Knee OSCE

Question 1

Internal/External rotation of tibia on femur evaluation

Answer 1

Patient supine Physician faces patient on side that is being tested. Flex hip and knee to 90°. Thumbs on each side of tibial tuberosity with hands wrapped around calf. Put the lower extremity in the doctor’s upper extremity. Induces internal rotation (medial turn) & external rotation (lateral turn) motion of the tibia on the femur.

Question 2

Internal rotation dysfunction

Answer 2

increased internal rotation with restricted external rotation

Question 3

External rotation dysfunction

Answer 3

increased external rotation with restricted internal rotation

Question 4

ER Tibiofemoral somatic dysfx: ME

Answer 4

Patient: Seated with legs off table Physician grasps the lateral aspect of the patient’s foot and ankle with one hand and the other hand contacts the medial tibial plateau to monitor motion (anteromedial and posterolateral glide). Dorsiflex and IR the distal tibia to edge of Restrictive barrier (white arrow). Instruct patient to turn foot into ER (black arrow) for 3-5 seconds against your resistance. Repeat 3-5 times or until motion is fully restored.

Question 5

IR Tibiofemoral somatic dysfx: ME

Answer 5

Patient: Seated with legs off table Physician grasps the medial aspect of the patient’s foot and ankle with one hand and the other hand contacts the medial tibial plateau to monitor motion (anteromedial and posterolateral glide) Dorsiflex and ER the distal tibia to edge of Restrictive barrier (white arrow). Instruct patient to turn foot into IR for 3-5 seconds against your resistance (black arrow). Repeat 3-5 times or until motion is fully restored.

Question 6

Flexion/extension of tibia on femur evaluation

Answer 6

Patient: Prone Observe if knee at rest extends to 0⁰. Instruct patient to attempt to bring the knee to buttocks.

Question 7

Flexed TF joint dysfunction

Answer 7

resists extension. Pay close attention to ROM, pt discomfort, and end-feel

Question 8

Extended TF joint dysfunction

Answer 8

resists flexion. Pay close attention to ROM, pt discomfort, and end-feel.

Question 9

Extended Tibiofemoral Somatic Dysfunction: Muscle Energy

Answer 9

Patient: Prone Physician flexes pt’s knee to restrictive barrier. Physician places shoulder or hand proximal to ankle of ipsilateral LE. Pt is instructed to extend knee against counter resistance for 3-5 seconds. Repeat 3-5 times or until no new barriers are attained. Reassess for TART.

Question 10

Flexed Tibiofemoral Somatic Dysfunction: Muscle Energy

Answer 10

Patient: Supine Physician extends pt’s knee to restrictive barrier. Physician places distal hand under the pt’s calcaneus and proximal hand over pt’s knee cap. Pt is instructed to flex knee against counter resistance for 3-5 seconds. Repeat 3-5 times or until no new barriers are attained. Reassess for TART.

Question 11

Anteroposterior glide of tibia on femur evaluation

Answer 11

Patient: supine, knee flexed, foot flat on table, doctor at side. Physician sits on patient’s foot anchoring it to table. Wrap both hands around the proximal tibia with thumbs in front of medial & lateral condyles, fingers in popliteal space. Translate anterior & posterior noting ease of glide. *Note: Identical to Anterior Drawer Test but reduced force used. Assesses restricted motion (Anterior Drawer Test assesses excessive motion).

Question 12

Abduction/Adduction of tibia on femur evaluation

Answer 12

Patient: supine, knee fully extended Physician on the side of table. One hand grasps the distal femur, the other hand grasps the ankle. Create a valgus-varus stress.

Question 13

ADduction dysfunction – like to adduct (varus)

Answer 13

ease of motion with valgus force, restriction to varus. (Valgus>Varus) Ease of medial translatory motion

Question 14

ABduction dysfunction –

Answer 14

ease of motion with varus force, restriction to valgus. (Varus>Valgus) Ease of lateral translatory motion

Question 15

Proximal fibular head dysfunction: Osteopathic Evaluation

Answer 15

Patient supine, knee flexed, foot flat on table, doctor at side. (Can also do with knee fully extended) Pinch fibular head with thumb & index fingers, stabilize knee with other hand. Translate head anteriorly and posteriorly to assess gliding motion noting asymmetry between anterior and posterior glide.

Question 16

Anterior fibular head dysfunction

Answer 16

ease of glide anterior, restricted glide posterior

Question 17

Posterior fibular head dysfunction

Answer 17

ease of glide posterior, restricted glide anterior

Question 18

Posterior Fibular Head: Muscle Energy

Answer 18

*Accompanied by plantarflexion, foot inversion, adduction and lower leg IR Patient: Supine or seated Physician flexes pt’s hip and knee to 90⁰ and holds fibular head between thumb and index finger. Physician uses other hand to evert, abduct, and dorsiflex pt’s foot, while also externally rotating lower leg (white arrow). Have pt move medially against resistance for ME tx (black arrow). Reassess for TART.

Question 19

Anterior Fibular Head: Muscle Energy

Answer 19

*Accompanied by dorsiflexion, foot eversion, abduction, and lower leg ER Patient: Supine or seated Physician flexes pt’s hip and knee to 90⁰ and holds fibular head between thumb and index finger. Physician uses other hand to invert, adduct, and plantarflex pt’s foot, while also internally rotating lower leg (white arrow). Have pt move laterally against resistance for ME tx (black arrow). Reassess for TART.