An example of a perfect knee examination for OSCE/ISCEs for medical students, or in clinical practice for junior doctors. Step-by-step guide covering an examination that includes special tests and abides by MSK "look, feel, move" principle.
Knee Examination
1. Wash hands Special Tests
2. Introduce
3. Explain and gain consent - Collateral ligaments; hand on knee and ankle,
4. Correct position – standing upright to begin push leg
5. Exposure – wearing shorts/underwear - Cruciate ligaments: 90degrees, sit on foot
o Anterior draw = thumbs on patella and
pull towards
Look o Posterior draw = thumbs on tibial
Observe the patient from the front, back and side tuberosity, push away
- Menisci test = McMurray’s
- Joint deformity? o Can be very painful so offer this to
o Genu valgus = knock kneed examiner
o Genu varus = bow-legged o Stabilise femur and try and rotate
- Scars? lower leg
- Swelling – inflammation, infection, gout?
o Inflammation = trauma; septic arthritis
- Erythema What next?
- Muscle wasting
- Bruising? - Neurovascular status
- Do they have any walking aids? - Joint above + below
- X-ray/MRI
- Functional assessment
Feel
Ask the patient to lie down on a bed
Ask the patient if they have any pain
- Temperature changes above/on/below knee
- Run back of fingers over joint lines, muscle bulk
and ligaments/tendons
- Patella tap – test for fluid/swelling
- Bulge test – firm motion, around patella,
moving any potential fluid, will see bulge if +
- Grab knee and feel popliteal fossa with fingers
Move
Active and passive movements of flexing knee towards
chest and rotating femur outwards
Check for:
- Normal range of movement, both sides same
- Hyperextension
- Extensor lag
- Crepitus – Velcro/crackling feeling
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