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Clinical Skills > Joint Examinations > Flashcards

Joint Examinations Flashcards

1
Q

What may be picked up on an X-ray as a result of leaning on the elbow?

A

Fluid-filled sacs

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2
Q

What is your very first step in any examination?

A
  • Wash your hands! (could do it after introductions, to show patient you’ve done it)
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3
Q

How would you go about introduction and consent in a joint examination?

A
  • What are you going to say?
  • Your name, role and purpose of examination
  • ‘Before I start do you have any pain?’
  • ‘Could you tell me which joints are affected?’
  • ‘May I examine your elbow(s)?’ (make sure elbows and knees are exposed – could provide shorts if trousers can’t be rolled up)
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4
Q

How should you position the patient in a joint examination?

A
  • Ensure the patient is:
    o Comfortable (may require analgesia)
    o In a private area (maintaining their dignity and privacy)
    o Sitting on a chair or the edge of the bed
    o BOTH elbows should be exposed for comparison (ideally patient should remove their top clothes)
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5
Q

What are the five steps in an elbow examination?

A
  • LOOK - FRONT, SIDE, BACK!
    o (OBSERVE – deformity, scars, signs of inflammation)
  • FEEL
    o (PALPATE – crepitus, swelling, tenderness)
  • MOVE
    o (ACTIVE (they move it)-PASSIVE (you move their joint)-RESISTED (against resistance) movements .(Range of Movements (ROM)); Assessment of joint stability)
  • SPECIAL TESTS
    o Specific to joint
  • FUNCTION
    o (ask the patient to perform an everyday activity that ‘emphasises’ normal function of this joint)
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6
Q

What are common abnormalities of the elbow upon inspection?

A
  • CUBITUS (Elbow)‏
    o . Varus (distal deformity towards the midline)‏
    o B. Valgus – Distal deformity away from the midline (naturally more in women)
  • Is the joint in neutral?
    o Fixed flexion or hyperextension
  • Scars, swelling, psoriasis
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7
Q

What are the signs of inflammation that you can see/feel in the elbow?

A
  • RUBOR – Redness (Erythema)
  • CALOR – Hot / heat
  • DOLOR – Pain / tenderness (localise)
  • TUMOR – swelling / effusion (fluctuant)
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8
Q

What is the difference between active/passive movement in the elbow and how do you carry it out?

A
  • First check the joint is ‘in neutral’ (normal anatomical position)
  • Move through each of the movements – assessing Range of movement (ROM)
  • Active (patient moves unassisted) vs
  • Passive (you assist patient moving the joint; feel for crepitus)
  • Always be wary of causing pain!
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9
Q

Which four movements can the elbow perform?

A

Flexion
Extension
Supination
Pronation

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10
Q

How can you assess the stability of the elbow?

A
  • STABILITY - The elbow is one of the most stable joints of the skeleton; Instability is therefore relatively uncommon.
  • FUNCTION – think of an everyday that requires normal elbow function (e.g. feeding self).
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11
Q

How do you complete an elbow examination?

A
  • Thank the patient and ensure they are comfortable
  • Offer to help them dress again (especially if in pain or disabled by the joint problem(s))
  • Think about your findings – what do they mean?
    WASH HANDS AGAIN!
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12
Q

How would you begin a knee examination?

A
  • What are you going to say?
  • Name, Role and purpose of examination
  • ‘Before I start do you have any pain?’
  • ‘Could you tell me which joints are affected?’
  • ‘May I examine your knees, ….your joints?’
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13
Q

How should you position the patient for a knee examination?

A
  • Ensure the patient is
  • Comfortable (may require analgesia)
  • In a private area (maintaining their dignity and privacy)
  • Sitting / lying on the examination couch
  • BOTH knees should be fully exposed for comparison (ideally patient should remove their trousers / skirt (as shown) and take socks off)
  • Look at their gait as they walk in (look for limping etc.)
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14
Q

What are the five stages of examination for the knee?

A
  • LOOK - FRONT, SIDE, BACK! (OBSERVE – deformity, scars, signs of inflammation)
  • FEEL – (PALPATE – crepitus, swelling, tenderness)
  • MOVE - (Active vs Passive movements (resisted not required as much for the knee) (Range of Movements (ROM)); Assessment of joint stability)
  • FUNCTION – (ask the patient to perform an everyday activity that ‘emphasises’ normal function of this joint – e.g. go for a walk around the room)
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15
Q

What are common abnormalities of the knee that you might be able to see upon inspection?

A
  • GENU (KNEE)
    o A. Varum (distal deformity towards the midline – ‘Bow legged’)
    o B. Valgum (distal deformity away from the midline – ‘Knocked knees’ – more common in females due to wider pelvis)
  • Is the joint in neutral?
    o Fixed flexion (knee locked) or hyperextension
  • See if legs are the same length – measure to medial malleolus of the ankle – major cause of knee pain (at least 1cm difference to treat it)
    SAY WHAT YOU SEE
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16
Q

What signs of inflammation might you be able to look/feel on the knee?

A
  • RUBOR – Redness (Erythema)
  • CALOR – Hot / heat
  • DOLOR – Pain / tenderness (localise)
  • TUMOR – swelling / effusion (fluctuant)
17
Q

How would you test for an effusion?

A
  • Method (1) – The ‘BULGE’ test (Small effusions)
    o With the patient sitting on the examination couch, smooth your hand across the medial aspect of the knee (watch for a bulge in the lateral aspect of the knee joint)
    o Now smooth your hand across the lateral aspect and watch for any ‘refilling’ or BULGE of the medial aspect.
  • Method (2) – The Patella tap or ‘BOUNCE’ test (large effusions)
    o With the patient sitting on the examination couch, empty the supra-patellar bursa with your non-dominant hand.
    o Now attempt to ‘bounce’ the patella on the anterior joint by pushing down with two to three fingers of your other hand.
    o This test will only be positive for larger effusions.
18
Q

How would you carry out active/passive movement?

A
  • First check the joint is ‘in neutral’ (normal anatomical position)‏
  • Move through each of the movements – assessing Range of movement (ROM)‏
  • Active (patient moves unassisted) vs
  • Passive (you assist patient moving the joint)‏
  • Always be wary of causing pain!
19
Q

How would you test the stability of the knee?

A 
-	Test.
o	Medial (MCL) and lateral collateral (LCL) ligaments
o	Anterior (ACL) and posterior (PCL) cruciate ligaments
-	There are also tests for the integrity of the menisci –joint line tenderness and Mcmurreys (painful) - Look for joint line tenderness instead where possible with fingers to avoid this test
20
Q

What must you take into account before doing a test of stability on the knee?

A
  • For the following assessments to be valid the patient must be able to relax the muscles around their knee; This may not be possible!
  • DO NOT ATTEMPT THE TESTS IF THE PATIENT IS IN PAIN
21
Q

How would you stress the MCL?

A
  • Support the lateral aspect of the knee
  • Move the distal leg laterally
  • The idea is to try and ‘open up’ the joint – ‘stressing’ the ligament
22
Q

How would you stress the LCL?

A
  • Support the medial aspect of the knee
  • Move the distal leg medially
  • The idea is to try and ‘open up’ the joint – ‘stressing’ the ligament
23
Q

What is alternative way to test to MCL/LCL?

A
  • Place the patient’s foot gently in your axilla / under your arm
  • Hold the knee as shown in your two hands
  • Stress each ligament in turn, by moving the distal leg medially (opens LCL), then laterally (opens MCL)
  • Compare to other knee to see if movement is limited
24
Q

How do you carry out an anterior draw test?

A
  • With the patient sitting on the bed, place the patient’s knee in flexion (as shown)
  • Gently sit on the planted foot
  • Now attempt to draw the tibia forward
  • A positive drawer test is one where the ACL is torn and thus allows the tibia to move forwards on the femur
25
Q

How would you carry out a Lachman’s test? What does this test?

A

Tests the ACL

  • With the patient sitting on the bed, place the patient’s knee in slight flexion (as shown)
  • Hold the distal thigh in your left hand and the proximal leg in your right hand
  • Now attempt to draw the leg forward whilst stabilising the thigh.
  • A positive drawer test is one where the ACL is torn and thus allows the tibia to move forwards on the femur
26
Q

How would you carry out an anterior draw test if the patient has large thighs or you have small hands?

A
  • If the patient has very large thighs or your have small hands – you can perform the test (as shown) with the leg hanging over the edge of the examination couch.
27
Q

How do you carry out a posterior draw test?

A
  • With the patient sitting on the bed, place the patient’s knee in flexion (as shown)
  • Gently sit on the planted foot
  • Now attempt to push the tibia posteriorally
  • A positive drawer test is one where the PCL is torn and thus allows the tibia to move backwards on the femur
  • Will need an MRI to confirm
28
Q

What kind of function test can you do on the knee?

A
  • Ask the patient to stand and re- assess the posterior aspect of the knee – cysts and other abnormalities may become more obvious on standing)
  • Ask the patient to walk (as an everyday activity)
  • Examine the joints above and below as well
29
Q

How would you complete the knee examination?

A
  • Thank the patient and ensure they are comfortable
  • Offer to help them dress again (especially if in pain or disabled by the joint problem(s))
  • Think about your findings – what do they mean?
    WASH YOUR HANDS!

Clinical Skills (4 decks)

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