Dial Test
Original Editors - Gaëlle Vertriest as part of the Vrije Universiteit Brussel's Evidence-based Practice project
Top Contributors - Tomer Yona, Gaëlle Vertriest, Rachael Lowe, Admin, Kim Jackson, Yvonne Yap, Daphne Jackson, Uchechukwu Chukwuemeka, Tony Lowe, Kai A. Sigel, WikiSysop and Wanda van NiekerkPurpose Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[edit | edit source]
The purpose of the Dial Test is to diagnose posterolateral instability and to differentiate between isolated PLC injury and combination PLC/PCL injury [1].
The test can be clinically valuable when:
1. Three posterolateral structures (Popliteus tendon, Popliteofibular ligament, Lateral collateral ligament) are injured.
2. There is combined injury to the PCL and two other posterolateral structures.
Its important to know that when only one or two structures are injured , the dial test is not enough to diagnose the injury. For an isolated PCL tear, the posterior drawer test or sag tests are more relevant.
Clinically Relevant Anatomy[edit | edit source]
Relevant structure of the posterolateral corner in the knee [2]
Technique
[edit | edit source]
The test can be done with the patient either in prone or supine position (Different authors prefer different positions[1] [3])
The goal of test is to inspect the external rotation (foot-thigh angle, best measured in a clinical setting [4])at the knee joint while the knees are in 30° and 90° of flexion .
Patient in prone position :The clinician flexs the patient knees to 30° and places both hands on the feet of the patient, cupping his heels. A maximal external rotation force is then applied, and the foot-thigh angle is measured and compared with the other side. The knees are then flexed to 90°, and again an external rotation force is applied and the foot-thigh angle is measured again [1].
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°.
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.
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.
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)
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.
| Standard injury | Mild injury | Moderate injury | Severe Injury |
| <5° | 6-10° | 11-19° | >20° |
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.
- 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.
- 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.
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 Lubowitz JH, Bernardini BJ, Reid JB. Current Concepts Review Comprehensive Physical Examination for Instability of the Knee. The American journal of sports medicine. 2008 Mar 1;36(3):577-94.
- ↑ Noyes FR. Noyes' knee disorders: surgery, rehabilitation, clinical outcomes. Elsevier Health Sciences; 2009 Aug 20.
- ↑ LaPrade RF, Wentorf F. Diagnosis and treatment of posterolateral knee injuries. Clinical Orthopaedics and related research. 2002 Sep 1;402:110-21.
- ↑ Krause DA, Levy BA, Shah JP, Stuart MJ, Hollman JH, Dahm DL. Reliability of the dial test using a handheld inclinometer. Knee Surgery, Sports Traumatology, Arthroscopy. 2013 May 1;21(5):1011-6.
