OSCE: Knee

Question 1

What is a Q angle?

What is the normal Q angle for the knee?

Answer 1

• Q Angle: Difference creating one straight line from ASIS to center of patella and another straight line through tibial tuberosity and center of patella.
• Typically 15^o but for females it can be increased

Question 2

What is the normal ROM for knee flexion?

What muscles are involved?

Answer 2

145-150^o

• Biceps Femoris (long head and short head)
• Semimembranosis
• Semitendinosis
• Gracilis
• Gastrocnemius
• Plantaris
• Sartorius
• Popliteus

Question 3

What is the normal ROM for knee extension?

What muscles are involved?

Answer 3

0^o

Quadriceps Muscles

• Rectus Femoris
• Vastus Lateralis, Medialis, Intermedius

Question 4

What does the L4 deep tendon reflex test?

Answer 4

Patella

Question 5

Valgus Test

How do you peform this test?

What does a positive test indicate?

Answer 5

1. Patient supine with the knee flexed to 30°.
2. Physician supports the lower leg with one and other hand placed on the lateral aspect of the patient’s knee.
3. Apply a medial force to the proximal tibia while abducting the lower leg.

• This test is done at 30° flexion and neutral.
• Knee toward body and leg goes away*

Positive Test (increased laxity/pain) indicates Medial Collateral Ligament (MCL) Disruption.

Question 6

Varus Test

How do you peform this test?

What does a positive test indicate?

Answer 6

1. Patient supine with the knee flexed to 30°.
2. Physician supports the lower leg with one and other hand placed on the medial aspect of the patient’s knee.
3. Apply a lateral force to the proximal tibia while adducting the lower leg.

• This test is done at 30° flexion and neutral.
• Knee away from body and leg goes toward*

Positive Test (increased laxity/pain) indicates Lateral Collateral Ligament (LCL) Disruption.

Question 7

Anterior Drawer Test

How do you peform this test?

What does a positive test indicate?

Answer 7

1. Patient supine with knee flexed to 90°.
2. Examiner sits on the patient’s foot
3. Examiner grasps the proximal tibia with both hands, pulling the tibia anteriorly.

Positive Test (excessive translation) indicates ACL Insufficiency.

Question 8

Lachman’s Test

How do you peform this test?

What does a positive test indicate?

Answer 8

1. Patient supine.
2. Examiner places cephalad hand on the distal thigh, superior to patella.
3. Caudad hand grasps the proximal tibia.
4. Flexing the knee to 10-30°, the examiner uses his caudad
   hand to pull the tibia anteriorly while the cephalad hand
   stabilizes the thigh.

Positive Test (increased laxity) indicates ACL Insufficiency.

Question 9

Posterior Drawer Test

How do you peform this test?

What does a positive test indicate?

Answer 9

1. Patient supine with knee flexed to 90°.
2. Examiner sits on the patient’s foot.
3. Examiner grasps the proximal tibia with both hands, pulling the tibia posteriorly.

Positive Test (excessive translation) indicates PCL Insufficiency.

Question 10

McMurray’s Test

How do you peform this test?

What does a positive test indicate?

Answer 10

1. Patient supine with knee flexed to 90°.
2. Examiner uses caudad hand to control the ankle and cephalad hand placed on distal femur.

• Lateral Meniscus: Examiner rotates the tibia into
  internal rotation and applies a varus stress, then
  continues the leg into extension
• Medial Meniscus: Examiner rotates the tibia into
  external rotation and applies a valgus stress, then
  continues the leg into extension

Positive Test (pain) indicates Medial or Lateral Meniscus Tear.

Question 11

Apley’s Grind Test: Compression

How do you peform this test?

What does a positive test indicate?

Answer 11

1. Patient prone with knee flexed to 90°.
2. Examiner uses downward force on the foot to provide a compressive force on the meniscus, while rotating the foot internally and externally.

Positive Test (pain) indicates possible meniscal injury, collateral ligament injury, or both.

Question 12

Apley’s Grind Test: Distraction

How do you peform this test?

What does a positive test indicate?

Answer 12

1. Patient prone with knee flexed to 90°.
2. Examiner stabilizes the thigh, then applies upward traction to the leg while rotating it.

Positive Test (pain) indicates collateral ligament injury.

Positive Test (relief of pain) indicates possible meniscal injury.

Question 13

Patella-Femoral Grinding Test

How do you peform this test?

What does a positive test indicate?

Answer 13

1. Compress patella caudally into trochlear groove
2. Instruct patient to tighten quadriceps against resistance

Positive Test (pain) indicates roughness of articulating surfaces