American Board of Internal Medicine (ABIM) Certification Practice Exam

What test is considered positive when pain is reproduced upon flexion and extension of the knee while palpating the lateral femoral epicondyle?

1. McMurray test

2. Patellar apprehension test

3. Noble test

4. Apley grind test

The correct answer is: Noble test

The Noble test is specifically designed to identify iliotibial band syndrome, which is associated with pain on the lateral side of the knee. In this test, the clinician palpates the lateral femoral epicondyle while flexing and extending the knee. The maneuver aims to compress the iliotibial band over the lateral femoral epicondyle, reproducing pain in patients with this condition. A positive Noble test indicates that the patient likely has irritation of the iliotibial band as it moves over the epicondyle, which can cause discomfort, especially during activities that involve repetitive knee flexion and extension. Other tests listed serve different purposes. For example, the McMurray test assesses meniscal tears, the patellar apprehension test evaluates patellar instability, and the Apley grind test is conducted to assess for meniscal tears in a different manner. Each of these tests engages different structures and mechanisms, highlighting the specificity of the Noble test in relation to iliotibial band syndrome pain.