Meniscus tear:
Tests:
- Joint line tenderness palpation:
Sensitivity = 83%
Specificity = 83%
Most clinical value.
1.Patient laying on back with knee flexed to 90º
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- Patient with knee at 90º makes it possible for us to palpate anterior surface of each meniscus
2. Medially rotate tibia in this position – makes medial meniscus more accessible as the femoral condyles push the medial meniscus forwards
3.palpate along the joint line and observe patient’s reaction
4.Lateral meniscus: rotate the tibia laterally and palpate along joint line
positive test = patients’ pain is reproduced
- Apley’s Grind Test:
Statistical accuracy of this test is 58% – meaning only 58% of patients were correctly diagnosed
- Patient laying on front
- Knee 90 degrees flexion
- perform distraction: by pulling leg up
- while performing distraction, medially and laterally rotate the leg
Excessive movement = positive test
- Then perform compression: by pushing leg down and medially and laterally rotate the leg
Decreased rotation or pain = positive test
Clinical impression:
If rotation + distraction is more painful or shows increased rotation compared to the normal side = more likely to be a ligament problem
If rotation + compression is more painful or shows decreased rotation compared to the normal side = more likely to be meniscus
Thessaly’s
- Test un-injured side and then injured side
- Stand on leg and then flex to 20º
- Rotate 3 times on each side
- positive if patient complaining of pain in joint line