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Apleys Compression Test

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1. Apley's Compression Test

Apley's Compression Test Apleys Compression Test Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Apley's Compression Test Apley's (...) Compression Test Aka: Apley's Compression Test , Apley's Distraction Test , Apley's Grind Test II. Indication Evaluation for knee III. Technique Images Patient position Patient lies prone on examining table Testing leg flexed to 90 degrees Compression Test Lean on patient's foot, applying pressure to heel Compresses tibia into femur Rotate tibia internally and externally on femur Distraction Test l gently on back of patient's thigh to stabilize Apply traction to leg pulling tibia from femur Rotate tibia

2018 FP Notebook

2. Apley's Compression Test

Apley's Compression Test Apleys Compression Test Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Apley's Compression Test Apley's (...) Compression Test Aka: Apley's Compression Test , Apley's Distraction Test , Apley's Grind Test II. Indication Evaluation for knee III. Technique Images Patient position Patient lies prone on examining table Testing leg flexed to 90 degrees Compression Test Lean on patient's foot, applying pressure to heel Compresses tibia into femur Rotate tibia internally and externally on femur Distraction Test l gently on back of patient's thigh to stabilize Apply traction to leg pulling tibia from femur Rotate tibia

2015 FP Notebook

3. Medical Concepts: I Kneed You – The Thessaly Test for Meniscal Injury

tears. Used in combination with the joint line tenderness test, McMurray’s test or the Apley’s test can increase the likelihood of the correct diagnosis and appropriate management. Remember that while these are important physical exam tests to perform, in the presence of other knee pathologies, these tests are no longer accurate. Used in the right patient – with the history suspicious for a meniscus injury, the Thessaly test can be a useful test to perform. Fareen Zaver MD Dr. Fareen Zaver (...) Medical Concepts: I Kneed You – The Thessaly Test for Meniscal Injury I Kneed You - The Thessaly Test for Meniscal Injury - CanadiEM I Kneed You – The Thessaly Test for Meniscal Injury In , by Maeghan Fu July 7, 2017 The Case You are working a shift in the ambulatory zone of your emergency department. Your next patient is a 27 year old female with a chief complaint of “lower extremity injury”. On history, her right knee has been sore for the past 2 days, with swelling and worsening pain since

2017 CandiEM

4. AIM Clinical Appropriateness Guidelines for Joint Surgery

of the following tests: o O’Brien (active compression) o Anterior slide o Biceps load (I and II) o Pain provocation o Crank Test o Jobe relocation o Forced shoulder abduction and elbow flexion o Resisted supination – external rotation ? MRI demonstrating a traumatic non-anatomic SLAP lesion consistent with subjective and objective findings ? Failure of at least twelve (12) weeks of conservative management Copyright © 2019. AIM Specialty Health. All Rights Reserved. Joint Surgery 14 Subacromial Impingement (...) osteophytes, joint subluxation, avascular necrosis or bone on bone articulations. The degree of joint space narrowing should also be noted. Tobacco Cessation – Adherence to a tobacco-cessation program resulting in abstinence from tobacco for at least six (6) weeks prior to surgery is recommended. Documentation of nicotine-free status by laboratory testing (e.g., cotinine level or carboxyhemoglobin) is recommended. After six (6) weeks of tobacco cessation, labs should be performed with ample time afforded

2019 AIM Specialty Health

5. Exam Series: Guide to the Knee Exam

Likelihood Ratio MM LM MM LM MM LM Joint line tenderness 71% 78% 87% 90% 5.46 7.80 McMurray 48% 65% 94% 86% 8.00 4.64 Apley’s 41% 41% 93% 86% 5.85 2.93 Thessaly 89% 92% 97% 96% 29.7 23.0 Clinical Utility of Special Tests for Meniscal Injury 7,8 Neurovascular exam: It is essential, especially in the case of trauma or suspected knee dislocation, to conduct a neurovascular exam as injury to the popliteal artery can result in loss of limb in as little as 8 hours. At the bedside, this involves locating distal (...) of the knees can be assessed by bending both the knee and hips to 90° while the patient lies supine, and then asking them to point their toes inwards (up to 30°) and outwards (up to 20°) Power: Check for power bilaterally, assessing for any muscular atrophy or spasm. Special tests: ACL Tear Rest both of your forearms on the patient’s tibia with their knee flexed to 90° and foot resting on the table. Pull forwards to elicit any anterior displacement. : Place one hand on the femur and the other

2018 CandiEM

6. AIM Clinical Appropriateness Guidelines for Joint Surgery

activities of daily living ? Symptoms aggravated by heavy lifting, pushing, and overhead motion ? Physical exam demonstrating a positive response to at least one of the following tests: o O’Brien (active compression) o Anterior slide o Biceps load (I and II) o Pain provocation o Crank Test o Jobe relocation o Forced shoulder abduction and elbow flexion o Resisted supination – external rotation ? MRI demonstrating a traumatic non-anatomic SLAP lesion consistent with subjective and objective findings (...) program resulting in abstinence from tobacco for at least six (6) weeks prior to surgery is recommended. Documentation of nicotine-free status by laboratory testing (e.g., cotinine level or carboxyhemoglobin) is recommended. After six (6) weeks of tobacco cessation, labs should be performed with ample time afforded to submit this confirmation and complete the prior authorization process. Diabetes – It is recommended that a patient with history of diabetes maintain hemoglobin A1C 8% or less prior

2017 AIM Specialty Health

7. Knee Surgery

, and nature of pain, including how it may manifest during sleep, and presence of any instability, locking, or problems with mobility and weight bearing are all important to assess. Clinical examination typically assesses and documents: range of motion, effusion, crepitus, tenderness, stability, and provocative tests e.g. McMurray’s, patellar apprehension, Apley’s, and Lachman’s tests. Clinically meaningful improvement in function is an improvement in pain and function of 30% over baseline [14] . This can (...) realignment procedure with or without lateral retinacular release Patellar dislocation History of acute traumatic dislocation Lateral tracking of the patella OR Recurrent effusion OR Positive patellar apprehension test OR Synovitis with or without crepitus OR Recurrent dislocations MRI (not x-ray or CT scan) shows: Medial Patellofemoral Ligament (MPFL) disruption OR Osseous contusion OR Cartilage injury 6 weeks of physical therapy is required for first time dislocation; physical therapy is not required

2016 Washington State Department of Labor and Industries

8. Conservative Management of Possible Meniscal Derangement Using the Mulligan Concept: A Case Report (PubMed)

tenderness, a positive Apley's compression test, and a positive Thessaly's test at 20° of knee flexion. A working diagnosis was established of a meniscal pathology with the differential diagnoses of meniscal derangement and synovial plica.The patient received 3 total treatments using the Mulligan concept over the course of 11 days. The treatments included the application of a tibia internal rotation mobilization with movement and the "squeeze" technique to the affected knee. Patient outcomes, including

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2017 Journal of chiropractic medicine

9. Meniscal tear presentation, diagnosis and management

the meniscus is compressed between the tibia and femur 32 Figure 2. Apley test (grinding) test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. The clinician applies axial pressure to the foot and rotates the tibia internally and externally. Pain and/or clicking on compression suggest a meniscal lesion 1,32 Figure 3. Thessaly test: The clinician holds the patient's outstretched hands for support, while the patient stands flat-footed with their knee flexed to 20 degrees (...) be significant quadriceps wasting. McMurray (Figure 1) and Apley tests (Figure 2) are often positive, although these are specific but not sensitive – specificity being 57–98% and 80–99%, and sensitivity being 10–66% and 16–58% respectively. 2,9 The most useful clinical test for meniscal injury is the Thessaly test, which is demonstrated in Figure 3 . Although rarely taught and poorly utilised, recent validation demonstrated a sensitivity of 90%, and specificity of 98% in detecting meniscal injury. 10

2012 Clinical Practice Guidelines Portal

10. Collateral Ligament Pathology, Knee (Diagnosis)

a grade 1 sprain. Pain and opening of the joint space up to 10 mm with an endpoint indicates a grade 2 injury to the MCL. Complete joint space opening of more than 10 mm indicates a grade 3 injury. Marked medial laxity suggests possible concomitant knee ligament injuries or reduced . Careful evaluation of the medial joint line and tests for should also be performed to confirm that the pain is due to stress of the ligament and not to mechanical pain from a torn medial meniscus. The Apley grind (...) /distraction test can be helpful but not entirely diagnostic or specific for this. With the patient prone, the knee is flexed to 90 degrees and the foot and ankle are grasped. The tibia is then rotated on the femur with distraction and compression of the tibia on the femur. If pain is generated in the unloaded situation, in which the ligament is stretched, then the medial pain is likely due to ligamentous or capsular injury. If the pain is worsened by compression, then a meniscal or chondral origin

2014 eMedicine Surgery

11. Meniscus Injuries (Diagnosis)

test – Asymmetric pain with external (medial meniscus) or internal (lateral meniscus) rotation Apley test – Pain at the medial or lateral joint Thessaly test – Pain or a locking or catching sensation at the medial or lateral joint line Similar tests, including those that elicit the Bragard, Böhler, Payr, Merke, Childress, and Finochietto signs See for more detail. Diagnosis Imaging studies that may be considered include the following: Plain radiography – Anteroposterior weight-bearing view (...) with a possible meniscus injury include the following: Joint line tenderness (77-86% of patients with a meniscal tear) Effusion (~50% of patients presenting with a meniscal tear) Impaired range of motion – A mechanical block to motion or frank locking can occur with displaced tears; restricted motion commonly results from pain or swelling Provocative maneuvers that may elicit characteristic results in the presence of a meniscal tear include the following: McMurray test – Pain or a reproducible click Steinmann

2014 eMedicine.com

12. Meniscus Injuries (Overview)

test – Asymmetric pain with external (medial meniscus) or internal (lateral meniscus) rotation Apley test – Pain at the medial or lateral joint Thessaly test – Pain or a locking or catching sensation at the medial or lateral joint line Similar tests, including those that elicit the Bragard, Böhler, Payr, Merke, Childress, and Finochietto signs See for more detail. Diagnosis Imaging studies that may be considered include the following: Plain radiography – Anteroposterior weight-bearing view (...) with a possible meniscus injury include the following: Joint line tenderness (77-86% of patients with a meniscal tear) Effusion (~50% of patients presenting with a meniscal tear) Impaired range of motion – A mechanical block to motion or frank locking can occur with displaced tears; restricted motion commonly results from pain or swelling Provocative maneuvers that may elicit characteristic results in the presence of a meniscal tear include the following: McMurray test – Pain or a reproducible click Steinmann

2014 eMedicine.com

13. Knee Injury, Soft Tissue (Treatment)

of sonographic examination in traumatic knee internal derangement. Arch Phys Med Rehabil . 2007 Aug. 88(8):984-7. . Media Gallery Anatomy of the knee. Knee ballottement. Lachman test. Anterior drawer sign. Pivot test. McMurray test. Apley compression test. of 7 Tables Contributor Information and Disclosures Author David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College (...) sure patients ingest nothing by mouth (NPO) until the need for emergency or urgent surgery is ascertained. General treatment principles include the following: Aside from the particular injury, treatment plans depend on the patient's age and activity level and the presence of additional injuries. Obtain orthopedic consultation when appropriate. Initial nonpharmaceutical treatment includes rest, ice, compression, and elevation (RICE). For the first 1-3 days, use therapeutic measures that minimize

2014 eMedicine Emergency Medicine

14. Knee Injury, Soft Tissue (Overview)

(ROM) testing Lachman maneuver Anterior and posterior drawer tests Tibial sag test Pivot-shift test McMurray test Apley compression test Thessaly and Ege tests See for more detail. Diagnosis The following laboratory studies may be helpful: Blood typing and screening Complete blood count (CBC) Erythrocyte sedimentation rate (ESR) Serum electrolytes Blood glucose Blood urea nitrogen (BUN) and creatinine Analysis of aspirated synovial fluid for white blood cell (WBC) count and differential (...) Rehabil . 2007 Aug. 88(8):984-7. . Media Gallery Anatomy of the knee. Knee ballottement. Lachman test. Anterior drawer sign. Pivot test. McMurray test. Apley compression test. of 7 Tables Contributor Information and Disclosures Author David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine David B Levy, DO, FAAEM is a member of the following medical

2014 eMedicine Emergency Medicine

15. Knee, Meniscal Tears (MRI)

of concurrent acute ligamentous injuries of the knee. With acute anterior cruciate ligament (ACL) tears, the sensitivity for diagnosing medial meniscus (MM) tears is 45% and 58% for lateral meniscus (LM) tears. The sensitivity of joint line tenderness for diagnosing meniscal tears is 75%. The sensitivity of the Apley grinding test for meniscal tears is about 45%. The sensitivity of the Payr test for diagnosing meniscal tears is about 40%. [ , , ] Specificity also decreases, most likely due to the presence

2014 eMedicine Radiology

16. Collateral Ligament Pathology, Knee (Overview)

a grade 1 sprain. Pain and opening of the joint space up to 10 mm with an endpoint indicates a grade 2 injury to the MCL. Complete joint space opening of more than 10 mm indicates a grade 3 injury. Marked medial laxity suggests possible concomitant knee ligament injuries or reduced . Careful evaluation of the medial joint line and tests for should also be performed to confirm that the pain is due to stress of the ligament and not to mechanical pain from a torn medial meniscus. The Apley grind (...) /distraction test can be helpful but not entirely diagnostic or specific for this. With the patient prone, the knee is flexed to 90 degrees and the foot and ankle are grasped. The tibia is then rotated on the femur with distraction and compression of the tibia on the femur. If pain is generated in the unloaded situation, in which the ligament is stretched, then the medial pain is likely due to ligamentous or capsular injury. If the pain is worsened by compression, then a meniscal or chondral origin

2014 eMedicine Surgery

17. Knee Injury, Soft Tissue (Diagnosis)

(ROM) testing Lachman maneuver Anterior and posterior drawer tests Tibial sag test Pivot-shift test McMurray test Apley compression test Thessaly and Ege tests See for more detail. Diagnosis The following laboratory studies may be helpful: Blood typing and screening Complete blood count (CBC) Erythrocyte sedimentation rate (ESR) Serum electrolytes Blood glucose Blood urea nitrogen (BUN) and creatinine Analysis of aspirated synovial fluid for white blood cell (WBC) count and differential (...) Rehabil . 2007 Aug. 88(8):984-7. . Media Gallery Anatomy of the knee. Knee ballottement. Lachman test. Anterior drawer sign. Pivot test. McMurray test. Apley compression test. of 7 Tables Contributor Information and Disclosures Author David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine David B Levy, DO, FAAEM is a member of the following medical

2014 eMedicine Emergency Medicine

18. Knee Injury, Soft Tissue (Follow-up)

, Wang TG, Jiang CC. Role of sonographic examination in traumatic knee internal derangement. Arch Phys Med Rehabil . 2007 Aug. 88(8):984-7. . Media Gallery Anatomy of the knee. Knee ballottement. Lachman test. Anterior drawer sign. Pivot test. McMurray test. Apley compression test. of 7 Tables Contributor Information and Disclosures Author David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine (...) ) the mechanism of injury suggests a more serious injury, or (3) the patient perceives a snap or pop at the time of the incident and a hemarthrosis evolves. Promote RICE therapy for mild to moderately severe strains and/or sprains. R - Rest (crutch ambulation without weight bearing for initial 24-48 h) I - Ice (application of ice on injured region for 20 min of each waking hour during the initial 48 h after injury) C - Compression (with knee brace or splint, if necessary) E - Elevation (above the level

2014 eMedicine Emergency Medicine

19. Diagnostic arthroplasty for conditions of the knee

in those late in their seventh decade (Wells et al 2002). Diagnosing knee conditions Initial screening usually involves a comprehensive patient history and preliminary physical examination. Physical tests for meniscal injuries include the McMurray test, the joint line tenderness test and the Apley compression test (Scholten et al 2007; Ryzewicz et al 2007). The three physical tests commonly used to assess ligamentous injuries are the anterior drawer test, the Lachman test and the pivot shift test (...) and reference test among consecutive or non-consecutive patients. Diagnostic performance outcomes examined included specificity, sensitivity, likelihood ratios and predictive values. Safety outcomes examined included pain, patholaxity, complications related to anaesthesia, haemarthrosis, infection, deep vein thrombosis and knee stiffness. Methods Studies were identified by searching BMJ Clinical Evidence, the York (UK) Centre for Reviews and Dissemination (CRD), the Cochrane Library, PubMed and EMBASE from

2008 ASERNIP-S

20. Shoulder problem

. The Apley scratch test is the most useful: touch opposite scapular by reaching behind the head for adduction and external rotation and behind the back for abduction and internal rotation. Finally, there are more specific maneuvers that can home in on a diagnosis, however their accuracy is limited. Diagnostic tests [ ] Tests to confirm the diagnosis of certain conditions. Some of these tests include: —Diagnostic record that can be seen on an X-ray after injection of a contrast fluid into the shoulder (...) be a consideration < >. Arthritis or osteolysis of the AC (acromioclavicular) joint [ ] Description [ ] The consists of the and a small disk of cartilage located in between the acromion and the clavicle. This disk can wear down through , extreme joint stress (via ) or normal wear. Signs and diagnosis [ ] Pain is perceived on shoulder motion, especially on certain movements. Often a crossover arm test is utilized in diagnosis because this compresses the AC joint, exacerbating the symptoms. X-rays of the shoulder

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2012 Wikipedia

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