Dr. Kevin Yip

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

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SPECIFIC TESTS-Medial shearing

Significance

This test is used to detect internal derangement at the inner side of the knee. Pain on jerk is suggestive for a minor lesion at the tibial insertion of the anterior cruciate ligament.

Positioning.

The subject lies in the supine position with the knee flexed to a right angle, and the
heel resting on the couch. The examiner sits at the foot-end of the couch. The heel of the ipSilateral hand is placed at the medial femoral condyle. The heel of the contralateral hand is at the lateral tibial condyle. The fingers of both hands are interlocked.Procedure Apply a strong shearing strain that forces the tibia medially on the femur.

Common mistakes:

• The hands are not high enough on the femur or low enough on the tibia respectively.
• The contralateral hand presses against the fibular head instead of the lateral tibial condyle, provoking a painful compression of the upper tibiofibular joint.

Normal functional anatomy:

• Rallge: Virtually no movement can be elicited in a normal knee
• Elld-feel: hard ligamentous
• Limititlg structures:

– articular surfaces
– intercondylar spines of the tibia
– menisci
– anterior cruciate ligament.

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