Joint Examinations for MCEM OSCE (Videos Included)

For all Joint Exams:

Gel In

Introduction:

Hi, My Name is Dr.  XYZ, I am one of the ED Registrars who will be taking care of you today.

May I ask know your name please? How old are you? And What do you do for your living?

As I understand you are having pain in the Knee/Shoulder/Wrist/Hip? Let me offer you some pain medications before we begin your examination. I have been asked to examine you, is that okay with you?

But before I begin, I want to know since when are you having this pain, and is it radiating anywhere, Did you get hurt or injured? Are you on any medications like steroids? Are you having any medical illness? If Upper limb, ask if they are right or left handed.  Are you having any other symptoms?

I would like to get your vitals signs recorded.

I would examine your  Joint by looking and then feeling, and then doing some specific tests and then we can summarize. Does that sound Okay?

I begin with your general appearance, and you appear to be in hemodynamically stable.

Ideally, I would like to expose and examine one joint above and below, maintaining privacy (Chaperone if female patient)

On inspecting both your joints from front, sides, and back, I am looking for any gross deformity of skin, any scars, bruises, signs of inflammation, any muscle atrophy, and the overall integrity of your joint.

Now, I would like to palpate the joint: Feel the temperature and crepitus, feel the joints and associted structures.

Next, we move on movements (Active & Passive)

Special tests:

Shoulder: Test for Impingement (NEER), Integrity of Infraspinatus & Teres minor (External Rotation), Internal Rotation (GERBER), Drop arm test (Supraspinatus)

Wrist & Hand:

Median Nerve: Abductor pollicis, FDP Index, Volar flexion of palm

Ulnar Nerve: FDP Little finger, Abbductor (Paper between Ring & Middle)

Radial Nerve: Dorsiflexion

Brachioradialis: Flexion at elbow

Radial: Extension at Elbow (Triceps)

Hip: Thomas Test, ER, IR, Abduction, FABER, FADIR

Knee: Drawer Tests, Collateral Stretch, Mc Murray Test

(In lower limb joints, Check Gait)

Finally, end the examination by thanking the patient and inform them that you would like to examine the joints above and below, and do a detailed neurovascular assessment soon.

Inform them the possible diagnosis, and tests required and further management plan.

Ask if the have any concerns.

Thank the examiner (Present to the examiner)

Gel out!!!

Look at these good videos on Hip & Knee Examination from OXFORD Medical

Hip Examination

Knee Examination

Send me your feedback and suggestions in the comment section below.

Good Luck with your exams!!!