Joint Line Tenderness
Purpose: To assess for meniscal injury.
Test Position: Sitting.
Performing the Test: With the patient sitting at the edge of the table and the patient's knees bent 90 degrees, palpate the lateral and medial tibiofemoral joint line. A positive test occurs when pain is produced.
Diagnostic Accuracy: Sensitivity: .63; Specificity: .77; +LR: 2.74; -LR: .53 ("Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis").
Importance of Test: According to Neumann, the menisci are crescent-shaped structures that help increase the concavity of the tibia for acceptance of the femoral condyles. They attach anteriorly and posteriorly to the intercondylar area of the tibia. Laterally, they adhere to the tibia loosely via the coronary ligaments (this allows some sliding of the menisci!). With its concave shape, the meniscus acts to decrease compressive forces of the knee by increasing the force distribution of the femoral condyles onto the tibia. Due to decreased blood supply to the inner aspects of each meniscus, an injury in this area is less likely to heal. The added pressure applied by the examiner stresses the menisci and can signal injury due to its partial proximity to the surface. The meniscus is usually injured through twisting motions on a slightly bent knee or sometimes through strong contractions of the semimembranosus, quadriceps, or popliteus, due to their attachments to the menisci. Whenever an injured meniscus is present or a meniscus is removed, the force distribution characteristic is loss and increased compressive forces are placed on the knee. These individuals have been found to have increased development of arthritis! Due to the low diagnostic accuracy of this test, it is important to combine it with the cluster that's located on the knee homepage when assessing for injury to the ligament.
Note: these tests should only be used by properly trained health care practitioners
Test Position: Sitting.
Performing the Test: With the patient sitting at the edge of the table and the patient's knees bent 90 degrees, palpate the lateral and medial tibiofemoral joint line. A positive test occurs when pain is produced.
Diagnostic Accuracy: Sensitivity: .63; Specificity: .77; +LR: 2.74; -LR: .53 ("Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis").
Importance of Test: According to Neumann, the menisci are crescent-shaped structures that help increase the concavity of the tibia for acceptance of the femoral condyles. They attach anteriorly and posteriorly to the intercondylar area of the tibia. Laterally, they adhere to the tibia loosely via the coronary ligaments (this allows some sliding of the menisci!). With its concave shape, the meniscus acts to decrease compressive forces of the knee by increasing the force distribution of the femoral condyles onto the tibia. Due to decreased blood supply to the inner aspects of each meniscus, an injury in this area is less likely to heal. The added pressure applied by the examiner stresses the menisci and can signal injury due to its partial proximity to the surface. The meniscus is usually injured through twisting motions on a slightly bent knee or sometimes through strong contractions of the semimembranosus, quadriceps, or popliteus, due to their attachments to the menisci. Whenever an injured meniscus is present or a meniscus is removed, the force distribution characteristic is loss and increased compressive forces are placed on the knee. These individuals have been found to have increased development of arthritis! Due to the low diagnostic accuracy of this test, it is important to combine it with the cluster that's located on the knee homepage when assessing for injury to the ligament.
Note: these tests should only be used by properly trained health care practitioners
|
|
References:
Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. "Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis." The Journal of orthopaedic and sports physical therapy. Sep 2007;37(9):541-550. Web. 09/05/2012.
Neumann, Donald. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd edition. St. Louis, MO: Mosby Elsevier, 2010. 526-528. Print.
Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. "Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis." The Journal of orthopaedic and sports physical therapy. Sep 2007;37(9):541-550. Web. 09/05/2012.
Neumann, Donald. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd edition. St. Louis, MO: Mosby Elsevier, 2010. 526-528. Print.
