Joint Examinations Flashcards
(29 cards)
1
Q
What may be picked up on an X-ray as a result of leaning on the elbow?
A
Fluid-filled sacs
2
Q
What is your very first step in any examination?
A
- Wash your hands! (could do it after introductions, to show patient you’ve done it)
3
Q
How would you go about introduction and consent in a joint examination?
A
- What are you going to say?
- Your name, role and purpose of examination
- ‘Before I start do you have any pain?’
- ‘Could you tell me which joints are affected?’
- ‘May I examine your elbow(s)?’ (make sure elbows and knees are exposed – could provide shorts if trousers can’t be rolled up)
4
Q
How should you position the patient in a joint examination?
A
- Ensure the patient is:
o Comfortable (may require analgesia)
o In a private area (maintaining their dignity and privacy)
o Sitting on a chair or the edge of the bed
o BOTH elbows should be exposed for comparison (ideally patient should remove their top clothes)
5
Q
What are the five steps in an elbow examination?
A
- LOOK - FRONT, SIDE, BACK!
o (OBSERVE – deformity, scars, signs of inflammation) - FEEL
o (PALPATE – crepitus, swelling, tenderness) - MOVE
o (ACTIVE (they move it)-PASSIVE (you move their joint)-RESISTED (against resistance) movements .(Range of Movements (ROM)); Assessment of joint stability) - SPECIAL TESTS
o Specific to joint - FUNCTION
o (ask the patient to perform an everyday activity that ‘emphasises’ normal function of this joint)
6
Q
What are common abnormalities of the elbow upon inspection?
A
- CUBITUS (Elbow)
o . Varus (distal deformity towards the midline)
o B. Valgus – Distal deformity away from the midline (naturally more in women) - Is the joint in neutral?
o Fixed flexion or hyperextension - Scars, swelling, psoriasis
7
Q
What are the signs of inflammation that you can see/feel in the elbow?
A
- RUBOR – Redness (Erythema)
- CALOR – Hot / heat
- DOLOR – Pain / tenderness (localise)
- TUMOR – swelling / effusion (fluctuant)
8
Q
What is the difference between active/passive movement in the elbow and how do you carry it out?
A
- First check the joint is ‘in neutral’ (normal anatomical position)
- Move through each of the movements – assessing Range of movement (ROM)
- Active (patient moves unassisted) vs
- Passive (you assist patient moving the joint; feel for crepitus)
- Always be wary of causing pain!
9
Q
Which four movements can the elbow perform?
A
Flexion
Extension
Supination
Pronation
10
Q
How can you assess the stability of the elbow?
A
- STABILITY - The elbow is one of the most stable joints of the skeleton; Instability is therefore relatively uncommon.
- FUNCTION – think of an everyday that requires normal elbow function (e.g. feeding self).
11
Q
How do you complete an elbow examination?
A
- Thank the patient and ensure they are comfortable
- Offer to help them dress again (especially if in pain or disabled by the joint problem(s))
- Think about your findings – what do they mean?
WASH HANDS AGAIN!
12
Q
How would you begin a knee examination?
A
- What are you going to say?
- Name, Role and purpose of examination
- ‘Before I start do you have any pain?’
- ‘Could you tell me which joints are affected?’
- ‘May I examine your knees, ….your joints?’
13
Q
How should you position the patient for a knee examination?
A
- Ensure the patient is
- Comfortable (may require analgesia)
- In a private area (maintaining their dignity and privacy)
- Sitting / lying on the examination couch
- BOTH knees should be fully exposed for comparison (ideally patient should remove their trousers / skirt (as shown) and take socks off)
- Look at their gait as they walk in (look for limping etc.)
14
Q
What are the five stages of examination for the knee?
A
- LOOK - FRONT, SIDE, BACK! (OBSERVE – deformity, scars, signs of inflammation)
- FEEL – (PALPATE – crepitus, swelling, tenderness)
- MOVE - (Active vs Passive movements (resisted not required as much for the knee) (Range of Movements (ROM)); Assessment of joint stability)
- FUNCTION – (ask the patient to perform an everyday activity that ‘emphasises’ normal function of this joint – e.g. go for a walk around the room)
15
Q
What are common abnormalities of the knee that you might be able to see upon inspection?
A
- GENU (KNEE)
o A. Varum (distal deformity towards the midline – ‘Bow legged’)
o B. Valgum (distal deformity away from the midline – ‘Knocked knees’ – more common in females due to wider pelvis) - Is the joint in neutral?
o Fixed flexion (knee locked) or hyperextension - See if legs are the same length – measure to medial malleolus of the ankle – major cause of knee pain (at least 1cm difference to treat it)
SAY WHAT YOU SEE
16
Q
What signs of inflammation might you be able to look/feel on the knee?
A
- RUBOR – Redness (Erythema)
- CALOR – Hot / heat
- DOLOR – Pain / tenderness (localise)
- TUMOR – swelling / effusion (fluctuant)
17
Q
How would you test for an effusion?
A
- Method (1) – The ‘BULGE’ test (Small effusions)
o With the patient sitting on the examination couch, smooth your hand across the medial aspect of the knee (watch for a bulge in the lateral aspect of the knee joint)
o Now smooth your hand across the lateral aspect and watch for any ‘refilling’ or BULGE of the medial aspect. - Method (2) – The Patella tap or ‘BOUNCE’ test (large effusions)
o With the patient sitting on the examination couch, empty the supra-patellar bursa with your non-dominant hand.
o Now attempt to ‘bounce’ the patella on the anterior joint by pushing down with two to three fingers of your other hand.
o This test will only be positive for larger effusions.
18
Q
How would you carry out active/passive movement?
A
- First check the joint is ‘in neutral’ (normal anatomical position)
- Move through each of the movements – assessing Range of movement (ROM)
- Active (patient moves unassisted) vs
- Passive (you assist patient moving the joint)
- Always be wary of causing pain!
19
Q
How would you test the stability of the knee?
A
- Test. o Medial (MCL) and lateral collateral (LCL) ligaments o Anterior (ACL) and posterior (PCL) cruciate ligaments - There are also tests for the integrity of the menisci –joint line tenderness and Mcmurreys (painful) - Look for joint line tenderness instead where possible with fingers to avoid this test
20
Q
What must you take into account before doing a test of stability on the knee?
A
- For the following assessments to be valid the patient must be able to relax the muscles around their knee; This may not be possible!
- DO NOT ATTEMPT THE TESTS IF THE PATIENT IS IN PAIN
21
Q
How would you stress the MCL?
A
- Support the lateral aspect of the knee
- Move the distal leg laterally
- The idea is to try and ‘open up’ the joint – ‘stressing’ the ligament
22
Q
How would you stress the LCL?
A
- Support the medial aspect of the knee
- Move the distal leg medially
- The idea is to try and ‘open up’ the joint – ‘stressing’ the ligament
23
Q
What is alternative way to test to MCL/LCL?
A
- Place the patient’s foot gently in your axilla / under your arm
- Hold the knee as shown in your two hands
- Stress each ligament in turn, by moving the distal leg medially (opens LCL), then laterally (opens MCL)
- Compare to other knee to see if movement is limited
24
Q
How do you carry out an anterior draw test?
A
- With the patient sitting on the bed, place the patient’s knee in flexion (as shown)
- Gently sit on the planted foot
- Now attempt to draw the tibia forward
- A positive drawer test is one where the ACL is torn and thus allows the tibia to move forwards on the femur
25
How would you carry out a Lachman's test? What does this test?
Tests the ACL
- With the patient sitting on the bed, place the patient’s knee in slight flexion (as shown)
- Hold the distal thigh in your left hand and the proximal leg in your right hand
- Now attempt to draw the leg forward whilst stabilising the thigh.
- A positive drawer test is one where the ACL is torn and thus allows the tibia to move forwards on the femur
26
How would you carry out an anterior draw test if the patient has large thighs or you have small hands?
- If the patient has very large thighs or your have small hands – you can perform the test (as shown) with the leg hanging over the edge of the examination couch.
27
How do you carry out a posterior draw test?
- With the patient sitting on the bed, place the patient’s knee in flexion (as shown)
- Gently sit on the planted foot
- Now attempt to push the tibia posteriorally
- A positive drawer test is one where the PCL is torn and thus allows the tibia to move backwards on the femur
- Will need an MRI to confirm
28
What kind of function test can you do on the knee?
- Ask the patient to stand and re- assess the posterior aspect of the knee – cysts and other abnormalities may become more obvious on standing)
- Ask the patient to walk (as an everyday activity)
- Examine the joints above and below as well
29
How would you complete the knee examination?
- Thank the patient and ensure they are comfortable
- Offer to help them dress again (especially if in pain or disabled by the joint problem(s))
- Think about your findings – what do they mean?
WASH YOUR HANDS!
