OSCE 1_Knee

Question 1

What is the difference between RISOM and MMT?

Answer 1

RISOM - strength screening
MMT - strength grading

Question 2

When is RISOM performed compared to MMT?

Answer 2

RISOM is done at midrange, while MMT is done near end range.

Question 3

When should MMT not be used?

Answer 3

In cases of suspected muscle strain, fracture, or pain with RISOM.

Question 4

What precautions should be taken when using MMT?

Answer 4

Be careful if there is muscle strain, capsular sprain, active infection, pain, Valsalva maneuver in cardio patients, or post abdominal/thoracic surgery, or fatigue related to illness.

Question 5

When should RISOM not be used?

Answer 5

No RISOM if there is a fracture.

Question 6

What are the instructions for performing RISOM?

Answer 6

1) Explain procedure, demo movement
3) Positioning: stabilize proximally, joint angle between mid and end range, use bodyweight to apply pressure when possible
4) Instruction: let me know if you feel pain or discomfort, don’t let me move you
5) Apply resistance gradually until patient gives way.

Question 7

What does MMT grading 0, 1, and 1+ indicate?

Answer 7

0 = no movement, no muscle contraction
1 = trace contraction
1+ = less than 50% AROM (no gravity)

Question 8

What does MMT grading 2- and 2 indicate?

Answer 8

2- = greater than 50% AROM (no gravity)
2 = full AROM (no gravity)

Question 9

When is gravity added in MMT?

Answer 9

Starting at 2+.

Question 10

What does MMT grading 2+, 3-, and 3 indicate?

Answer 10

2+ = less than 50% AROM (gravity)
3- = greater than 50% AROM (gravity)
3 = full AROM with gravity, no resistance (unable to hold)

Question 11

When can a patient hold against resistance in MMT?

Answer 11

Starting at 3+.

Question 12

What does MMT grading 3+, 4-, 4, 4+, and 5 indicate?

Answer 12

3+ = full AROM + isometric minimal resistance
4- = full AROM + isometric near moderate resistance
4 = full AROM + isometric moderate resistance
4+ = full AROM + isometric near maximum resistance
5 = full AROM + isometric maximum resistance (normal)

Question 13

What is the joint position for MMT?

Answer 13

Just before full range of motion.

Question 14

What is the order of assessments?

Answer 14

AROM + overpressure (OP) / PROM, RISOM, MMT.

Question 15

What is the positioning for knee RISOM in extension?

Answer 15

Supine, one arm (or knee or bolster) under tested knee,
Stabilization: hand on distal thigh
Force: pressing down at ankle.

Question 16

What is the positioning for knee RISOM in flexion?

Answer 16

Supine. Feet off the plinth, 45 degrees flexion of the knee

Stabilization:, one hand: femur (lateral side of thigh), other hand pulling ankle (knee in flexed position)

We can be at the edge of the plinth to increase pull

Question 17

What is the positioning for knee extension MMT against gravity?

Answer 17

High sitting, ensure full AROM with overpressure.

Question 18

What is the positioning for knee extension MMT with resistance?

Answer 18

High sitting, knee just out of extension end range, stabilize distal femur and press down on anterior ankle.

Question 19

What is the positioning for knee extension MMT with gravity eliminated?

Answer 19

Patient in side lying, arm wrapped around anterior thigh and under thigh, other arm supporting distal tibia.

Question 20

What is the positioning for knee flexion MMT with gravity?

Answer 20

Patient prone, bends knee (bring foot to butt), check with overpressure.

Question 21

What is the positioning for knee flexion MMT with resistance?

Answer 21

Patient in prone, stabilize posterior surface distal femur, pull back on ankle (70 degrees knee flexion).

Question 22

What is the positioning for knee flexion MMT with gravity eliminated?

Answer 22

Same as flexion - patient in side lying, one arm wrapped around anterior thigh, one hand supporting ankle.

Question 23

What is the usual testing order for MMT?

Answer 23

Usually start with RISOM, MMT first on unaffected side.

Question 24

What are the steps for MMT testing order?

Answer 24

1) AROM against gravity
2) If full AROM, add resistance
If partial, then stop and grade
If unable, then do gravity eliminated.

Question 25

What cueing is used for RISOM/MMT?

Answer 25

'Don't let me move you' + gradual pressure.

Question 26

When should overpressure not be done?

Answer 26

If there is pain during AROM (do PROM instead).

Question 27

What is the brush test?

Answer 27

Brush up medial side of knee around patella 3 times, other hand compressing lateral distal edge of knee.

Question 28

What is the patellar tap test?

Answer 28

Hold web of hand against proximal edge of patella, press down on patella gently to feel movement downwards (floating feeling indicates swelling).

Question 29

How is knee flexion ROM assessed?

Answer 29

Patient in supine, AROM - apply OP by pressing on shin, stabilizing femur; PROM - support under knee, move at ankle, at end of range stabilize distal thigh and press shin.

Question 30

How is knee extension ROM assessed?

Answer 30

Patient in supine Pillow under the femur Stabilization: Distal femur + distal tib/fib Extension of the leg (AROM). "Is this as far as you can go"? No pain = OP Pain = PROM Gonio: Center=lateral epicondyle, stabilizing arm = GT, moveable arm = lateral malleoli

Question 31

How is tibial internal/external rotation ROM assessed?

Answer 31

High sitting, ask patient to turn feet inwards or outwards, manually turn their leg to do OP or PROM, stabilize at anterior distal thigh.

Question 32

What is the purpose of patellar glide?

Answer 32

Checking for patellar mobility.

Question 33

What are the steps for patellar glide?

Answer 33

Supine or in long sitting, quads relaxed, hands positioned perpendicular to leg at knee, pressing laterally with both index fingers, pressing medially with thumbs, press distally with index + thumb, press proximally with index + thumb.

Question 34

What are the contraindications for TKA?

Answer 34

No contraindication, but can damage tibial nerve which runs through popliteal fossa, affecting plantar flexion, eversion, and toe flexion.

Question 35

What are important things to consider post TKA?

Answer 35

Very important to do *ROM* right after TKA Stay in extension +++ (no pillow under the knee)

Question 36

How is swelling assessment of the knee performed?

Answer 36

Girth measurement at joint line, 5cm proximal, and 5cm distal.

Question 37

What are the two ways to assess hamstring flexibility?

Answer 37

SLR (straight-leg raise): pt supine - stabilization: place hand on distal tib/fib to ensure knee is in full extension + other hand over the knee - Lift the leg while keeping FULL knee extension. Stop when symptoms are reproduced / EF does not go further - Gonio: center on greater trochanter, stabilizing arm parallel to the plinth 90-90 test: pt supine, hip at 90, knee at 90 -stabilization: hand over the distal femur (hip stabilization), hand on distal tib/fib -gonio: Center on GT, stabilizing arm along the body, moveable arm towards lateral epicondyle

Question 38

How is rectus femoris flexibility assessed?

Answer 38

Pt Prone -stabilization: Hand over distal fib/tib + hand stabilizing the pelvis -Gonio: place center on lateral epicondyle, stabilizing arm = along the femur (GT), moveable arm = along the tibia (lateral malleoli)

Question 39

How long should resistance be held during RISOM and MMT?

Answer 39

5 seconds.

Question 40

What is the normal ROM for knee flexion and extension?

Answer 40

Flexion: 135 degrees Extension: 0 degrees (hyperextension possible, 5-10 degrees).