Orthopaedic ExaminationElbowKnee

TERMS TO BE FAMILIAR WITH

Flexion Extension Adduction Abduction Varus Valgus

What will you be examined? Knee or elbow Examination EMQ questions after OSCE station Anatomy of elbow and knee Identify simple generic abnormalities Correct techniques & terminology

COMMON FOR ALL JOINTS Do not cause patient additional pain Expose the joint and surrounding

tissues adequately Always compare ‘abnormal’ limb with

normal limb. Assess joint above and below Assess active before passive Standard terminology!

COMMON FOR ALL JOINTS LOOK FEEL MOVE SPECIAL TESTS FUNCTION

ELBOW W- wash your hands! I – ‘My name is … and I am a 1st year

medical student.’ C- ‘May I examine your elbows’ E- -both joints should be exposed!

Ideally remove top clothes.

What next? LOOK- deformity, swelling, erythema,

scars, sinuses, muscle wasting› FRONT AND BACK

FEEL- joint tenderness, swelling, crepitus, warmth!

MOVE- active, passive, resistive? SPECIAL TESTS FUNCTION- every day activity (touch

mouth/comb hair)

What do you see?

Epicondylitis› Tennis› Golfers

Fractures Bursitis Psoriasis Gout Rheumatoid Arthritis

What can you feel Warmth Tenderness -Palpate the olecranon and

lateral and medial epicondyles. Swelling Crepitus

MOVE 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) Resisted; tests tendon bone junction

[enseopathy] and muscle strength

Function ‘Can you touch your mouth?’

Complete the Examination Thank the patient Wash your hands Report findings to examiner Help patient get dressed Insure patient is comfortable! -ONTO THE NEXT ONE

Examination 12:54

KNEE

COMMON FOR ALL JOINTS Do not cause patient additional pain Expose the joint and surrounding

tissues adequately Always compare ‘abnormal’ limb with

normal limb. Assess joint above and below Assess active before passive Standard terminology!

COMMON FOR ALL JOINTS LOOK FEEL MOVE SPECIAL TESTS FUNCTION

KNEE W- wash your hands! I – ‘My name is … and I am a 1st year

medical student.’ C- ‘May I examine your knees’ E- -both joints should be exposed!

Ideally remove trousers/ skirt.

LOOK Bedside for any clues e.g. walking aids With the patient standing look at

› FRONT, SIDE AND BACK› Alignment› Genu varus (bow legged)› Genu Valgus (knock-knees)

With patient lying down and look for:› Scars (anterior cruciate ligament repair, knee replacement,

arthroscopy)› Swelling (effusion, infection, arthritis, Baker’s Cyst)› Wasting (quadriceps wasting, secondary to disuse)› Skin changes (psoriasis, erythema)

FEEL (warmth/tenderness/crepituus/swelling)

PALPATE WITH THE KNEE STRAIGHT› Tenderness along patella border

Feel temperature with the back of your hand, compare with thighs

FLEX KNEE 90 DEGREESFeel along joint line (inferior pole of patella)Begin at femoral condylesmove down to base of patellathen tibial tuberosity.

SPECIAL TESTS

Function Walk- already assessed?

Complete the Examination Thank the patient Wash your hands Report findings to examiner Help patient get dressed Insure patient is comfortable! -ONTO THE NEXT ONE

Examination 20:30