Slocum's Test: Difference between revisions

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<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox">
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'''Original Editors ''' - [[User:Sarah Harnie|Sarah Harnie]]
'''Original Editors ''' - [[User:Sarah Harnie|Sarah Harnie]] as part of the [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;  
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;  
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== Search Strategy  ==
A search was done on PUBmed, web of knowledge, article database, the library, google books and google scholar to find some interesting evidence based articles about this subject. Different terms were used, such as ‘slocum test knee’, ‘anterolateral rotatory instability knee’ and ‘ALRI test’. 14 Results were found on PUBmed but no full texts were available. On web of knowledge, only 3 results were found but none of them contained interesting information and article database showed no results. Only two articles of ‘The Journal of Bone and Joint Surgery’ were found on google scholar, where they described the technique of the Slocum’s test. Unfortunately no articles were found concerning the reliability of instability tests of the knee. Interesting information was also found in several books in google books and the library. Later a search was done in google for ‘Slocum’s test’ to read some extra information about it and then a search on youtube for some videos of the technique.<br>


== Definition/Description  ==
== Definition/Description  ==


The Slocum’s test (1976) represents a modification of the Anterior Drawer test&nbsp;<ref name="vier">Postsurgical orthopedic sports rehabilitation: knee and shoulder – Robert C Manske</ref>&nbsp;which tests anteromedial rotary instability (AMRI) and anterolateral rotary instability (ALRI) of the knee.&nbsp;<ref name="vijf">Kaplan National Physical Therapy exam – Bethany Chapman, Mary Friatinni</ref><br>The anterior drawer test evaluates the anterior cruciate ligament. When inserting an internal or external rotation to this test, anterolateral and anteromedial rotary instability can be evaluated.<br><br>
The Slocum’s test (1976) represents a modification of the Anterior Drawer test&nbsp;<ref name="vier">Postsurgical orthopedic sports rehabilitation: knee and shoulder – Robert C Manske</ref>&nbsp;which tests anteromedial rotary instability (AMRI) and anterolateral rotary instability (ALRI) of the knee.&nbsp;<ref name="vijf">Kaplan National Physical Therapy exam – Bethany Chapman, Mary Friatinni</ref><br>The anterior drawer test evaluates the anterior cruciate ligament. When inserting an internal or external rotation to this test, anterolateral and anteromedial rotary instability can be evaluated.<br><br>  


== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==


Following structures may be involved when the test comes out positive:<br>-Anterolateral: Anterior and posterior cruciate ligament, posterolateral capsule, arcuate – popliteus complex, lateral collateral ligament and iliotibial band.<br>-Anteromedial: Anterior cruciate ligament, medial collateral ligament, posterior oblique ligament, posteromedial capsule. <ref name="zes" /><br>
Following structures may be involved when the test comes out positive:<br>-Anterolateral: Anterior and posterior cruciate ligament, posterolateral capsule, arcuate – popliteus complex, lateral collateral ligament and iliotibial band.<br>-Anteromedial: Anterior cruciate ligament, medial collateral ligament, posterior oblique ligament, posteromedial capsule. <ref name="zes" /><br>  


== Purpose<br>  ==
== Purpose<br>  ==


Testing for anterior rotatory instability of the knee.<br>
Testing for anterior rotatory instability of the knee.<br>  


== Technique<br>  ==
== Technique<br>  ==
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The patient is lying supine with the knee flexed 90 degrees and the foot fixed to the examining table by the examiner. 30 degrees of internal rotation is applied to the tibia by rotating the foot. The examiner pulls anteriorly on the tibia to assess for anterolateral rotary instability. Results are compared bilaterally.<br>Positive: Increased amount of anterior tibial translation with tibial internal rotation or<br>excessive movement on the lateral aspect of the knee indicates anterolateral instability.&nbsp;<ref name="zes">Neuromusculoskeletal examination and assessment: a handbook for therapists – Nicola F Petty, Ann P Moore</ref><br>Anterolateral rotatory instability (ALRI) is a manifestation of an anterior cruciate ligament (ACL) deficient knee.&nbsp;<ref name="drie">Larson RL, Physical examination in the diagnosis of rotatory instability, clin orthop relat res, 1983, 172, 38-44</ref><br>This technique allows the hamstrings to relax because of the 90 degrees flexion of the knee (origin and insertion of the hamstrings are closer to each other in flexion).&nbsp;<ref name="één">Donald B. Slocum, Robert L Larson. Rotatory Intability of the Knee: its pathogenesis and a clinical test to demonstrate its presence. The journal of Bone and Joint Surgery, american volume, 1968; 50-A, No.2:211-225.</ref>  
The patient is lying supine with the knee flexed 90 degrees and the foot fixed to the examining table by the examiner. 30 degrees of internal rotation is applied to the tibia by rotating the foot. The examiner pulls anteriorly on the tibia to assess for anterolateral rotary instability. Results are compared bilaterally.<br>Positive: Increased amount of anterior tibial translation with tibial internal rotation or<br>excessive movement on the lateral aspect of the knee indicates anterolateral instability.&nbsp;<ref name="zes">Neuromusculoskeletal examination and assessment: a handbook for therapists – Nicola F Petty, Ann P Moore</ref><br>Anterolateral rotatory instability (ALRI) is a manifestation of an anterior cruciate ligament (ACL) deficient knee.&nbsp;<ref name="drie">Larson RL, Physical examination in the diagnosis of rotatory instability, clin orthop relat res, 1983, 172, 38-44</ref><br>This technique allows the hamstrings to relax because of the 90 degrees flexion of the knee (origin and insertion of the hamstrings are closer to each other in flexion).&nbsp;<ref name="één">Donald B. Slocum, Robert L Larson. Rotatory Intability of the Knee: its pathogenesis and a clinical test to demonstrate its presence. The journal of Bone and Joint Surgery, american volume, 1968; 50-A, No.2:211-225.</ref>  


To examine anteromedial rotary instability the tibia is laterally rotated 15 degrees and the tibia is once again pulled forward. Results are compared bilaterally.<br>Positive: When pathologically increased forward and outward displacement of the tibia on the femur is possible, <ref name="zes">Neuromusculoskeletal examination and assessment: a handbook for therapists – Nicola F Petty, Ann P Moore</ref>excessive anterior rotation of the medial tibial plateau indicates laxity of the medial structures.&nbsp;<ref name="drie">Larson RL, Physical examination in the diagnosis of rotatory instability, clin orthop relat res, 1983, 172, 38-44</ref><br>
To examine anteromedial rotary instability the tibia is laterally rotated 15 degrees and the tibia is once again pulled forward. Results are compared bilaterally.<br>Positive: When pathologically increased forward and outward displacement of the tibia on the femur is possible, <ref name="zes">Neuromusculoskeletal examination and assessment: a handbook for therapists – Nicola F Petty, Ann P Moore</ref>excessive anterior rotation of the medial tibial plateau indicates laxity of the medial structures.&nbsp;<ref name="drie">Larson RL, Physical examination in the diagnosis of rotatory instability, clin orthop relat res, 1983, 172, 38-44</ref><br>  
 


<br>


There’s also another technique described for the anterolateral rotatory instability test <br>The patient is lying on his or her uninvolved side and uninvolved hip and knee flexed. The patient rolls the pelvis backward until it reaches a position that is 30 degrees from the supine position. The medial side of the foot of the involved extremity is placed firmly on the surface of the examining table with the knee in full extension. This position eliminates any rotation of the hip, allows the knee to fall into a valgus position and causes internal rotation of the tibia on the femur. <br>With both hands placed on the lateral aspect of the knee joint, while the patient slowly flexes the knee, the examiner assists this maneuver and also exerts downward pressure to produce a valgus stress on the knee and anterior subluxation of the tibia if rotatory instability is present. The subluxation can be seen and felt to reduce as the knee flexes from 25 to 40 degrees of flexion.<ref name="twee">J C Kennedy, F.R.C.S, Roger Stewart and Dennis M. Walker. Anterolateral rotatory instability of the knee joint: an early analysis of the elisson procedure, The journal of bone and joint surgery. 1978; Vol 60-A, No 8; 1031-1039.</ref>  
There’s also another technique described for the anterolateral rotatory instability test <br>The patient is lying on his or her uninvolved side and uninvolved hip and knee flexed. The patient rolls the pelvis backward until it reaches a position that is 30 degrees from the supine position. The medial side of the foot of the involved extremity is placed firmly on the surface of the examining table with the knee in full extension. This position eliminates any rotation of the hip, allows the knee to fall into a valgus position and causes internal rotation of the tibia on the femur. <br>With both hands placed on the lateral aspect of the knee joint, while the patient slowly flexes the knee, the examiner assists this maneuver and also exerts downward pressure to produce a valgus stress on the knee and anterior subluxation of the tibia if rotatory instability is present. The subluxation can be seen and felt to reduce as the knee flexes from 25 to 40 degrees of flexion.<ref name="twee">J C Kennedy, F.R.C.S, Roger Stewart and Dennis M. Walker. Anterolateral rotatory instability of the knee joint: an early analysis of the elisson procedure, The journal of bone and joint surgery. 1978; Vol 60-A, No 8; 1031-1039.</ref>  
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{{#ev:youtube|VhfREARlHpU}} last checked: 2011.01.03  
{{#ev:youtube|VhfREARlHpU}} last checked: 2011.01.03  


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== Key Research  ==
== Key Research  ==
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== Resources <br>  ==
== Resources <br>  ==


-http://ahn.mnsu.edu/athletictraining/spata/kneemodule/specialtests.html<br>- http://www.docstoc.com/docs/6608205/special-test-knee<br>-http://www.maitrise-orthop.com/viewPage_us.do?id=115<br><br>
-http://ahn.mnsu.edu/athletictraining/spata/kneemodule/specialtests.html<br>- http://www.docstoc.com/docs/6608205/special-test-knee<br>-http://www.maitrise-orthop.com/viewPage_us.do?id=115<br><br>  


== Clinical Bottom Line  ==
== Clinical Bottom Line  ==
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==


see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
 
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<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>  
<rss>https://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1rA3jDUv55FmQUFb_PLnRf3TGpX9h-jVnWR4D1MrZb5kXhJoF1|charset=UTF-8|short|max=10</rss>  
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== References  ==
== References  ==


see [[Adding References|adding references tutorial]].


<references />  
<references />  


[[Category:Vrije_Universiteit_Brussel_Project|Template:VUB]]
[[Category:Vrije_Universiteit_Brussel_Project]][[Category:Assessment]][[Category:Musculoskeletal/Orthopaedics|Orthopaedics]][[Category:Knee]][[Category:Special_Tests]]

Revision as of 03:20, 6 October 2014

Definition/Description[edit | edit source]

The Slocum’s test (1976) represents a modification of the Anterior Drawer test [1] which tests anteromedial rotary instability (AMRI) and anterolateral rotary instability (ALRI) of the knee. [2]
The anterior drawer test evaluates the anterior cruciate ligament. When inserting an internal or external rotation to this test, anterolateral and anteromedial rotary instability can be evaluated.

Clinically Relevant Anatomy[edit | edit source]

Following structures may be involved when the test comes out positive:
-Anterolateral: Anterior and posterior cruciate ligament, posterolateral capsule, arcuate – popliteus complex, lateral collateral ligament and iliotibial band.
-Anteromedial: Anterior cruciate ligament, medial collateral ligament, posterior oblique ligament, posteromedial capsule. [3]

Purpose
[edit | edit source]

Testing for anterior rotatory instability of the knee.

Technique
[edit | edit source]

The patient is lying supine with the knee flexed 90 degrees and the foot fixed to the examining table by the examiner. 30 degrees of internal rotation is applied to the tibia by rotating the foot. The examiner pulls anteriorly on the tibia to assess for anterolateral rotary instability. Results are compared bilaterally.
Positive: Increased amount of anterior tibial translation with tibial internal rotation or
excessive movement on the lateral aspect of the knee indicates anterolateral instability. [3]
Anterolateral rotatory instability (ALRI) is a manifestation of an anterior cruciate ligament (ACL) deficient knee. [4]
This technique allows the hamstrings to relax because of the 90 degrees flexion of the knee (origin and insertion of the hamstrings are closer to each other in flexion). [5]

To examine anteromedial rotary instability the tibia is laterally rotated 15 degrees and the tibia is once again pulled forward. Results are compared bilaterally.
Positive: When pathologically increased forward and outward displacement of the tibia on the femur is possible, [3]excessive anterior rotation of the medial tibial plateau indicates laxity of the medial structures. [4]


There’s also another technique described for the anterolateral rotatory instability test
The patient is lying on his or her uninvolved side and uninvolved hip and knee flexed. The patient rolls the pelvis backward until it reaches a position that is 30 degrees from the supine position. The medial side of the foot of the involved extremity is placed firmly on the surface of the examining table with the knee in full extension. This position eliminates any rotation of the hip, allows the knee to fall into a valgus position and causes internal rotation of the tibia on the femur.
With both hands placed on the lateral aspect of the knee joint, while the patient slowly flexes the knee, the examiner assists this maneuver and also exerts downward pressure to produce a valgus stress on the knee and anterior subluxation of the tibia if rotatory instability is present. The subluxation can be seen and felt to reduce as the knee flexes from 25 to 40 degrees of flexion.[6]

last checked: 2011.01.03



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
[edit | edit source]

-http://ahn.mnsu.edu/athletictraining/spata/kneemodule/specialtests.html
- http://www.docstoc.com/docs/6608205/special-test-knee
-http://www.maitrise-orthop.com/viewPage_us.do?id=115

Clinical Bottom Line[edit | edit source]

add text here

Recent Related Research (from Pubmed)[edit | edit source]

Failed to load RSS feed from https://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1rA3jDUv55FmQUFb_PLnRf3TGpX9h-jVnWR4D1MrZb5kXhJoF1|charset=UTF-8|short|max=10: There was a problem during the HTTP request: 422 Unprocessable Entity

References[edit | edit source]

  1. Postsurgical orthopedic sports rehabilitation: knee and shoulder – Robert C Manske
  2. Kaplan National Physical Therapy exam – Bethany Chapman, Mary Friatinni
  3. 3.0 3.1 3.2 Neuromusculoskeletal examination and assessment: a handbook for therapists – Nicola F Petty, Ann P Moore
  4. 4.0 4.1 Larson RL, Physical examination in the diagnosis of rotatory instability, clin orthop relat res, 1983, 172, 38-44
  5. Donald B. Slocum, Robert L Larson. Rotatory Intability of the Knee: its pathogenesis and a clinical test to demonstrate its presence. The journal of Bone and Joint Surgery, american volume, 1968; 50-A, No.2:211-225.
  6. J C Kennedy, F.R.C.S, Roger Stewart and Dennis M. Walker. Anterolateral rotatory instability of the knee joint: an early analysis of the elisson procedure, The journal of bone and joint surgery. 1978; Vol 60-A, No 8; 1031-1039.