Muller's Test: Difference between revisions
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== Purpose == | == Purpose == | ||
Muller's test is a clinical assessment used to detect posterior Cruciate Ligament disruption and measure posterior knee laxity.This test has also been termed the '''[[Quadriceps Muscle|Quadriceps]]''' Active(QA) Test by Daniel, et al<ref name=":0" /> | Muller's test is a clinical assessment used to detect posterior Cruciate Ligament disruption and measure posterior knee laxity.This test has also been termed the '''[[Quadriceps Muscle|Quadriceps]]''' Active(QA) Test by Daniel, et al<ref name=":0" /> | ||
The Muller test is performed with the patient supine | == Technique == | ||
The Muller test is performed with the patient lying in the supine position and with the relaxed limb supported with the [[knee]] flexed to 90 degrees in the [[Posterior Drawer Test (Knee)|posterior drawer-test]] position, the hip is flexed 45° and the foot is in neutral position. The patient is asked to actively contract the [[Quadriceps Muscle|quadriceps]] gently to move the [[tibia]] without extending the [[knee]].<ref name=":0" /> During this action, the activation of the [[Quadriceps Muscle|quadriceps muscle]] is believed to anteriorly translate the tibia from a posteriorly subluxed position to a reduced neutral position. This translation is clinically observed and used to further confirm the diagnosis.<ref name=":1" /> | |||
The second part of the test is to examine the anterior silhouette of the proximal tibia from the side and compare this to the uninjured, contralateral [[knee]]. The patient is then asked to raise his or her foot off the table. A positive test reveals posterior sag of the proximal [[tibia]] initially, and anterior translation of the proximal [[tibia]] before the foot leaving the table with attempted elevation of the foot. This anterior translation can be quantified and compared to the opposite [[knee]].<ref name=":0">Daniel DM, et al. Use of the Quadriceps Active Test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee. JBJS. 1988;70A:386–391</ref>The degree of laxity is determined by comparing the posterior translation to that of the contralateral normal [[knee]]. The posterior tibial sag and [[Lachman Test|Lachman test]] can be occasionally helpful.<ref name=":1">Kieser DC, Savage E, Sharplin P. [https://www.researchgate.net/publication/12690277_Posterior_Cruciate_Ligament_Injuries_of_the_Knee_Joint A Positive Quadriceps Active Test, without the Quadriceps Being Active.] Case Rep Orthop. 2019;2019:1–4. </ref> | |||
{{#ev:youtube|5H0dALG6RR4|300}}<ref>The Knee Resource. Quads Active Test. Available from:https://www.youtube.com/watch?v=5H0dALG6RR4 [last accessed 29/6/2024]</ref> | {{#ev:youtube|5H0dALG6RR4|300}}<ref>The Knee Resource. Quads Active Test. Available from:https://www.youtube.com/watch?v=5H0dALG6RR4 [last accessed 29/6/2024]</ref> | ||
== Evidence == | == Evidence == | ||
In the Quadriceps Active Test, the patient is asked to contract the quadriceps muscle while maintaining the knee in a flexed position. This action pulls the tibia upward, eliminating the sag.<ref>Rossi R, Dettoni F, Bruzzone M, Cottino U, D’Elicio DG, Bonasia DE. Clinical examination of the knee: Know your tools for diagnosis of knee injuries. Sport Med Arthrosc Rehabil Ther Technol [Internet]. 2011;3(1):25. Available from: <nowiki>http://www.smarttjournal.com/content/3/1/25</nowiki></ref> | In the Quadriceps Active Test, the patient is asked to contract the [[Quadriceps Muscle|quadriceps muscle]] while maintaining the [[knee]] in a flexed position. This action pulls the [[tibia]] upward, eliminating the sag.<ref>Rossi R, Dettoni F, Bruzzone M, Cottino U, D’Elicio DG, Bonasia DE. Clinical examination of the knee: Know your tools for diagnosis of knee injuries. Sport Med Arthrosc Rehabil Ther Technol [Internet]. 2011;3(1):25. Available from: <nowiki>http://www.smarttjournal.com/content/3/1/25</nowiki></ref> | ||
However, a positive quadriceps test might not always indicate [[Quadriceps Muscle|quadriceps muscle]] weakness in some patients, but rather be caused by gravity and [[Hamstrings|hamstring]] tightness pushing the [[tibia]] out, then the [[Gastrocnemius|gastrocnemius muscle]] pulling it back in. This helps in diagnosing [[Posterior Cruciate Ligament|Posterior cruciate ligament]](PCL) tears even if the [[Quadriceps Muscle|quadriceps muscles]] are weak and strengthening the [[gastrocnemius]] could be beneficial in PCL rehabilitation. | |||
== Resources == | |||
[[Posterior Cruciate Ligament Injury|Posterior Cruciate ligament Injury]] | |||
[[Posterior Drawer Test (Knee)|Posterior Drawer Test]] | |||
== References == | == References == | ||
Latest revision as of 13:51, 1 July 2024
Original Editor - Rachael Lowe
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Purpose[edit | edit source]
Muller's test is a clinical assessment used to detect posterior Cruciate Ligament disruption and measure posterior knee laxity.This test has also been termed the Quadriceps Active(QA) Test by Daniel, et al[1]
Technique[edit | edit source]
The Muller test is performed with the patient lying in the supine position and with the relaxed limb supported with the knee flexed to 90 degrees in the posterior drawer-test position, the hip is flexed 45° and the foot is in neutral position. The patient is asked to actively contract the quadriceps gently to move the tibia without extending the knee.[1] During this action, the activation of the quadriceps muscle is believed to anteriorly translate the tibia from a posteriorly subluxed position to a reduced neutral position. This translation is clinically observed and used to further confirm the diagnosis.[2]
The second part of the test is to examine the anterior silhouette of the proximal tibia from the side and compare this to the uninjured, contralateral knee. The patient is then asked to raise his or her foot off the table. A positive test reveals posterior sag of the proximal tibia initially, and anterior translation of the proximal tibia before the foot leaving the table with attempted elevation of the foot. This anterior translation can be quantified and compared to the opposite knee.[1]The degree of laxity is determined by comparing the posterior translation to that of the contralateral normal knee. The posterior tibial sag and Lachman test can be occasionally helpful.[2]
Evidence[edit | edit source]
In the Quadriceps Active Test, the patient is asked to contract the quadriceps muscle while maintaining the knee in a flexed position. This action pulls the tibia upward, eliminating the sag.[4]
However, a positive quadriceps test might not always indicate quadriceps muscle weakness in some patients, but rather be caused by gravity and hamstring tightness pushing the tibia out, then the gastrocnemius muscle pulling it back in. This helps in diagnosing Posterior cruciate ligament(PCL) tears even if the quadriceps muscles are weak and strengthening the gastrocnemius could be beneficial in PCL rehabilitation.
Resources[edit | edit source]
Posterior Cruciate ligament Injury
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Daniel DM, et al. Use of the Quadriceps Active Test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee. JBJS. 1988;70A:386–391
- ↑ 2.0 2.1 Kieser DC, Savage E, Sharplin P. A Positive Quadriceps Active Test, without the Quadriceps Being Active. Case Rep Orthop. 2019;2019:1–4.
- ↑ The Knee Resource. Quads Active Test. Available from:https://www.youtube.com/watch?v=5H0dALG6RR4 [last accessed 29/6/2024]
- ↑ Rossi R, Dettoni F, Bruzzone M, Cottino U, D’Elicio DG, Bonasia DE. Clinical examination of the knee: Know your tools for diagnosis of knee injuries. Sport Med Arthrosc Rehabil Ther Technol [Internet]. 2011;3(1):25. Available from: http://www.smarttjournal.com/content/3/1/25
