OSCE: How to examine the knee Dr A Barai MBBS, MRCS, MSc (Critical care) Registrar, Emergency Medicine
Introduce yourself“Hello, I am Dr Barai. I am the Registrar in the Emergency Department. I would like toexamine your knees if that is alright with you”
Ask about pain“Do you have any painanywhere? Do you like tohave some painkillersbefore I examine you?”
Take permission“During the examination I would likeyou to expose your legs upto thegroin if that is alright with you.During the examination I may haveto touch your knees and do somemanoeuvres if that is alright withyou? May I proceed please?”
Hand washingTell the patient and the examiner that beforeyou examine the patient you would like towash your hands
Look• Ask the patient to stand up on the floor.• Look from front, side and behind• Comment on: - Skin condition: bruises, laceration - Scar mark - Muscle wasting - Deformity - Discharging sinus - Asymmetry
Gait• Ask the patient to walk a few steps if they are happy to do that.• Look for antalgic gait
Feel• Ask the patient to lie on the couch• Feel for temperature• Feel quads• Bulge test• Patellar tap test• Bony tenderness over patella, medial and lateral joint lines
Move• Active flexion and extension• Passive flexion and extension• Comment on the range of movement
Special tests• Lachman test• Varus and valgus test• McMurray’s test
Conclude• Thank the patient.• Offer help in dressing him up.
To the examinerI would like to examine the fullneurovascular status of the lower limband joint above eg the hip joint andjoint below eg ankle.I would like to give him analgesia,crutches and would also like to have axray of the knee to see if there is anybony injury
FinishThank both the examiner and the patientbefore leaving.