Routine for a Knee exam for an OSCE

How to do a knee exam for an OSCE:

  1. Wash hands + Introduce and gain consent
  2. Check for pain status.
  3. LOOK
    1. Observe gait
      1. Comment on ratio between stance phase and swing phase
      2. e.g Antalgic gait - stance phase reduced on painful side.
      3. Stepping height
    1. Observe from front while standing
      1. Scars
      2. Swellings/colour
      3. Assymmetry
      4. Valgus/Varus
    1. Observe from side while standing
      1. Fixed flexion deformity
    1. Observe from back while standing
      1. Popliteal swelling
      2. Scars/assymetry
    1. Observe from side while standing
      1. Fixed flexion deformity
    1. Get patient to lie on bed
      1. Check once more for cheeky arthroscopy scars
  1. FEEL
    1. With the leg extedned
      1. Feel for temperature
      2. Feel for effusion
        1. Milk and patella tap or sweep test
      1. Offer to measure the quadriceps 20cm above tibial tuberosity
    1. With the leg flexed
      1. Feel around the patella
      2. Feel the tibial tuberosity (Osgood Schlatter's disease)
      3. Feel head of the fibula
      4. Feel the joint line
      5. Feel the collateral ligaments
      6. Feel the popliteal fossa
  1. MOVE
    1. Passive
      1. Knee flexion (feel for crep)
      1. Knee extension
      2. Hyperextension, pick up the heel slightly
    1. Active
      1. Bend the knee as much as possible
        1. Heel to bum distance - compare

  1. Special test
    1. Anterior drawer and posterior drawer test - when leg is flexed at 90deg
      1. Sit on the patients leg and move the tibia
    1. (alternatively do lachman's test which is the same but bent around 30 degrees)
    1. Assess MCL and LCL
    1. Do McMurray's test for menisci
      1. To test medial meniscus- Push on the lateral side of knee (valgus) externally rotate and extend
      1. To test lateral meniscus - Push on medial side of knee (valgus) and internally rotate and extend
    1. Get patient to Sit on edge of the bed
      1. Check for J-shaped tracking.

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