orthopaedic examination elbow and knee
TRANSCRIPT
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Orthopaedic ExaminationElbowKnee
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TERMS TO BE FAMILIAR WITH
Flexion Extension Adduction Abduction Varus Valgus
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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
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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!
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COMMON FOR ALL JOINTS LOOK FEEL MOVE SPECIAL TESTS FUNCTION
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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.
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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)
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What do you see?
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Epicondylitis› Tennis› Golfers
Fractures Bursitis Psoriasis Gout Rheumatoid Arthritis
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What can you feel Warmth Tenderness -Palpate the olecranon and
lateral and medial epicondyles. Swelling Crepitus
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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
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Function ‘Can you touch your mouth?’
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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
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Examination 12:54
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KNEE
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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!
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COMMON FOR ALL JOINTS LOOK FEEL MOVE SPECIAL TESTS FUNCTION
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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.
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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)
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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.
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SPECIAL TESTS
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Function Walk- already assessed?
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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
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Examination 20:30