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    Pemeriksaan Fisik Lutut

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    Shone Nam
    The document provides guidance on performing physical examinations for common knee injuries, including tests for ligament tears like the Lachman test and anterior drawer test, meniscal injuries like the McMurray test, and other conditions like patellofemoral pain syndrome. Examiners are instructed on patient positioning, techniques for applying stress to the knee in different planes of motion, and what physical findings indicate positive results for each test.

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    Pemeriksaan Fisik Lutut

    Uploaded by

    Shone Nam
    45 views54 pages
    The document provides guidance on performing physical examinations for common knee injuries, including tests for ligament tears like the Lachman test and anterior drawer test, meniscal injuries like the McMurray test, and other conditions like patellofemoral pain syndrome. Examiners are instructed on patient positioning, techniques for applying stress to the knee in different planes of motion, and what physical findings indicate positive results for each test.

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    PEMERIKSAAN FISIK LUTUT

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    The document provides guidance on performing physical examinations for common knee injuries, including tests for ligament tears like the Lachman test and anterior drawer test, meniscal injuries like the McMurray test, and other conditions like patellofemoral pain syndrome. Examiners are instructed on patient positioning, techniques for applying stress to the knee in different planes of motion, and what physical findings indicate positive results for each test.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    45 views54 pages

    Pemeriksaan Fisik Lutut

    Uploaded by

    Shone Nam
    The document provides guidance on performing physical examinations for common knee injuries, including tests for ligament tears like the Lachman test and anterior drawer test, meniscal injuries like the McMurray test, and other conditions like patellofemoral pain syndrome. Examiners are instructed on patient positioning, techniques for applying stress to the knee in different planes of motion, and what physical findings indicate positive results for each test.

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    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

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