Osteopathic Testing of the Knee OSCE

Question 1

what is the Q angle?

Answer 1

• normal Q angle is 15 degrees
• females typically have increased Q angle
• line from tibial tuberosity to midpoint of patella and line from ASIS to midpoint of patella

Question 2

m and n for strength testing extension of knee

Answer 2

• quadriceps m

- femoral n

Question 3

m and n for strength testing flexion of knee

Answer 3

• hamstrings

- sciatic n

Question 4

d. Perform the internal rotation/external rotation evaluation of the tibia/knee joint for somatic dysfunction and document appropriately.

Answer 4

• Student is standing at side of table facing patient and places patient in a supine position with hip and knee flexed to 90 degrees or prone with knee flexed to 90 degrees.
• Student assesses passive internal rotation of the tibia by blocking linkage proximally and noting 10 degrees expected range of motion.
• Student assesses passive external rotation of the tibia by blocking linkage proximally and noting 10 degrees expected range of motion.
• Student states internal rotation dysfunction has ease of motion to internal rotation and restriction to external rotation.
• Student states external rotation dysfunction has ease of motion to external rotation and restriction to internal rotation.
• Student notes a tibia/knee internal rotation or external rotation dysfunction would be documented in the objective portion of the chart noting side of laterality.

Question 5

e. Perform the abduction/adduction evaluation of the knee joint for somatic dysfunction and document appropriately.

Answer 5

• Doctor standing at side of table with patient in a supine position.
• Doctor contacts the lateral aspect of the knee with one hand and the medial ankle with the
  other.
• Doctor applies a valgus force to assess for adduction ease or restriction of motion
• Doctor reverses hand to medial knee and lateral ankle and applies a varus force to assess for
  abduction ease or restriction of motion.
• Doctor notes this is evaluating for a functional change not a structural change in the tissues.
• Doctor states that an adduction somatic dysfunction will have ease of motion with valgus
  force.
• Doctor states that an abduction somatic dysfunction will have ease of motion with varus
  force.
• An adduction or abduction dysfunction will be documented in the objective portion of the chart with the side of laterality noted.

Question 6

ROM for flexion of knee

Answer 6

145-150 deg

Question 7

ROM for extension of knee

Answer 7

0 to -5 deg

Question 8

ROM for internal rotation of knee

Answer 8

10 deg

Question 9

ROM for external rotation of knee

Answer 9

10 deg

Question 10

f. Perform the proximal fibula evaluation of the knee joint for somatic dysfunction and document appropriately.

Answer 10

• Doctor standing at side of table and patient supine with knee flexed and foot flat on table. (Can also do supine with knee fully extended)
  
  • Doctor contacts the head of the fibula with the thumb and index finger of one hand
  • Doctor slowly applies an anterior then posterior force to assess for gliding motion of the fibular head with the tibia.
  • Doctor notes if there is asymmetry between anterior and posterior glide.
  • Doctor notes an ease of anterior glide with posterior glide restriction defines an anterior fibular head somatic dysfunction
  • Doctor notes an ease of posterior glide with anterior glide restriction defines an posterior fibular head somatic dysfunction
  • Doctor notes an anterior or posterior fibular head somatic dysfunction will be documented in the objective portion of the chart with the side of laterality noted.

Question 11

genu valgum

Answer 11

knock knees–knees bend in

Question 12

genu varum

Answer 12

bow legged–knees bend out

Question 13

genu recurvation

Answer 13

hyperextension of knee

Question 14

if you have a fibular head fraction or somatic dysfunction, what nerve could be injured?

Answer 14

common perineal nerve b/c it goes around fibular head