MUSCULOSKELETAL SCREENING ASSESSMENT Tests for the anterior cruciate ligament include the


following: n Anterior draw test: the knee is at 90°, with the foot on the plinth and the examiner’s hands behind the tibia; the examiner draws the tibia forwards in relation to the femur – a positive test shows excessive movement compared with the other side. n Lachman’s test: the knee is at 30° flexion, with one hand on the anterior femur and the other hand around the posterior tibia; the examiner draws the tibia forwards, while stabilising the femur (8).


The following test the posterior cruciate ligament: n Posterior draw of the tibia: this is the same as the anterior draw, except that the force is in a posterior direction. n Godfrey test: the patient’s hips and knees are flexed to 90° and placed on a stool; if there is a torn posterior cruciate ligament, then the tibia will sag in a posterior direction; contracting the hamstrings will further displace the tibia (2). To test the lateral and medial collateral ligaments of the


knee, either a valgus or varus force is applied to the knee in neutral and 30° flexion. This change in position tests different parts of the ligaments. A positive test would be pain or laxity (2). The McMurray test is for a meniscal lesion


and involves taking the knee into full flexion while simultaneously rotating the tibia on the femur to provide a sheering on the menisci while palpating the joint lines of the knee. A positive test is apprehension, clicking, clunking or pain (2). Finally, the position of the patella while the knee is relaxed in 30° of flexion is observed. The patella should


sit exactly in between the femoral epicondyles, with no tilt present (2). The patella can be a source of pain on weight- bearing exercises; there are many causes. If the athlete is thought to have patellar femoral signs, then musculoskeletal screening must include more specific testing.


Ankle and foot Observation of the ankle and foot should be with the athlete standing. The markers are calf bulk, Achilles tendon alignment with the calcaneus, whether the toes are gripping to the floor for extra balance and stability, whether any bunions are present, and whether the foot is overpronated or supinated (2). Complex foot mal-alignments are always better seen by a podiatrist, as this is their specialty. In professional sport, initial assessment by a podiatrist is recommended. Active and resisted movement of the ankle and toes are performed for plantiflexion, dorsiflexion, inversion and eversion at the ankle and flexion and extension of the toes (8). The following special tests are used for the main ligaments around the ankle are: n Anterior draw test: tests the anterior talo-fibular ligament. This involves stabilising the tibia with one hand while grasping the calcaneum and drawing the foot forwards on the tibia. n Passive eversion of the ankle to end-of-range: tests the deltoid ligament. n Passive plantiflexion and inversion: tests the anterior talo-fibular ligament. n Passive inversion: tests the calcaneo-fibular ligament. n Passive dorsiflexion and inversion: tests the posterior talo-fibular ligament. Positive tests in any of these result in instability or pain


(1,3).


online Launch the extras by clicking on the images or links


A series of YouTube playlists from a range of reputatable sources, selected and compiled by sportEX and including an exceptionally thorough series on examination of the shoulder and knee from the British Journal of Sports Medicine n Assessment of the vertebral column - http://bit.ly/ODE9i n Assessment of the shoulder - http://bit.ly/EQKWA n Assessment of the hand and wrist - http://bit.ly/17Cq1V n Assessment of the hip - http://bit.ly/17Cq1V n Assessment of the knee - http://bit.ly/3tQnQE n Assessment of the ankle and foot - http://bit.ly/LCCt6 n sportEX animation demonstrating the dermatomes and related nerves


www.sportEX.net


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