The Knee
Range of Motion
|
ROM Using a Goniometer (Norkin and White, 2003):
Flexion: 135-150 degrees Extension: 0 degrees |
Special Tests
Knee Research
Cluster for Meniscal Injury (Lowery et al, 2006):
-History of Joint Locking
(+) Joint Line Tenderness
(+) McMurray Test
-Pain with Flexion Overpressure
-Pain with Extension Overpressure
3 positive: Sn .31, Sp .9, +LR 3.15, -LR .77
4 positive: Sn .17, Sp .96, +LR 4.29, -LR .86
5 positive: Sn .11, Sp .99, +LR 11.45, -LR .9
-History of Joint Locking
(+) Joint Line Tenderness
(+) McMurray Test
-Pain with Flexion Overpressure
-Pain with Extension Overpressure
3 positive: Sn .31, Sp .9, +LR 3.15, -LR .77
4 positive: Sn .17, Sp .96, +LR 4.29, -LR .86
5 positive: Sn .11, Sp .99, +LR 11.45, -LR .9
Cluster for MCL Injury (Kastelein et al, 2008):
-History (1 or 2: external force, rotational trauma)
-Pain with Valgus Stress at 30 degrees
-Laxity with Valgus Stress at 30 degrees
Sn .56, Sp .91, +LR 6.4, -LR .5
-History (1 or 2: external force, rotational trauma)
-Pain with Valgus Stress at 30 degrees
-Laxity with Valgus Stress at 30 degrees
Sn .56, Sp .91, +LR 6.4, -LR .5
Clinical Diagnosis of Knee Osteoarthritis (Cibere et al, 2004):
-Age > 50 years
-Stiffness > 30 min.
-Crepitus
-Bony tenderness
-Bony enlargement
-No palpable warmth
At least 3 positive: Sn .95, Sp .69, +LR 3.1, -LR .07
Cluster for Patients with Knee OA Likely to Respond to Hip Mobilization (Currier LL et al, 2007):
-Hip or groin pain or paresthesia
-Anterior thigh pain
-Passive knee flexion <122 deg
-Passive hip IR < 17 deg
-Pain with hip distraction
1 variable: +LR 5.1
2 variables: +LR 12.9
-Age > 50 years
-Stiffness > 30 min.
-Crepitus
-Bony tenderness
-Bony enlargement
-No palpable warmth
At least 3 positive: Sn .95, Sp .69, +LR 3.1, -LR .07
Cluster for Patients with Knee OA Likely to Respond to Hip Mobilization (Currier LL et al, 2007):
-Hip or groin pain or paresthesia
-Anterior thigh pain
-Passive knee flexion <122 deg
-Passive hip IR < 17 deg
-Pain with hip distraction
1 variable: +LR 5.1
2 variables: +LR 12.9
Ottawa Knee Rules (Steil et al, 1999):
-Age > 55 years
-Isolated patellar tenderness without other bone tenderness
-Tenderness of the fibular head
-Inability to flex to 90 degrees
-Inability to bear weight immediately after injury and in the emergency department (4 steps) regardless of limping
(Adults): Sn 1.0, Sp .49-.56, +LR 1.8, -LR 0
(Pediatrics): Sn 1.0, Sp .43, +LR 1.8, -LR 0
Note: tests should only be used by properly trained health care practitioners
-Age > 55 years
-Isolated patellar tenderness without other bone tenderness
-Tenderness of the fibular head
-Inability to flex to 90 degrees
-Inability to bear weight immediately after injury and in the emergency department (4 steps) regardless of limping
(Adults): Sn 1.0, Sp .49-.56, +LR 1.8, -LR 0
(Pediatrics): Sn 1.0, Sp .43, +LR 1.8, -LR 0
Note: tests should only be used by properly trained health care practitioners
References:
Bachmann LM, Haberzeth S, Steurer J, et al. "The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review." Ann Intern Med 2004; 140(2):
121-124.
Bulloch B, Neto G, Plint A, et al. "Validation of the Ottawa Knee Rule in children: a multicenter study." Ann Emerg Med 2003; 42(1): 48-55.
Cibere J, Bellamy N, Thorne A, Esdaile JM, McGorm KJ, Chalmers A et al. "Reliability of the knee examination in osteoarthritis: effect of standardization." Arthritis
Rheum 2004; 50(2): 458-468.
Currier LL, et al. Development of a Clinical Prediction Rule to Identify Patients with Knee Pain and Clinical Evidence of Knee OA who Demonstrate a Favorable Short-Term Response to Hip Mobilization. Physical Therapy. 2007; 87(9): 1106-1119.
Kastelein M, Wagemakers HP, Luijsterburg PA, Verhaar JA, Koes BW, Bierma-Zeinstra SM. "Assessing medial collateral ligament knee lesions in general practice." The American journal of medicine. Nov 2008; 121(11):982-988 e982.
Ketelslegers E, Collard X, Vande BB, et al. "Validation of the Ottawa knee rules in an emergency teaching centre." Eur Radiol 2002; 12(5): 1218-1220.
Khine H, Dorfman DH, Avner JR. "Applicability of Ottawa knee rule for knee injury in children." Pediatr Emerg Care 2001; 17(6):401-404.
Lowery DJ, Farley TD, Wing DW, Sterett WI, Steadman JR. "A clinical composite score accurately detects meniscal pathology." Arthroscopy. Nov 2006; 22(11):1174- 1179.
Norkin C, White DJ. "Measurement of Joint Motion: A Guide to Goniometry." 3rd ed. Philadelphia: F.A. Davis Company, 2003. Print.
Stiell IG, Greenberg GH, Wells GA, et al. "Derivation of a decision rule for the use of radiography in acute knee injuries." Ann Emerg Med 1995; 26(4): 405-413.
Stiell IG, Greenberg GH, Wells GA, et al. "Prospective validation of a decision rule for the use of radiography in acute knee injuries." JAMA 1996; 275(8): 611-615.
Stiell IG, Wells GA, Hoag RH, et al. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries." JAMA 1997; 278(23): 2075-2079.
Stiell IG, Wells GA, McDowell I, et al. "Use of radiography in acute knee injuries: need for clinical decision rules." Acad Emerg Med 1995; 2(11):966-973.
Stiell IG, Wells GA, McKnight RD. Validating the "real" Ottawa Knee Rule." Ann Emerg Med 1999; 33(2):241-243.
Bachmann LM, Haberzeth S, Steurer J, et al. "The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review." Ann Intern Med 2004; 140(2):
121-124.
Bulloch B, Neto G, Plint A, et al. "Validation of the Ottawa Knee Rule in children: a multicenter study." Ann Emerg Med 2003; 42(1): 48-55.
Cibere J, Bellamy N, Thorne A, Esdaile JM, McGorm KJ, Chalmers A et al. "Reliability of the knee examination in osteoarthritis: effect of standardization." Arthritis
Rheum 2004; 50(2): 458-468.
Currier LL, et al. Development of a Clinical Prediction Rule to Identify Patients with Knee Pain and Clinical Evidence of Knee OA who Demonstrate a Favorable Short-Term Response to Hip Mobilization. Physical Therapy. 2007; 87(9): 1106-1119.
Kastelein M, Wagemakers HP, Luijsterburg PA, Verhaar JA, Koes BW, Bierma-Zeinstra SM. "Assessing medial collateral ligament knee lesions in general practice." The American journal of medicine. Nov 2008; 121(11):982-988 e982.
Ketelslegers E, Collard X, Vande BB, et al. "Validation of the Ottawa knee rules in an emergency teaching centre." Eur Radiol 2002; 12(5): 1218-1220.
Khine H, Dorfman DH, Avner JR. "Applicability of Ottawa knee rule for knee injury in children." Pediatr Emerg Care 2001; 17(6):401-404.
Lowery DJ, Farley TD, Wing DW, Sterett WI, Steadman JR. "A clinical composite score accurately detects meniscal pathology." Arthroscopy. Nov 2006; 22(11):1174- 1179.
Norkin C, White DJ. "Measurement of Joint Motion: A Guide to Goniometry." 3rd ed. Philadelphia: F.A. Davis Company, 2003. Print.
Stiell IG, Greenberg GH, Wells GA, et al. "Derivation of a decision rule for the use of radiography in acute knee injuries." Ann Emerg Med 1995; 26(4): 405-413.
Stiell IG, Greenberg GH, Wells GA, et al. "Prospective validation of a decision rule for the use of radiography in acute knee injuries." JAMA 1996; 275(8): 611-615.
Stiell IG, Wells GA, Hoag RH, et al. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries." JAMA 1997; 278(23): 2075-2079.
Stiell IG, Wells GA, McDowell I, et al. "Use of radiography in acute knee injuries: need for clinical decision rules." Acad Emerg Med 1995; 2(11):966-973.
Stiell IG, Wells GA, McKnight RD. Validating the "real" Ottawa Knee Rule." Ann Emerg Med 1999; 33(2):241-243.