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GP INFORMATION

EXAMINATION TECHNIQUES

Trendelenburg Test

Trendelenburg test:   The patient is asked to stand on one leg for 30 seconds without leaning to one side. You observe to see if the pelvis stays level during the one-leg stance. In a positive Trendelenburg test, the pelvis drops towards the unsupported side. Another easier way of doing the test is to stand in the front of the patient and ask the patient to place his/her hands on to your hands and check the one-leg stance. In a positive Trendelenburg test, the patient puts more pressure on your hand to on the side opposite to the weight bearing leg. It can be confirmed by checking whether the pelvis drops on that side.

The test essentially evaluates the function of the hip abductors and could be positive with abductor tear, superior gluteal nerve palsy, as well as defective function of the hip abductors due to inadequate “lever” (for example supra trochanteric shortening in severe osteoarthritis or dysplastic hip). However, it should be notes that if the hip is painful, it would be unrealistic to expect the patient to do a prolonged single stance weight bearing test without support!

In this video the patient can be seen applying more pressure with her left hand when standing on her left side. She did have MRI proven abductor tear.  

EXAMINATION TECHNIQUES FOR HIPS

Hip Impingement Test

Impingement test: This is suggestive of hip impingement. The patient is placed supine on the examination table. The affected hip and knee are flexed to 90 degrees. The hip is then adducted and internally rotated in the flexed position. In a positive test, a sudden, often sharp pain is felt in the hip (reproducing the patient’s symptoms). However , it is important to understand that this manoeuvre  would be painful in a  number of hip conditions including hip arthritis although in those cases other movements are also likely to be painful.

Log Rolling Test

Log rolling: A very sensitive test to identify possible hip pathology (but not specific). With the hip in extension, the leg is gently rolled internally and externally. Reproduction of groin pain particularly during internal rotation suggest hip problem. However, it is likely to be negative in cases like hip impingement where the pain occurs in flexion activities.

EXAMINATION TECHNIQUES FOR KNEES

Wipe Test

Wipe Test:   This test is used to diagnose subtle effusion (when there is not enough fluid to do patellar tap test). The effusion is wiped in from the medial aspect and then wiped out from the lateral aspect. If there is fluid, a fluid bulge will be visible over the medial aspect). Wipe test is negative in the patient.

Clarke’s Test

Clarke’s Test:   This test is used to diagnose pain from the patello-femoral compartment (anterior knee pain which is quite a common condition). The examiner places his/her hand underneath the patient’s knee and the patient is asked to actively contract the quadriceps against the examiner’s hand. This is repeated with the examiner exerting pressure on the superior pole of the patella trying to prevent the proximal movement of the patella with the quadriceps contraction. While it can produce some discomfort even in normal people, the reproduction of the symptoms suggest pain from patello-femoral origin. I tend to do this as the last test in knee examination as sometimes the patients may feel as sharp pain.

Lachman Test Method 1

Lachman test (method 1): This is a better test to check for anterior instability (suggesting ACL injury)  than the anterior drawer test.  With the knee in about 30 degrees of flexion, the examiner  lifts the tibia anteriorly with one hand, while supporting the thigh with the other hand. If the anterior cruciate is ruptured, there is more anterior translation of the tibia when  compared to the opposite knee and there is no firm end point. Sometimes it is a difficult test to perform particularly if the patient is apprehensive or the patient is very muscular. In those instances, method 2 may be easier.

Lachman Test Method 2

Wipe Test:   This test is used to diagnose subtle effusion (when there is not enough fluid to do patellar tap test). The effusion is wiped in from the medial aspect and then wiped out from the lateral aspect. If there is fluid, a fluid bulge will be visible over the medial aspect). Wipe test is negative in the patient.

McMurray’s Test for Medial Mensicus

McMurray’s test (for medial meniscus):   This test is used to diagnose medial meniscal tear. The examiner feels the medial joint line with one hand. The knee is fully flexed and gradually extended while at the same time exerting a valgus force and external rotation to the knee. A painful clicking contributes a positive McMurray’s test suggesting a lateral meniscal tear. However, there may only be pain in many cases and it is not a very sensitive test. It may also be difficult to perform when there is an acute injury.

McMurray’s Test for Lateral Mensicus

McMurray’s test (for lateral meniscus):   This test is used to diagnose lateral meniscal tear. The examiner feels the lateral joint line with one hand. The knee is fully flexed and gradually extended while at the same time exerting a varus force and internal rotation of the knee. A painful clicking contributes a positive McMurray’s test suggesting lateral meniscal tear. However, there may only be pain in many cases and it is not a very sensitive test. It may also be difficult to perform when there is an acute injury.