knee osce

Question 1

Intro

Answer 1

hand hygiene, intro, explain, consent, expose lower leg, stand pt up

Question 2

look

Answer 2

cachexia, scaring, varus, valgus, STDCAL, walk 5 steps

Question 3

Feel

Answer 3

Pt supine
swelling, heat (artheritis) spasms
bones/ femur/ patella/ tibia/ fibula
muscles- rectus femoris/ vastus intermedius (under rectus)/ vastus lateralis/ vastus medialis

baker’s cyst

Question 4

Sensation

Answer 4

L1 greater tronchlear/ groin

L2 proximal aspect of medial thigh

L3 distal aspect of medial thigh

L4 medial aspect of calf

L5 dorsal aspect of third toe

S1 lateral aspect of little toe

pulses- dorsal pedis/ posterior tibilars/ popliteal pulse

colour

warmth

cap refil

Question 5

move both legs passive and active

Answer 5

flexion 135 degrees

extension 15 degrees (more ? hyper)

Question 6

Special test

Answer 6

Supine
apprehension patella test- relax pt, move patella laterally and watch pt

patella tap- push patella down, observe for sinking patella with rise (oedema)

Swipe- push distal on upper leg and proximal of lower leg, towards patella and swiping to side looking for oedema

anterior/posterior crucial ligament test (drawer test) plant foot on bed and flex knee, observe laterally for sag, pull and push knee if easy dmg ligament

collateral ligament (varus/valgus) have pt knee lifted an supported, push lower leg against side being tested (lateral, medial) pain or lax in movement is positive, do each with knee at 30 degrees and 0 degrees

McMurry’s- hold leg at 90 degrees, rotate lower leg laterally and move knee back and forth, then repeat with leg medially rotated, checking for meniscus dmg

Apleys grind test- have pt prone, and flex leg to 90 degrees, twist lower leg medially and laterally whilst pushing down-meniscus dmg if pain

Question 7

ottawa knee

Answer 7

> 55yrs, pain isolated to patella and head of fibula, inability to flex knee 90 degrees, cant walk more then 4 steps