Pembimbing: dr. Deta Tanuwidjaja,Sp.KFR Mc Murray test • Examine of meniscus tear • Lie supine, legs flat in neutral position. One hand hold his heel and flex his leg fully • Place free hand on knee joint • Rotate the leg internally and externally loosen the knee joint • Push on lateral side to apply valgus stress to the medial side of the joint, at same time , rotating the leg externally. • Maintain valgus stress and external rotation , and extend the leg slowly as you palpate the medial joint line • If palpable or audible “click’ within the joint -> medial meniscus tear Reduction click • Applicable for patients • Position = McMurray with locked knee due to test torn, dislocated, or • Flex knee while it is heaped up meniscus rotated internally & • To reduce the displaced externally or torn portion of • Then rotate & extend meniscus by clicking it leg until you hear back into place “click”, as meniscus slips • To unlock a locked knee back to its proper (by torn meniscus) & position permit full extension Mc Murray test Apley compression test/grinding test • To aids dx meniscal tear • patient lie prone with one leg flexed to 90O • Gently kneel on the back of his thigh to stabilize it • While leaning hard on the heel to compress medial & lateral menisci • Rotate tibia internally & externally on femur as you maintain firm compression • Positive = pain + = meniscal tear • Pain on medial side = medial meniscal tear • Pain on lateral side = lateral meniscal tear Apley’s Distraction Test • To distinguish between meniscal & ligamentous problem of knee joint • Should follow Apley’s compression test • Remain in the same position after Apley’s compression test • Maintain stabilization of posterior thigh • Apply traction to leg • While rotating tibia internally & externally on femur • Positive = pain + = damaged ligaments • Negative = pain - = only the meniscus were torn, ligaments not damaged Bounce home test • To evaluate lack of full knee extension, secondary by torn meniscus, loose body within knee joint, intracapsular joint swelling • Patient supine • Cup his heel on your palm • Bend his knee into full flexion • Passively allow knee to extend • Positive = knee extend completely/ bounce home with sharp end point = normal • Negative = knee falls short, offering rubbery resistance to further extension = probably torn meniscus or other blockage Patellar Femoral Grinding Test • To determine quality of articulating surfaces of patella and trochlear groove of femur • Patient supine with legs relaxed in neutral position • Push patella distally in trochlear groove • Instruct him to tighten his quadriceps • Palpate & offer resistance to patella as it moves under your fingers • Negative = patella moves smooth & gliding • Positive = pain/ discomfort + Apprehension Test for Patellar Dislocation & Subluxation • To determine whether patella is prone to lateral dislocation • If you suspect patient has recurrent dislocating patella, attempt to manually dislocate it while observing his reaction face • Patient lie supine with legs flat & quadriceps relaxed • Press medial border of patella with your thumb • Negative = little reaction = normal • Positive = expression on patients face becomes one of apprehension & distress = patella begins to dislocate Tinel Sign • To elicit pain from tapping for neuromata on the end of a cut nerve • To the provocation of pain on the leading edge of a regenerating nerve • tap area around medial side of tibial tubercle (infrapatellar branch saphenous nerve) • Positive = tenderness over bulbous end of the severed nerve if neuroma has developed. • In knee surgery, this nerve frequently cut during removal of medial meniscus Test for Major Effusion • To examine effusion on knee joint • When joint distended by large effusion • Carefully extend patient’s knee • Instruct him to relax quadriceps m. • Push patella into trochlear groove & quickly release it
• Positive = ballotable patella;
large amount of fluid under patella first forced to the joint sides, then flows back to its former position, forcing patella to rebound Test for Minor Effusion • Keep patient’s knee extended • Milk the fluid from suprapatellar pouch & lateral side into medial side of knee
• Positive = Gently tap the
joint over the fluid, which will traverse knee to create fullness on lateral side KNEE JOINT EFFUSION TESTS These tests are designed to document suspected effusion in the knee joint. Test for Major Effusion. • When the joint is distended by a large effusion, carefully extend the patient’s knee • instruct him to relax the quadriceps muscles. • Then, push the patella into the trochlear groove and quickly release it. Test for Minor Effusion • keep your patient’s knee in extension, and then “milk” the fluid from the suprapatellar pouch and lateral side into the medial side of the knee. • When the fluid has been forced to the medial side, gently tap the joint over the fluid, which will traverse the knee to create a fullness on the lateral side TERIMA KASIH