Sometimes, when we run, jump, or play a game like cricket or football with friends, our knee suddenly buckles. The pain that comes with a "click" sound is unbearable. Has this happened to you too? When you go to see a doctor with knee pain, one of the various tests he will do is the Apley test. Although the name may sound like a big deal, it is a very simple test. Let's see what it is, how it is done, and what it can find out.
Simply put, what is the Apley Test?
The Apley test is a simple physical test that a doctor performs when they suspect you have a torn meniscus in your knee. It is also sometimes called the Apley grind test or the Apley compression test. All three names refer to the same test.
This is something that can be done in-office. That means you don't have to come in on a separate day or be put under a big machine. You lie on your stomach on an examination table and the doctor slowly rotates your lower leg. He or she will listen carefully to you about any pain or discomfort you may be experiencing.
This is usually one of the first tests that a doctor will do when you see a doctor with a knee injury. However, this alone does not complete the diagnosis. Often, after this test, you will be referred for a scan to confirm the injury.
Is there an Apley test for the shoulder?
Yes, but it's a completely different test. You may have heard of the Apley scratch test. Although the name is similar, it's done to look for problems in the shoulder . The movements used are completely different. So if you have a knee problem, you don't even need to think about the Apley scratch test for your shoulder.
Are there other tests like the Apley Test?
Yes, there are several other tests like this that are used to look for damage inside the knee. The McMurray test and the Thessaly test are the two main ones. Although the purpose of all three is the same, the way they are performed, that is, the position you need to be in and the movements the doctor makes, are different. Let's see what the difference is.
| Name of the test | The way you want to be. | What the doctor does |
|---|---|---|
| Apley Test | Lie on your stomach in bed (prone) | Bend the knee 90 degrees and rotate the lower leg to the side. |
| McMurray Test | Supine in bed | Bend your knees and extend your legs while rotating them. |
| Thessaly Test | Standing | Standing on one leg, bending the knee slightly and rotating the body. |
When performing all three of these tests, the doctor will listen for sounds like "clicks" and "clicks" coming from your knee, and will also ask you carefully about the pain you are feeling.
When do I need an Apley Test?
A doctor is most likely to perform this test on you if they suspect you have a meniscus tear . This is one of the most common knee injuries, especially in athletes.
What is this meniscus?
Imagine, inside your knee joint, between the thigh bone (Femur) and the shin bone (Tibia), there are two C-shaped pieces of rubbery cartilage. That's what the meniscus is called. Simply put, it's like a shock absorber in a car. Its job is to prevent the two bones from rubbing together and to absorb the pressure that comes to the joint when we run and jump.
This meniscus can tear during any sudden movement of the knee. Sports injuries are the main cause. Apart from that, it can also happen in things like falls and car accidents.
Common symptoms of a meniscus tear:
- When injured , you may hear or feel a "click" sound coming from your knee.
- The knee feels lifeless , and the knee feels like it is "bending" when standing.
- Knee pain .
- Knee stiffness .
- Swelling .
- You will not be able to bend or fully extend your knee normally.
If you have symptoms like these, your doctor will perform the Apley test to check for damage to the ligaments of the knee in addition to the meniscus.
How exactly is the Apley Test performed?
The procedure for this test is very simple. You have nothing to worry about. Here is the step-by-step procedure:
1. First, you will be asked to lie prone on the examination table.
2. The doctor will then place his knee behind your thigh and gently press it down. Keep your leg still and don't move.
3. Now bend your knees to 90 degrees , which is exactly like the shape of the letter 'L'.
4. Next, grab your lower leg and slowly pull it up (distraction), rotating the leg in and out, side to side .
5. Then, instead of pulling the leg up, hold the lower leg and slowly press it down (compression), while rotating it from side to side in the same way.
While doing these movements, the doctor will often ask you, "Do you feel any pain?", "Does your knee feel tight?", and he will also listen for sounds coming from your knee.
The important thing is that the doctor will often do this test on your uninjured healthy leg first to get an idea of your normal range of motion. Only then will the injured leg be tested.
What happens after the test?
After the Apley test, the doctor will have some idea about the problem with your knee. But to be 100% sure of the diagnosis, they will often refer you for a scan .
The most commonly used types of scans for this are:
- MRI (Magnetic Resonance Imaging) Scan: This is the best way to see soft tissues in the knee, such as the meniscus, cartilage, and ligaments.
- Ultrasound scan: This can also provide some visualisation of the soft tissues of the knee.
- X-rays: Although these cannot show the meniscus, they can check for fractures or other problems in the knee bones.
In some cases, knee arthroscopy may be performed to check for or repair damage to the knee. This involves making a small incision in the knee and inserting a camera. This is usually not a major operation, and you can go home the same day.
What are the risks or how to read the results of the Apley Test?
There are no major risks to having this test. You may feel some discomfort or mild pain during the test. However, if the pain is too severe to bear, it is best not to come.
Speaking of results, this is not a test that comes up with a specific number like a math problem. It is categorized as 'positive' or 'negative'.
- Positive result: If you feel pain during the test, especially when you press down on your leg (compression) and rotate it, or if you hear a "click" sound in your knee, that's a 'positive' result. It means you may have a torn meniscus.
- Negative result: If you don't feel any pain or discomfort, it's a 'negative' result. But it doesn't mean there's 100% no injury. There could be another problem. That's why a scan is important.
When should I see a doctor or go to the ETU?
It is very important to know what to do when you have a knee injury.
| Status | What to do |
|---|---|
| See your doctor. | |
| If the pain or swelling does not subside after a few days and gradually increases . | See your family doctor or an orthopedic surgeon as soon as possible. |
| Go to the Emergency Treatment Unit (ETU) immediately. | |
| These may be signs of a serious injury. Go to the nearest hospital Emergency Department (ETU) without delay. |
The Apley test is a valuable test that can help a doctor quickly get an idea of what is going on in your knee, especially if you suspect a meniscus tear. Although it shouldn't cause you any pain, don't be afraid to tell your doctor if you're feeling any discomfort. The information you provide will be the biggest help in helping him make an accurate diagnosis.
Take-Home Message
- The Apley test is a simple physical test performed by a doctor to check for a torn meniscus in the knee.
- In this test, you are turned over on your stomach, your knees bent, and your legs rotated.
- This test may cause some discomfort, but it should not be too painful. If you feel this way, tell your doctor immediately.
- This is just a preliminary examination. To confirm the exact location of the injury, a scan such as an MRI is usually performed.
- If you have severe knee pain, rapidly increasing swelling, or an inability to move your knee, see a doctor without delay or go to the ETU immediately.
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