Station Progress:

[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“This patient has complained of a limp.  Please examine his knees and present your findings to the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/150907380″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”8″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”2″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]Common examiner questions include the following:

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?
  3. What do you think the underlying cause of this patient’s signs is?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has normal knees.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

Masterclass: knee examination

  1. Wash your hands
  2. Introduce yourself to the patient
  3. Ask permission to examine their knees
  4. Check if the patient is in any pain, and if they do experience any pain, to inform you immediately
  5. Watch the patient walk
  6. Ensure the knees are well exposed
  7. Look at the knees:
    • any  skin changes or scars
    • swellings may be present, and can be either prepatellar, infrapatellar or popliteal
    • in popliteal swellings, the most common cause is a Baker’s cyst and if ruptured, it can spread down to the calf
    • check for a valgus (inverted) or varus (everted) deformity
    • check for any muscle wasting
  8. Feel the skin for any increased warmth
  9. Palpate the knee joint for any tenderness
  10. Examine the knee for an effusion via the patellar tap
    • squeeze any excess fluid into the joint space and then press down quickly upon the patella to determine if there is a bounce
  11. Examine the knee for a small effusion by milking:
    1. Gently stroke up long the medial aspect of the patella pushing fluid to the top and lateral aspect of the joint;
    2. Then gently push on the lateral aspect of the joint.  In the presence of a small effusion you may see the medial skin bulge out slightly.
  12. Flex the knees to 90 degrees and check for crepitus (osteoarthritis)
  13. Examine the anterior and posterior cruciate ligaments (and check for laxity in the ligaments) by pressing down and pulling upon on the tibia while sitting on the patient’s foot – this is called the anterior drawer test and the posterior drawer test
  14. Examine the medial and lateral collateral ligaments:
    1. Flex the knee to approximately 15 degrees;
    2. Place lateral then medial stress on the knee;
    3. Palpate for excessive joint laxity.
  15. State that you would not perform McMurray’s test for meniscal damage:
    1. Hold the knee fully flexed with one hand on the joint and the other hand on the foot;
    2. Medially and laterally rotate the foot;
    3. Pain or a click is an indication of meniscal damage;
    4. This test is not recommended in NICE guidelines as it may exacerbate injury and has poor diagnostic accuracy.
  16. Thank the patient and ensure their dignity is maintained at all times

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has clinically normal knees.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]