PEMERIKSAAN FISIK

LUTUT
Dr. Adam Herman, SpOk
FK Uniba
PATELLAR TAP / BALLOTABLE PATELLA
PATELLAR TAP / BALLOTABLE PATELLA
PATELLAR APPREHENSION TEST
 Evaluating the Patient
with a Knee Injury

• A positive Lachman test or Pivot test is strong

evidence of an existing anterior cruciate ligament
(ACL) tear, and a negative Lachman test is fairly good
evidence against that injury.
• Although widely used, the anterior drawer is the
least helpful maneuver for diagnosing an ACL tear.
• Joint line tenderness is not very helpful at ruling in or
ruling out meniscal injury, while a positive McMurray
test is most helpful for confirming the diagnosis.
 Lachman test
• Place patient supine on examining table, leg at
the examiner’s side, slightly externally rotated
and flexed (20 to 30 degrees).
• Stabilize the femur with one hand, and apply
pressure to the back of the knee with the
other hand with the thumb of the hand
exerting pressure placed on the joint line.
• A positive test result is movement of the knee
with a soft or mushy end point.
LIG CRUCIATUM ANTERIOR
LACHMAN TEST
LIG CRUCIATUM ANTERIOR
LACHMAN TEST
Modified Lachman Test
 Anterior drawer test
• Place patient supine, flex the hip to 45 degrees and the
knee to 90 degrees.
• Sit on the dorsum of the foot, wrap your hands around
the hamstrings (ensuring that these muscles are
relaxed), then pull and push the proximal part of the
leg, testing the movement of the tibia on the femur.
• Do these maneuvers in three positions of tibial
rotation: neutral, 30 degrees externally rotated, and 30
degrees internally rotated.
• A normal test result is no more than 6 mm to 8 mm of
laxity.
ANTERIOR DRAWER TEST
PERFORM AT 900 OF KNEE FLEXION
POSTERIOR CRUCIATE LIG
TIBIAL SAG
Posterior sag sign
Posterior drawer test
 Testing of collateral ligaments
•Valgus stress testing of the MCL
•The patient is in the supine position with the knee flexed 25-30 º.
•The examiner places one hand on the lateral knee and grasps the medial
ankle with the other hand. Then the knee is abducted.
•Pain and excessive laxity indicate stretching or tearing of the MCL.
•Perform the same technique as above with the knee extended. If
excessive knee joint laxity and pain are still noted, injury to the anterior
cruciate ligament also may be present.

•Varus stress testing of the LCL

•The patient is in the supine position with the knee flexed 20-25 º.
•The examiner places one hand on the medial knee and grasps the lateral
ankle with other hand. The knee is adducted.
•Pain and excessive laxity indicate injury to the LCL.
•Then perform the same technique as above with the knee extended. If
pain and laxity are still present, injury to the posterior capsule may be
present.
Medical Collateral Ligament
Valgus Stress Test of the MCL
Assess Integrity of Lateral Collateral
Ligament
Varus Stress Test to Assess LCL
Valgus stress to test the
medial collateral ligament Varus stress to test lateral collateral ligament
 McMurray test
• Flex the hip and knee maximally.
• Apply a valgus (abduction) force to the knee
while externally rotating the foot and
passively extending the knee.
• An audible or palpable snap during extension
suggests a tear of the medial meniscus.
• For the lateral meniscus, apply a varus
(adduction) stress during internal rotation of
the foot and passive extension of the knee
McMurray test
MENISCAL CARTILAGES
MCMURRAY TEST
 To stress the medial and lateral menisci, take the knee through several cycles of deep
flexion and partial extension. Deep flexion should bring the patient's heel nearly to the
buttock, and extension should bring the knee out to nearly 90° of flexion
 Swing the heel in "horseshoe-shaped" arcs of flexion and extension, while supplying
alternating inversion and eversion torque to the tibia. Note any palpable clicks or pain
Apley compression test Apley distraction test
 Pivot test
• Fully extend the knee, rotate the foot
internally.
• Apply a valgus stress while progressively
flexing the knee, watching and feeling for
translation of the tibia on the femur.
Bring the knee into full extension while maintaining a firm inversion torque on the tibia (as
though you were "screwing in" the tibia). Note any
medial or lateral joint pain or clicks.
Repeat the same sequence while maintaining a firm eversion torque on the tibia (as though
"unscrewing" the tibia). Again, note any pain or clicks.
 • Test for osteochondritis dissecans
Wilson’s sign (OCD) of the medial femoral condyle
of the knee using Wilson’s sign
• OCD is a condition in which a
fragment of cartilage and
subchondral bone separates from an
intact articular surface
• Flexes the hip and knee to 90°.
• Internally rotates the leg and then
slowly extends the knee
• When this maneuver elicits pain at
approximately 30° of flexion, the
patient has a positive Wilson’s sign
• When a positive Wilson’s sign is
elicited, the examiner next externally
rotates the leg, moving the tibial
spine away from the medial femoral
condyle. This external rotation
Should alleviate the patient’s pain in
a true positive Wilson’s sign
 Patellofemoral Pain Syndrome
• Patellofemoral pain is characterized by
– diffuse, aching, anterior knee pain which increases with
activities that load the patellofemoral joint: ascending or
descending stairs, kneeling and squatting, or after prolonged
sitting (car rides or movies).
• More common in women than men, it is usually not
associated with swelling or a history of prior injury.
• Physical examination is marked by anterior knee pain on
squatting and significant tenderness to palpation of the
patellar facets.
• The origin of patellofemoral pain is multifactorial, but
relative weakness/deconditioning of the quadriceps
muscles (especially the vastus medialis) may play an
important role in many patients