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Posterior Drawer Test and Quadriceps Active Tests

This video will demonstrate the Posterior Drawer Test and Quadriceps Active Tests, two common knee tests used to assess knee stability and ligament integrity. Learn how to perform them properly with detailed instructions and visual demonstrations.

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Transcript

00:04 - 00:07This is one of the Brooke Bush Institute in this video. We're doing
00:07 - 00:10two tests for the posterior cruciate ligament. That
00:10 - 00:13is the PCL. I'm gonna have my friend Yvette come
00:13 - 00:16out. She's gonna help me demonstrate the posterior drawer test
00:16 - 00:19as well as the quadriceps active test and explain why
00:19 - 00:22I chose those two particular tests. Now first things
00:22 - 00:25first. We do have to think about our predictive values
00:25 - 00:28guys. I don't use these tests on everybody who
00:28 - 00:31walks in the door. If I'm doing a posterior cruciate
00:31 - 00:34ligament test. There is a reason for me to believe
00:35 - 00:38That of that ruptured her posterior cruciate ligament IE. She's had some
00:38 - 00:41sort of trauma to her knee or she has some sort of feeling of
00:41 - 00:44kind of massive instability and this needs
00:44 - 00:47to be checked. Now, these two tests are not hard to do
00:47 - 00:51a couple details. You have to remember the the posterior drawer
00:50 - 00:52we're going to do at 90 degrees.
00:52 - 00:55Just like we did that anterior drawer test. And then
00:55 - 00:58of course the weird cue is we sit on the foot which
00:58 - 01:01is always one of those cues people like do you really have to sit on
01:01 - 01:04the foot? Yes, you have to sit on the foot. That's what you're gonna do to help
01:04 - 01:07stabilize the tibia, so it doesn't rotate on you or move
01:07 - 01:10further into flexion as you go into put
01:10 - 01:13some pressure. Now, the more important cue is
01:13 - 01:16the details around hand placement for this test.
01:17 - 01:20You want to wrap your hands around the quad get your
01:20 - 01:23thinar eminence your your thumb pads
01:23 - 01:23here.
01:24 - 01:27Over the tibia, so you got some good forced to
01:27 - 01:30push with and then the tips of your thumb. This is the
01:30 - 01:33important part are going to go right over that joint line. So you're
01:33 - 01:36not relying only on your eyeballs to
01:36 - 01:39try to see through skin to see if the tibia moves
01:39 - 01:42you're actually relying on the feeling of the tibial Plateau
01:42 - 01:45moving with your thumbs. So what this
01:45 - 01:46test would look like is I would come here like this.
01:47 - 01:51I would get myself set up and then I
01:50 - 01:53would bet you. Okay. All right
01:53 - 01:56good and then I would go ahead and give some some good
01:56 - 01:59little thrusts. Like I was trying to mobilize her knee did that
01:59 - 01:59hurt at all?
02:00 - 02:02No, that didn't replicate your symptoms.
02:03 - 02:06Now so it didn't replicate her symptoms and I didn't feel
02:06 - 02:09huge motion. Now. There are some texts that
02:09 - 02:13suggest that a positive posterior drawer
02:12 - 02:15is grated that is zero to
02:15 - 02:18five millimeters is a grade one five to
02:18 - 02:21ten millimeters is a grade two and then greater than 10 millimeters is
02:21 - 02:24of course a Grade Three, although I
02:24 - 02:27have to imagine that grading like that is not particularly
02:27 - 02:30reliable. It might be something for you to keep in the back
02:30 - 02:33of your mind just as a good scale
02:33 - 02:37for how much motion a positive
02:36 - 02:39test would feel like once again
02:39 - 02:42guys. This posterior cruciate ligaments are not ruptured
02:42 - 02:43often.
02:43 - 02:46So this is not going to get be something that you're gonna feel
02:46 - 02:49a whole lot of times throughout your career. Alright, so
02:49 - 02:52maybe we think about those scales zero all
02:52 - 02:56the way up to 10 millimeters being one full centimeter, as
02:55 - 02:58you know, you start getting up into that
02:58 - 03:01range of a centimeter of motion. This is definitely a positive
03:01 - 03:01test.
03:02 - 03:06now the reason why we're not just going to do the posterior drawer
03:05 - 03:08test is this test in most
03:09 - 03:13Research studies is sensitive but
03:12 - 03:14not particularly specific.
03:15 - 03:18And what that means is if you get a
03:18 - 03:21no right it's sensitive if you get a no
03:21 - 03:24there's a good chance that there isn't a PCL tear.
03:24 - 03:27But if you get a yes, we're still
03:27 - 03:28not sure.
03:29 - 03:32Right. So this isn't a great test for diagnosing with
03:32 - 03:35it's a better test to screen with we do
03:35 - 03:39have to make the one caveat that some of the studies out
03:39 - 03:43there also show. This test does have some problems with sensitivity because
03:42 - 03:43of
03:45 - 03:48False negatives having to do with like the
03:48 - 03:51quadriceps being active and guarding against getting
03:51 - 03:54any posterior motion or somebody getting into this
03:54 - 03:57position their tibia falling all the way back as far
03:57 - 04:00as it can go and then when you push on it, you get no further motion
04:00 - 04:03because essentially the tibia has gone where it
04:03 - 04:06can without the PCO. All right, so to make
04:06 - 04:07up for that.
04:07 - 04:10We're gonna go ahead and add the quadriceps.
04:10 - 04:11negative test
04:12 - 04:15Right. So the quadriceps active test looks like this.
04:16 - 04:17I'm going to
04:18 - 04:19keep her in about the same position.
04:20 - 04:23I'm going to use this hand over her quad to
04:23 - 04:26make sure it's relaxed. All right, so I want to
04:26 - 04:29make sure it's not active. If you don't know what a relaxed quad versus an active
04:29 - 04:32quad feels like have them go ahead and push into
04:32 - 04:35your hand like go ahead and slide your foot down the table
04:35 - 04:38good. All right. So now I know what active feels like good now
04:38 - 04:39totally relax good.
04:40 - 04:43Right, so she's nice and calm here. I'm then
04:43 - 04:46gonna use this hand for the test as a brace on
04:46 - 04:49front of her ankle. I'm gonna get my eye level with where
04:49 - 04:52I just had my thing my thumb tips right
04:52 - 04:53with the joint line.
04:54 - 04:57And then what I'm gonna have her do is go. Okay. Go ahead
04:57 - 05:00and slide your foot down the table. There you
05:00 - 05:02go. Can I relax do that one more time for me?
05:03 - 05:06Good, and if I see all the sudden her tibia Move
05:06 - 05:09anteriorly Like an anterior Glide?
05:09 - 05:11That's a positive test.
05:12 - 05:15Now this test according to research is more specific.
05:16 - 05:17Than sensitive.
05:18 - 05:18so
05:19 - 05:22you got to stay with me here in the
05:22 - 05:22sense that
05:23 - 05:27I don't actually have research to suggest that the two tests combined are
05:26 - 05:29more accurate than one or the other but it would make
05:29 - 05:32sense that if we have a sensitive test and a specific
05:32 - 05:35test and we get the same
05:35 - 05:38answer for both. We're probably in pretty good shape as
05:38 - 05:42far as our accuracy goes this quadriceps
05:41 - 05:44active test also helps get
05:44 - 05:47around one of those false negative
05:47 - 05:50issues with the posterior drawer test,
05:50 - 05:53which is okay the tibia fell all
05:53 - 05:56the way back because I had no PCL and
05:56 - 05:59then when I pushed on it, it didn't go any further back. Well that
05:59 - 06:02person who gave me a false negative on the posterior drawer
06:02 - 06:03because they're tibia fell back.
06:04 - 06:07Should be positive on the quadriceps active test.
06:08 - 06:11Of course if you got positives on these two tests and they
06:11 - 06:12hadn't already seen a physician.
06:13 - 06:17You're probably going to want to refer out for Imaging anyway.
06:18 - 06:21All right guys, so hopefully all of that made sense. You
06:21 - 06:23got the more sensitive we think.
06:24 - 06:28posterior drawer test the more specific quadriceps active
06:28 - 06:30test which also fills in
06:31 - 06:34One of the problems with the false negative on the posterior drawer.
06:34 - 06:37We're going to combine the two of those to try to
06:37 - 06:40get better accuracy for our diagnosis of
06:40 - 06:42PCL tear.
06:43 - 06:46what these two tests look like in success succession is
06:47 - 06:48sit on the foot.
06:49 - 06:52Wrap around the quad find The Joint line. Give it
06:52 - 06:53a couple good presses.
06:54 - 06:57All right, that seems negative. Let's double
06:57 - 06:57check.
06:59 - 07:02Hand placement here my eyes where my
07:02 - 07:03thumbs were just at.
07:03 - 07:06Make sure her quads nice and relaxed good
07:06 - 07:09go ahead and slide your foot down the table. I don't
07:09 - 07:12see any emotion. That's also negative if I
07:12 - 07:15wanted to be doubly. Oh, I guess I'm quadrupley
07:15 - 07:18sure, right because I'm gonna go two times to I could
07:18 - 07:21do these same two tests on her other
07:21 - 07:24side to compare assuming that she has one effective side
07:24 - 07:26and one unaffected side.
07:27 - 07:30Guys, if you have any questions on these tests whatsoever. Please leave
07:30 - 07:33your comments in the comments box below.
07:33 - 07:35I'll get to answering them as soon as possible.

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