FOSCE 2 knee exam part

Question 1

what do we need to do in a knee look examination

Answer 1

WIPER
get them to ware clothes in such a way that we can see their knees
lie on couch

Question 2

what am i looking for in a knee look exam

Answer 2

looking at the knee position, is there joint swelling, are the bursae swollen, are there local swellings that move as the knee moves
skin - erythema, bruising, rash, scarring
muscle wasting, any other deformities
maybe like the varus and valgus angles, hyper flexions and that, symmetrical?

Question 3

what are we feeling in a knee feel examination

Answer 3

palpate both knees to feel their temperature, quadriceps wasting,
tenderness in the ligaments and tendons (lateral and medial collateral L and the patellar L)
synovitis - sponginess on both sides of the quadriceps tendon
joint line tenderness - palpate the medial and lateral joint lines
crepitus as the knee is moved
joint effusions- patellar tap or ripple sign

Question 4

how do we perform the patellar tap

Answer 4

with the knee relaxed and in extension we want to empty the suprapatellar bursa by sliding left hand down the thigh until we reach the patella upper edge, keep your hand there,
push down on the patella with fingertips of your right hand

Question 5

what will you feel in a patellar tap if there is an effusion

Answer 5

when we tap, if there is an effusion, there will be a tapping sensation as we push the petalla down to the femur

Question 6

how do we do the ripple sign

Answer 6

this is for a small effusion,
we get the knee to be extended and relaxed and we empty the suprapatellar bursa with the left hand. keeping the hand there we stroke the medial side of the knee with the other hand to empty the fluid. we then stroke the lateral side to move fluid back to medial side

Question 7

what will we see in a ripple sign if its present

Answer 7

when we rub the lateral knee we will see the fluid be pushed back around to the medial side, as it moves around we will see a bulge in the medial side of the knee

Question 8

what do we need to do in a knee movement exam

Answer 8

WIPER
get them to lay on the examination couch with their knees fully exposed, observing any pain or anything as they get onto the couch

Question 9

what movements does the patient need to do in move knee exam

Answer 9

active flexion - move their heel toward their bottom
fixed flexion deformity: places their hands under the patients knees and asks them to push their knees downwards into your hands
active extension - lift their leg into the air with knee in extension - note extensor lag (the leg coming up after the thigh)
passive range of movement: check for hyperextension by lifting the foot to inspect how far the knee joint extends.
test passive flexion by asking patient to let us bend their knee for them.

Question 10

what do we need to do in a knee ligament move exam

Answer 10

WIPER, expose their knees and lay supine on the couch. make sure they are comfortable
encourage them to let know if there is any pain.

Question 11

what do we need to test for in the knee ligament exam

Answer 11

test the collateral ligaments and the cruciate ligaments

Question 12

how do we assess the collateral ligaments in the knee ligament move exam

Answer 12

doing one knee at a time. we first get them to fully extend knee. starting right we then place left hand at lateral knee and right hand medial ankle, testing right medial collateral ligament then push with the right hand doing valgus force outward, keep the knee in place with the left hand.
switch hand positons and repeat to test the lateral collateral ligament.
you then repeat this with the knee flexed 20-30 degrees, with your knee under theres.

Question 13

what are we testing for in the collateral knee exams

Answer 13

There should be no varus or valgus movement when the collateral ligaments are
assessed with the knee in extension. so we are looking for pain or laxity within these ligaments

Question 14

whats something we look for when doing the cruciate knee ligament exam

Answer 14

do both sides. flex the patients knee to 90 degrees, fix the joint by sitting on the foot of the flexed leg.
we then check for posterior sag on both knees - is one thigh dropping below other.

Question 15

how do we do the anterior draw test

Answer 15

pull the proximal tibia toward you. this assesses the ACL stability. more than 5mm of movement suggests some instability, possibly a tear.

Question 16

how do we do a posterior draw test

Answer 16

Posterior draw test: gently and firmly push the proximal tibia posteriorly
(backwards). This assesses posterior cruciate ligament stability. More than 5mm
of movement suggests a torn posterior cruciate ligament.