Knee examination scenario
candidate brief
actor brief
- 65yo with hot swollen left knee. PMH: high cholesterol, poorly controlled T2DM. Usually independently mobile. Currently febrile. Cellulitis over knee, unable to weight bear, reduced range of movement. Reluctant to stay in hospital initially but will settle if reason for staying explained well
- 17yo with swollen painful right knee. Twisted knee while on dirt bike today, since then has been hobbling. PMH nil. Knee XR is shown.
examiner brief
- Washes hands, introduces self
- Ensures no immediate pain/discomfort
- Enquires about symptoms
- Onset and duration
- Trauma?
- Systemic symptoms
- Past medical history
- Drug history and allergies
- Social history
- States need to examine patient
- Exposes area appropriately
- Assesses gait if possible
- Inspects both knees with patient standing
- Inspects knees with patient lying on bed
- Compares temperature of both joints
- Palpates knee while extended
- Patellar tap + sweep
- Repeat palpation while knee flexed to 90 deg - popliteal fossa, tibial tuberosity, head of fibula
- Active knee flex/ext
- Passive knee flex/ext
- Anterior drawer test
- Perform collateral ligament test
- Explains differentials
- Explains plan
- Further investigations required
- Initial treatment to start in ED
- Addresses patient's concerns
- Global mark