Knee OSCE Exam Flashcards
What are the first 3 things you should do on introduction to the examination?
Wash hands
Introduce yourself
Confirm pt details (name/DOB)
How should you explain the knee examination to the patient?
“Today I need to examine your knee joint. This will involve looking, feeling & moving the joint.”
How would you check the pt’s understanding & gain consent?
“Does everything I’ve said make sense?”
“Are you happy for me to examine your knee joint?”
How would you like to position your pt?
Expose pt’s legs: ideally pt should be wearing shorts.
Position the pt standing upright.
What crucial question should you ask before beginning the examination?
Ask the pt if they currently have any pain.
What are the 3 main components to a knee examination?
Look
Feel
Move
What 2 things are you looking for when you first look at your pt’s knees?
- Gait
- Inspect the knees (anteriorly & posteriorly)
What are you looking for in the pt’s gait?
- Is the pt demonstrating a normal heel strike / toe off gait?
- Is each step of normal height (increased stepping seen in foot drop)
- Is the gait smooth & symmetrical?
- Any obvious abnormalities? (antalgia / waddling / broad based)
When inspecting the knees, what are you looking for on the anterior aspect?
- Scars: previous surgery / trauma
- Swellings: effusions / inflammatory arthopathy / septic arthritis / gout
- Asymmetry / Leg length discrepancy
- Valgus or varus deformity
- Quadriceps wasting: suggests chronic inflammation / reduced mobility
When inspecting the knees, what are you looking for on the posterior aspect?
- Scars
- Asymmetry
- Popliteal swellings: Baker’s cyst / popliteal aneurysm
When you move onto the ‘feel’ part of the examination, how would you like to assess the pt?
Ask pt to lay on the bed.
What 2 things should you do first when feeling the knee joint?
- Assess temperature: increased temp mays suggest inflammation / infection
- Palpate the quadriceps tendon: whilst leg extended (tenderness suggests synovitis)
You need to palpate the knee joint. How would you like to position the knee?
Knee flexed at 90o.
On palpation of the knee joint, which areas need to be palpated?
- Patella: palpate borders for tenderness / effusion
- Tibial tuberosity: tenderness -> ? Osgood Schlatter disease
- Head of the fibula: irregularities / tenderness
- Tibial & femoral joint lines: irregularities / tenderness
- Collateral ligaments: both medial & lateral
- Popliteal fossa: feel for any obvious collection of fluid (eg. a Baker’s cyst).
Where should you measure the quadriceps circumference?
20cm above tibial tuberosity.
Compare legs.