### Date : 2024-06-16 10:20
### Topic : Knee Joint Specific Physical Examination Tests #medicine #orthopedic
----
## 1. Valgus/Varus Stress Test
The Valgus and Varus stress tests are used to assess the integrity of the medial collateral ligament (MCL) and lateral collateral ligament (LCL), respectively.
**Valgus Stress Test (for MCL):**
1. **Positioning:** Have the patient lie supine on the examination table with their knee slightly flexed (20-30 degrees).
2. **Procedure:**
- Place one hand on the lateral aspect of the knee to stabilize it.
- With the other hand, hold the ankle and apply a lateral-to-medial (valgus) force to the knee while keeping the foot stable.
3. **Interpretation:**
- Pain or excessive gapping on the medial side of the knee indicates a positive test, suggesting MCL injury.
**Varus Stress Test (for LCL):**
1. **Positioning:** Similar to the Valgus test, have the patient lie supine with the knee slightly flexed.
2. **Procedure:**
- Place one hand on the medial aspect of the knee to stabilize it.
- With the other hand, hold the ankle and apply a medial-to-lateral (varus) force to the knee while keeping the foot stable.
3. **Interpretation:**
- Pain or excessive gapping on the lateral side of the knee indicates a positive test, suggesting LCL injury.
## 2. McMurray Test
The McMurray test is used to detect meniscal tears.
<Photos from: https://www.osmosis.org/learn/Special_tests_for_the_lower_limb> Thx. Osmosis!
<iframe title="McMurray Test | Meniscus Damage" src="https://www.youtube.com/embed/lwDFPAyGGgI?feature=oembed" height="113" width="200" allowfullscreen="" allow="fullscreen" style="aspect-ratio: 1.76991 / 1; width: 100%; height: 100%;"></iframe>
**Positioning:** Have the patient lie supine on the examination table.
**Procedure:**
1. Hold the patient's heel with one hand and the knee with the other hand, with the knee fully flexed.
2. **Medial Meniscus Test:**
- Externally rotate the tibia (turn the foot outward) and slowly extend the knee while applying a valgus stress (pushing the knee medially).
3. **Lateral Meniscus Test:**
- Internally rotate the tibia (turn the foot inward) and slowly extend the knee while applying a varus stress (pushing the knee laterally).
**Interpretation:**
- A positive McMurray test is indicated by a clicking, locking, or pain in the knee, suggesting a meniscal tear.
## 3. Drawer Test
The Drawer test assesses the integrity of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL).
<iframe title="Anterior Drawer Test | Anterior Cruciate Ligament Rupture" src="https://www.youtube.com/embed/IdnBKv38EEQ?feature=oembed" height="113" width="200" allowfullscreen="" allow="fullscreen" style="aspect-ratio: 1.76991 / 1; width: 100%; height: 100%;"></iframe>
### **Anterior Drawer Test (for ACL):**
**Positioning:**
- Have the patient lie supine with the knee flexed to 90 degrees and the foot flat on the table.
- Sit on the patient’s foot to stabilize it.
**Procedure:**
1. Grasp the proximal tibia with both hands, placing your thumbs on the tibial plateau.
2. Apply an anterior force (pulling the tibia forward) while ensuring the hamstring muscles are relaxed.
**Interpretation:**
- Anterior movement of the tibia greater than 6 mm compared to the unaffected knee suggests a positive test, indicating ACL injury.
### **Posterior Drawer Test (for PCL):**
**Positioning:** Similar to the Anterior Drawer test.
**Procedure:**
1. Grasp the proximal tibia with both hands, placing your thumbs on the tibial plateau.
2. Apply a posterior force (pushing the tibia backward) while ensuring the hamstring muscles are relaxed.
**Interpretation:**
- Posterior movement of the tibia suggests a positive test, indicating PCL injury.
### Summary
- **Valgus/Varus Stress Test:** Assesses MCL and LCL integrity.
- **McMurray Test:** Detects meniscal tears.
- **Drawer Test:** Evaluates ACL and PCL integrity.