Step-by-Step OSCE Guide

GETTING STARTED

1. Perform hand hygiene and don PPE if required.
2. Introduce yourself: “Hi, I’m Jamie, one of the advanced clinical practitioners.”
3. Confirm the patient’s full name and date of birth.
4. Explain the examination: “I’d like to examine your knees today. I’ll be assessing their shape, movement, and stability.”
5. Gain verbal consent and offer a chaperone.
6. Ask the patient if they currently have any pain or recent injury.
7. Expose both lower limbs fully.
8. Position the patient standing initially for general inspection.

GENERAL INSPECTION

9. Observe the patient’s general appearance and posture.
10. Inspect both lower limbs from the front, side and back.
11. Look for: swelling, deformity, scars, muscle wasting, valgus/varus deformity, or bruising.
12. Ask the patient to walk a few steps to assess gait, weight-bearing, and symmetry.
13. Then position the patient supine on the examination couch.

PALPATION

14. Assess the temperature of both knees using the back of your hands.
15. Measure and compare the quadriceps bulk for wasting.
16. Palpate the knee in extension:
   – Joint line
   – Patella and patellar tendon
   – Tibial tuberosity
17. Perform a patellar tap test (for large effusions).
18. Perform a sweep test (for smaller effusions).
19. Flex the knee to 90° and palpate:
   – Popliteal fossa (for Baker’s cyst or mass)
   – Head of fibula

MOVEMENT

20. Ask the patient to actively flex and extend the knee.
21. Then assess passive range of motion in both knees.

SPECIAL TESTS

22. Inspect for a posterior sag sign (PCL injury).
23. Perform anterior drawer test (ACL integrity).
24. Perform valgus and varus stress tests to assess collateral ligaments.
25. Mention McMurray’s test or Thessaly’s test if meniscal tear suspected.

TO COMPLETE THE EXAM

26. Let the patient know the exam is finished and thank them.
27. Offer help with redressing.
28. Perform hand hygiene.
29. Summarise your findings clearly.
30. Suggest further assessments:
   – Joint above and below (hip, ankle)
   – Neurovascular assessment of the lower limb
   – Consider imaging (X-ray, MRI, USS)

The knee is a load-bearing joint prone to injury and degeneration. A thorough, structured exam will help you quickly identify mechanical issues, ligament instability, or inflammatory signs.