Dial Test
Original Editors - Gaelle Vertriest as part of the Vrije Universiteit Brussel's Evidence-based Practice project
Top Contributors - Tomer Yona, Gaëlle Vertriest, Rachael Lowe, Admin, Yvonne Yap, Kim Jackson, Uchechukwu Chukwuemeka, Daphne Jackson, Wanda van Niekerk, Tony Lowe, Kai A. Sigel and WikiSysopDefinition/Description[edit | edit source]
Purpose[edit | edit source]
The purpose of the ‘Dial Test’ is to diagnose posterolateral instability. By performing the test, we can detect whether there’s an isolated or combined injury of the knee. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
An injury to only one or two structures of the knee must be investigated by the dial test, other clinical tests en diagnostic methods. That can be physical examinations, magnetic resonance imaging, radiographs, and patient’s history. For an isolated PCL-tear, the posterior drawer test or sag tests are more provocative. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Clinically Relevant Anatomy[edit | edit source]
The dial test is clinically valuable when three structures are injured. These three posterolateral structures may be the popliteus tendon, the popliteofibular ligament (PFL) and the lateral collateral ligament (LCL). It may also be a combined injury with the posterior cruciate ligament (PCL) and two other posterolateral structures. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Technique
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It is possible to do the test both in a prone and supine position, and is performed in both 30° and 90° knee flexion. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The dial test inspects the external rotation at the knee joint. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The patient is in prone: performing the test is sensitive to the notice of a PLC-injury in a PCL-injured knee. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The knees are held together and bent at 30°, the therapist stands behind the table and keeps the feet in dorsiflexion. He turns the lower legs and feet outwards and compares the motion of the feet. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Repeat the test with the knees at 90°. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- www.youtube.com/watch Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The patient is in supine: there are 2ways to perform this test.
1) As in prone position: the knees are held together and bent at 30°, the therapist stands behind the table and keeps the feet in dorsiflexion. He turns the lower legs and feet outwards and compares the amount of rotation of the tibial tubercle. Repeat the test with the knees at 90°. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- www.youtube.com/watch Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
2) One leg is hanging off the edge of the table with the knee in 30° of flexion. The therapist stands beside the table and stabilizes the thigh with one hand; the other hand executes an external rotation of the foot. By observing the tibial tubercle motion, we can indicate any posterolateral knee injury. With an increase, compare to the normal contralateral side. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
If the dial test at 30° is positive, perform the test when the knee is flexed on 90°. The thigh does not touch the table, hold the leg in your hands or put the foot down on the table. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
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add appropriate resources here
Evaluation[edit | edit source]
The evaluation of the test for both prone and supine position:
The dial test is positive when there is more than 10° of external rotation in the injured knee compared to the uninjured knee. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
| Standard injury | Mild injury | Moderate injury | Severe Injury |
| <5° | 6-10° | 11-19° | >20° |
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There are different injuries:
- An isolated injury to the PLC: more than 10° of external rotation in the injured knee is present at 30° of flexion, but not at 90° of flexion. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- Instability of the PCL: more than 10° of external rotation in the injured knee is present at 90° of flexion, but not at 30° of flexion. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- A combined injury: more than 10° of external rotation in the injured knee is present at 30° and 90° of flexion. This is an injury of the PCL and the PLC. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Recent Related Research (from Pubmed)[edit | edit source]
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