Lab 8: Knee Treatments OSCE

Question 1

Internal and External Rotation Osteopathic Evaluation

How would you diagnose this somatic dysfunction?

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.

Internal rotation dysfunction: Increased internal rotation with restricted external rotation

External rotation dysfunction: increased external rotation with restricted internal rotation

Question 2

External Rotation Tibiofemoral SD MET

How would you perform this technique?

Answer 2

• *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).

1. Dorsiflex and IR the distal tibia to edge of Restrictive barrier (white arrow).
2. Instruct patient to turn foot into ER (black arrow) for 3-5 seconds against your resistance.
3. Repeat 3-5 times or until motion is fully restored.
4. Reassess

Question 3

Internal Rotation Tibiofemoral SD MET

How would you perform this technique?

Answer 3

• *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).

1. Dorsiflex and ER the distal tibia to edge of Restrictive barrier (white arrow).
2. Instruct patient to turn foot into IR (black arrow) for 3-5 seconds against your resistance.
3. Repeat 3-5 times or until motion is fully restored.
4. Reassess

Question 4

Flexion and Extension of Tibia on Femur Osteopathic Evaluation

How would you diagnose this somatic dysfunction?

Answer 4

Patient prone

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

Flexed TF joint dysfunction: resists extension. Pay close attention to ROM, pt discomfort, and end-feel

Extended TF joint dysfunction: resists flexion. Pay close attention to ROM, pt discomfort, and end-feel.

Question 5

Extended Tibiofemoral SD MET

How would you perform this technique?

Answer 5

• *Patient:** Prone
• *Physician** flexes pt’s knee to restrictive barrier.

1. Physician places shoulder or hand proximal to ankle of ipsilateral LE.
2. Pt is instructed to extend knee against counter resistance for 3-5 seconds.
3. Repeat 3-5 times or until no new barriers are attained.
4. Reassess for TART.

Question 6

Flexed Tibiofemoral SD MET

How would you perform this technique?

Answer 6

• *Patient:** Prone
• *Physician** extends pt’s knee to restrictive barrier.

1. Physician places distal hand under patient’s calcaneus and proximal hand over patient’s knee cap.
2. Pt is instructed to flex knee against counter resistance for 3-5 seconds.
3. Repeat 3-5 times or until no new barriers are attained.
4. Reassess for TART.

Question 7

Anteriorposterior Glide of Tibia on Femur Osteopathic Evaluation

How would you diagnose this somatic dysfunction?

Answer 7

• *Patient** supine, knee flexed, foot flat on table, doctor at side.
• *Physician** sits on patient’s foot anchoring it to table.

1. Wrap both hands around the proximal tibia with thumbs in front of medial & lateral condyles, fingers in popliteal space.
2. 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 8

Abduction and Adduction of Tibia on Femur Osteopathic Evaluation

How would you diagnose this somatic dysfunction?

Answer 8

• *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.

Adduction dysfunction: ease of motion with valgus force, restriction to varus. (Valgus>Varus)

Ease of medial translatory motion

Abduction dysfunction: ease of motion with varus force, restriction to valgus. (Varus>Valgus)

Ease of lateral translatory motion

Question 9

Proximal Fibular Head Dsyfunction Osteopathic Evaluation

How would you diagnose this somatic dysfunction?

Answer 9

Patient supine, knee flexed, foot flat on table, doctor at side. (Can also do with knee fully extended)

1. Pinch fibular head with thumb & index fingers, stabilize knee with other hand.
2. Translate head anteriorly and posteriorly to assess gliding motion noting asymmetry between anterior and posterior glide.

Anterior fibular head dysfunction: ease of glide anterior, restricted glide posterior

Posterior fibular head dysfunction: ease of glide posterior, restricted glide anterior

Question 10

Posterior Fibular Head SD MET

How would you perform this technique?

Answer 10

• *Patient:** Supine or seated
• *Physician** flexes pt’s hip and knee to 90⁰ and holds fibular head between thumb and index finger.

1. Physician uses other hand to evert, abduct, and dorsiflex pt’s foot, while also externally rotating lower leg (white arrow).
2. Have pt move medially against resistance for ME tx (black arrow).
3. Reassess for TART.

If patient has posterior fibular head, they like to plantarflex, invert, adduct, and IR lower leg.

Question 11

Anterior Fibular Head SD MET

How would you perform this technique?

Answer 11

• *Patient:** Supine or seated
• *Physician** flexes pt’s hip and knee to 90⁰ and holds fibular head between thumb and index finger.

1. Physician uses other hand to invert, adduct, and plantarflex pt’s foot, while also internally rotating lower leg (white arrow).
2. Have pt move laterally against resistance for ME tx (black arrow).
3. Reassess for TART.

If patient has anterior fibular head, they like to dorsiflex, evert, abduct, and ER lower leg.