Having assessed the menisci, we can now
move on to assess two other conditions that
are relatively common.
I'm going to first look at
patellofemoral pain syndrome.
This is particularly common in young women.
And essentially it's an overzealous Q angle where
they're even more valgus than the baseline.
And that's because of some imbalance in the different
ligamentous structures holding the knee together.
And oftentimes it's a problem with too much
activation of the quadriceps, the vastus lateralis
And so if the knee is a little bit too inward,
and so what I'm looking for is to see if there's
any pain associated with the kneecap itself
and how it's moving in
the patellofemoral groove.
So what we're going to do is put
your knee at around 30 degrees
and I'm simply trying to bring
your kneecap towards me.
Patients who have patellofemoral
pain syndrome will have a little bit of
instability around the patella.
And by bringing it towards me, the
patient will have what's called apprehension,
an apprehension sign where
she'll either put her hand up and say,
"stop, that's uncomfortable, I feel like you're going
to knock my knee off or just or dislocate my knee"
or they'll just immediately
bring the leg down like this
as sort of a reflex instinct that would
prevent me from dislocating her knee.
And that's because if I flip over my
kneecap here, your patient is having
discomfort to the lateral aspect of the knee
because it's chronically displaced laterally.
We'll have a lot of discomfort when I
bring that kneecap laterally in that position.
So that's called the
patellofemoral apprehension sign.
Next up, we'll do a test for the iliotibial band.
I'll have you roll over onto
your left hip again, please.
So the iliotibial band starts up here with the
tensor fascia lata, and it's coming down here
and inserting onto Gerdy's
tubercle down here by the fibula.
And if you could just lift up your leg,
if I pushed down and have her resist me,
I'm going to be able to feel very easily
this tight band here called the iliotibial band.
It's a very firm structure of musculotendinous
tissue, and it's inserting down here.
You can relax now.
And if I want to try and see if the iliotibial
band is inflamed, I can put my thumb.
I'm going to show it on my model here again.
I put my thumb right here just
proximal to the lateral epicondyle.
In this position, the iliotibial band is anterior
to my thumb, but as soon as I flex her knee,
the iliotibial band ends up behind my thumb.
So keeping my thumb here, by moving
her knee between flexion and extension,
the iliotibial band will pass
underneath my thumb repeatedly.
And if the patient has pain associated
with iliotibial pain syndrome,
this will reproduce that pain as the iliotibial
band passes to and fro underneath my thumb.
And this is called 'Noble's test'.
Noble's test is at the knee.
So that's one way that I remember that test.
The last test we're going to do, I'll have
you go again on to your back one last time,
is even in the setting of minor
trauma, patients sometimes can have
a tibial plateau fracture or
a tibial insufficiency fracture
and simply percussing along the tibial
like so to see if any specific point
causes any discomfort may be an
indication of a tibial insufficiency fracture.