OSCE - MSK Knee Flashcards
What is looked for in a general observation in a knee examination (3)?
- Scars/skin changes
- Posture/Knee alignment’ can be:
Normal
Valgus - knock knee posture
Varus - bow-legged posture
Tibial torsion - knees straight but feet pointing out - Popliteal fossa swelling
What does “valgus” mean?
What does “varus” mean?
What does valgus mean?
“Knock-knee” posture
What does varus mean?
“Bow legged” posture
What are the features to look for in a gait assessment for the knee?
Limp - hurrying off affected side (antalgic gait)
Pain - facial expressions
walking aids
What areas should be checked for swelling in a knee examination?
Anterior over the patella (prepatella bursa)
Medial knee
Suprapatella pouch
Popliteal fossa
On closer inspection of the knee, what signs are looked for while patient is lying supine?
- Patients resting position (may be slight flexion of the knee)
- Knee Deformity
- Knee Swelling
- Muscle wasting of quadriceps and hamstrings
- Scars and skin changes - look closely, done arthroscopically so scars will be small
Swelling of the knee may be due to?
Localised swelling - may be due to a cyst, bursitis, tendonitis (anterior patella)
General joint swelling - look for swelling medial to patella and above
Always compare to other knee
How would swelling be categorised around the knee?
Hard (bone)
Soft and mobile (effusion- can move fluid around)
Soft and spongy (synovium)
Feel
When feeling the knee joint, what tests are done?
- Characterise swelling if present
- Ligament (MCL, LCL)
- Knee joint lines (tibia-femur)
- Patella tap & Bulge sign (if swelling present and is fluid)
- Patella movement test (medial-lateral wiggle)
- Temperature of the joint (back of the hand on both knees)
Move
What movements are testing for a knee examination?
Flexion
Extension
What range of movement is normal for the following:
a) Knee flexion
b) Knee extension
a) Flexion
Range 135 degrees
b) Extension
Range 5 degrees
If all active movements are normal in all directions, what should be done next?
No need to conduct passive movements (but let examiner know this)
List the special tests are done for the knee
Testing for collateral ligaments
1. Varus test -Tests the integrity of the LCL
2. Valgus test - Tests the integrity of the MCL
Testing for cruciate ligaments
1. Lachman test (ACL)
2. Anterior drawer test (ACL)
3. Posterior drawer test (PCL)
Testing for Meniscal integrity
1. McMurrays test
How is the Lachman test performed and what does it test?
Lachman test tests the integrity of the ACL
If the patient has a larger thigh, place your leg under the patients thigh and popliteal area
Trying to move the tibia anterior in comparison to the thigh
When conducting this, place top hand at the distal thigh (just above the knee) and hold stable
The lower hand is what moves the leg anteriorly, and should feel a solid end point (where the anterior movement stops)
How much movement is considered abnormal for the posterior and anterior drawer tests?
5-10 degrees is abnormal
How is the valgus test performed and what does it test for?
Test at full knee extension (straight leg) then at 30 degrees of flexion (laxiy at full extension - worse injury)
Determines the integrity of the medial collateral ligament
Whichever way the examiners force hand is pushing, determines the ligament being stress tested (pushing medial; MCL)
How is the varus test performed and what does it test for?
Test at full knee extension, then 30 degrees flexion (laxity at full extension - worse injury)
Place one hand above knee along medial side and other hand along the lateral calf
Upper hand stabilises the thigh
Lower hand place inward pressure on the calf
Force applied is trying to “Open up” the lateral side of the knee joint
Tests the integrity of the lateral collateral ligament
How are the anterior and posterior drawer tests performed.
How do they differ form the Lachman test?
Knee to 90 degree bend
Sit onto the patients foot (to stabilse the leg)
Both hands wrap around the inferior knee, under the tibia condyle area (thumbs at the front)
Pull toward the anterior to test the anterior drawer, should find a solid end point is if ACL is in tact
Push the tibia toward the patient bed to test the posterior drawer test, will find a solid end point if PCL in tact
How is the meniscal test (McMurrays) undertaken?
Any movement that has a level of knee flexion and internal rotation (toes pointing into the midline) can aggravate the meniscus
One hand goes on the patients heel
The other hand supports at the knee itself (where the meniscus lies)
The knee is taken from full flexion to extension, in two ways:
Full knee flexion, valgus force and rotation (ankle and foot turned outward)
Full knee flexion, varus force and internal rotation (ankle and foot turned in)
