Knee Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Asks if patient suffers from pain, stiffness or locking in the knee	0	1
Washes hands	0	1
Exposes patient’s knees and the joints above and below (hip and ankle/foot) and asks them to stand	0	1
General inspection around bed and patient (walking aids, obvious scars, wasting or deformities)	0	1
Asks patient to walk to the end of room and turn	0	1
Comments on patient’s speed, the phases of walking, stride length and arm swing	0	1	2
Inspects front for shoulder/hip alignment, limb-limb discrepancy, varus/valgus deformity, wasting of quadriceps, swellings at the knee	0	1
Inspects back for wasting of muscles (gluteal, calf), popliteal swelling, scoliosis, skin changes, scars, hindfoot deformities, wear of shoes	0	1
Inspects sides for fixed flexion deformities and increased kyphosis or lordosis	0	1
With patient lying assesses the temperature of the knee joint	0	1
Palpates the quadriceps bulk, the quadriceps tendon, the borders of the patella, the patellar tendon, tibial tuberosity, joint lines, femoral condyles and popliteal fossa	0	1	2
Test active flexion and flex passively if range of movement is restricted. Comment on maximum angle (normal: 120 degrees)	0	1
Test active extension and extend passively if necessary (normal: 5-10 degrees)	0	1
Feels for crepitus during flexion and extension	0	1
Tests medial collateral ligament by applying valgus stress with the knee 30 degrees flexed	0	1
Tests lateral collateral ligament by applying varus stress with the knee 30 degrees flexed	0	1
Performs anterior drawer test for anterior cruciate ligament by flexing knee, sitting on foot and drawing tibia forward with fingers from behind whilst gastrocnemius is relaxed. Offers Lachman’s as an alternative test	0	1
Keeping knee in flexed position checks for tibial sag to test posterior cruciate ligament and considers using posterior drawer test	0	1
Offers McMurray’s test for the MEDIAL meniscus: completely flex the knee, then apply a valgus stress and externally rotate the foot whilst extending it. Positive if painful or a click is felt in the joint line	0	1
Offers McMurray’s test for the LATERAL meniscus: completely flex the knee, then apply a varus stress and internally rotate the foot whilst extending it. Positive if painful or a click is felt in the joint line	0	1
Performs patellar apprehension test by flexing knee 90 degrees then extending knee and pushing patella laterally. Stops and reports positive if patient appears anxious or in pain	0	1
Offers examination of hip and ankle, neurovascular exam and history	0	1
Thanks patient and offers help to redress	0	1
Washes hands	0	1
Offers next step (imaging: 2 plain x rays for bony pathology or CT if indicated, MRI for soft tissue)	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses	0	1

Ankle & Foot Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Asks if patient suffers from pain, stiffness or reduced range of movement in the ankle and foot	0	1
Washes hands	0	1
Exposes patient’s ankles and feet and the joints above (knees) and asks them to stand	0	1
General inspection around bed and patient (walking aids, obvious scars, wasting or deformities)	0	1
Asks patient to walk to the end of room and turn	0	1
Comments on patient’s speed, the phases of walking, stride length and arm swing	0	1	2
Inspects front for shoulder/hip alignment, limb-limb discrepancy, varus/valgus deformity, wasting of quadriceps	0	1
Inspects back for wasting of muscles (gluteal, calf), scoliosis, wear of shoes	0	1
Inspects sides for fixed flexion deformities and increased kyphosis or lordosis	0	1
Inspects foot closely for skin changes, arch abnormalities, scars, hindfoot deformities, corns, callosities, ulcers, infections, ingrown toenails	0	1
Palpates temperature of ankle and foot	0	1
Palpates joint margin, hindfoot, midfoot and forefoot for tenderness, effusions, oedema	0	1
Tests active dorsal and plantar flexion and flexes further passively if range of movement is restricted. Comments on maximum angle (normal: dorsiflexion - 10 degrees, plantar flexion 40 degrees)	0	1	2
Tests active inversion and eversion using the ankle as a pivot turning the sole towards the midline and away and extends passively if necessary (normal: 30 degrees for both)	0	1	2
Passively tests abduction/external rotation (normal: 40 degrees) and adduction/internal rotation (normal: 25 degrees)	0	1	2
Assesses midtarsal movement holding heel firmly and forefoot in other and moving forefoot up and down, side to side	0	1
Performs Simmond’s test for rupture of Achilles tendon (squeeze calves with patient lying prone and feet hanging off bed, looking for normal reflex plantar flexion)	0	1
Offers examination of hip and knee exam, neurovascular exam and history	0	1
Thanks patient and offers help to redress	0	1
Washes hands	0	1
Offers next step (imaging: 2 plain x rays for bony pathology or CT if indicated, MRI for soft tissue)	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses	0	1

Elbow Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Asks if patient suffers from pain, stiffness or reduced range of movement in the elbow	0	1
Washes hands	0	1
Exposes patient’s elbows and the joints above and below (shoulders and hands) and asks them to stand	0	1
General inspection around bed and patient (walking aids, obvious scars, wasting or deformities)	0	1
Inspects front for shoulder/hip alignment, limb-limb discrepancy, shoulder architecture	0	1
Inspects back for wasting of muscles (trapezius, paraspinal, deltoids), scoliosis, skin changes, scars, winging of scapulae, elbow nodules, deformities	0	1
Inspects sides for fixed flexion deformities, increased kyphosis or lordosis, carrying angle of the elbow	0	1
Palpates temperature of elbow joint	0	1
Palpates elbow structures: lateral and medial epicondyles, olecranon process and fossa, radial head and joint line feeling for tenderness. Also feels for tophi, tenderness and effusions	0	1	2
Tests active flexion and flexes further passively if range of movement is restricted. Comments on maximum angle (normal: 145 degrees). In the same way tests extension, supination and pronation at the elbow	0	1	2
Feels shoulder when moving arm in all planes for crepitus, pain or limitation of movement	0	1
Offers examination of shoulder and hand, neurovascular exam and history	0	1
Thanks patient and offers help to redress	0	1
Washes hands	0	1
Offers next step (imaging: 2 plain x rays for bony pathology or CT if indicated, MRI for soft tissue)	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses	0	1