDBOOK I