OSPE - patella fracture

Question 1

What walking aid would you recommend and teach the correct gait

Answer 1

2 crutches - promotes partial weight-bearing
Check ferrules and soundness of frame, measurement = handle reaches ulna styloid
3 point = 2 crutches, bad foot, good foot
4 point = left crutch, right foot, right crutch, left foot
Stairs = hold handrail and crutches.
Ascending = good foot up, bad foot up, crutch up
Descending = crutch down, then bad foot and good foot

Question 2

How would you measure ROM at the knee

Answer 2

Goniometer
Axis on the lateral epicondyle of the femur
Moving arm on the lateral midline of the fibula, pointing at the lateral malleolus
The stationary arm on the lateral midline of the femur, pointing at the greater trochanter
ALWAYS COMPARE WITH THE GOOD SIDE

Question 3

Suggest an exercise for improving strength at the knee joint

Answer 3

Quad sets = Sit on plinth with the injured leg out straight, and pillow below the knee. Press the back of your knee into the pillow by tightening the muscles of your thigh. Dorsiflex your ankle to help.
Hamstring curls = hold onto plinth, bring injured leg up towards bottom and hold for 5 seconds

Question 4

Suggest an exercise for improving ROM at the knee joint

Answer 4

Seated scoots = Sit all the way back in a chair with your feet flat on the floor. Scoot forward, while keeping your feet firmly on the floor. You should feel a stretch along the front of your knee. Hold for 20 seconds.

Question 5

What pulse can you find in the knee and where is it found?

Answer 5

Popliteal pulse;
Found in the back of the knee (popliteal artery).
Lay the patient on the plinth, with legs out flat and straight. Place both hands around the knees, with fingers in the popliteal fossa at the back of the knee. Patient relaxes leg so it goes “floppy”, physio lifts leg slightly, applying pressure to find the pulse.

Question 6

What are the muscles of the hamstring group called?

What action do they perform?

Answer 6

Biceps femoris, Semitendinosus, Semimembranosus

Prime movers of leg flexion at the knee.

Question 7

Name the origin and insertion of the biceps femoris

Answer 7

Arises from 2 heads (long head and short head)
Origin;
Ischial tuberosity (long head)
Linea Aspera (short head)
Insertion;
Head of the fibula and lateral condyle of tibia

Question 8

Name the origin and insertion of the semitendinosus

Answer 8

Origin; Ischial tuberosity

Insertion; Medial condyle of the tibia

Question 9

Name the origin and insertion of the semimembranosus

Answer 9

Origin; Ischial tuberosity

Insertion; Medial condyle of the tibia

Question 10

What ligaments and tendons can be found at the knee joint?

Answer 10

Anterior cruciate ligament (ACL)
Posterior cruciate ligament (PCL)
Medial collateral ligament
Lateral collateral ligament
Quadriceps tendon into patella tendon

Question 11

How would you palpate the medial and lateral epicondyles?

Answer 11

The lower end of the femur, epicondyles are in the centre of the condyles and are prominent

Question 12

How would you palpate the adductor tubercle?

Answer 12

Above the medial epicondyle is a small prominence of bone

Question 13

How would you palpate the tibial plateau?

Answer 13

The superior surface of the tibia. Anterior part can be palpated when the knee is in flexion.

Question 14

How would you palpate the tibial tuberosity?

Answer 14

The upper end of the anterior border of the tibia, inferior to the patella

Question 15

How would you palpate the head of the fibula?

Answer 15

Lies posterolateral to the tibia, just below the mid-point on the lateral side.

Question 16

How would you palpate the medial and lateral condyles?

Answer 16

2cm higher than the tibial tuberosity, on medial and lateral aspects of the knee.

Question 17

How would you palpate the trochlear groove?

Answer 17

The patella sits in this groove. In knee extension/flexion push patella to the side and feel femur underneath

Question 18

How would you palpate the Gerdy’s tubercle?

Answer 18

Midway between the head of the fibula and tibial tuberosity. Bony prominence.

Question 19

What nerve supplies the hamstring muscles?

Answer 19

The group is innervated by the sciatic nerve

Question 20

How do you palpate the medial collateral ligament?

Answer 20

Begin with the leg in flexion
Find the joint line, above the tibial tuberosity
Run your finger along the joint line posteriorly until your finger is “pushed out”.

Question 21

How do you palpate the lateral collateral ligament?

Answer 21

Flex the leg and cross it over the other.
Find head of fibula (lateral side, leverl with tibial tuberosity)
Feel a ropey band.

Question 22

Name the muscles on the anterior of the thigh

Answer 22

Quadricep group;
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius

Question 23

Name the origin and insertion for all muscles in the quadricep group

Answer 23

All 4 muscles originate from;
anterior inferior iliac spine and linea aspera
All 4 muscles insert into;
patella and tibial tuberosity via the patellar ligament