Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Passive extension

Positioning..

The subject lies in the supine position with the legs extended. The examiner stands
level with the subject’s knee. One hand grasps the lower leg at the heel, while the other carries the knee from the lateral side with the thumb on the tibial tuberosity.

Procedure.

Move the leg upwards. Perform a quick and short extension movement by a simultaneous upwards movement of the heel and a downwards pressure on the tibia.

Common mistakes.
.

The end-feel is not evaluated because the movement is not performed penetratingly enough.

Normal functional anatomy:

• Rmlge: 0° (some extension in recurvatum may be possible)
• End-feel: hard ligamentous, almost bony
• Limiting structures:

– posterior capsule
– posterior crudate ligament
– anterior <;ruciate ligament. Common pathological situations:

• Perception of the end-feel on passive extension is extremely important in clinical
diagnosis of knee joint lesions.
• Limited extension with a spastic end-feel in combination with more limitation of flexion indicates an acute arthritis.
• Painless and slight limitation with crepitus is typical for arthrosis.
• 10-30° of limitation with a springy block is evidence of a displaced meniscus.
• Pain at the end of range with a more or less normal end-feel is often seen in combination with a small ligamentous problem.

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