Checklist Pemeriksaan Fisik pada Cedera Lutut (OSCE)

 Kompetensi dalam SKDI 2012 :

 Tujuan pemeriksaan : mengetahui kelainan lutut yang cedera : fraktur patela ( sekitar lutut),
meniscus, ligament.
 Daftar keluhan : nyeri lutut, bengkak, pincang, dll.
 Prosedur : inspeksi ( look ), palpasi ( feel ), move

No. Aspek Skor

0 1 2
1. Pendahuluan:
 Cuci tangan
 Perkenalkan diri
 Klarifikasi identitas pasien
 Jelaskan tujuan dan langkah-langkah pemeriksaan, dapatkan persetujuan
(informed-consent)

2. Observasi umum :
 Ensure both knees are appropriately exposed, in this case
the patient will probably be wearing shorts = kedua lutut
lurus sejajar, pasien disarankan memakai celana pendek
3. Pemeriksaan

 ask the patient to walk for you. Observe any limp or

obvious deformities such as scars or muscle wasting.
Check if the patient has a varus (bow-legged) or valgus
(knock-knees) deformity. Also observe from behind to see
if there are any obvious popliteal swellings such as a
Baker’s cyst = minta pasien untuk jalan ke kamu,
perhatikan kelainan deformitas seperti bekas luka atau
pengecilan otot. Cek jika pasien mempunyai varus ( kaki
bengkok) atau valgus ( kaki X ). Dan amati dari belakang
untuk melihat jika ada pembengkakan popliteal seperti
kista Baker’s

 ask the patient to lie on the bed to allow a further general

inspection. Look for symmetry, redness, muscle wasting,
scars, rashes, or fixed flexion deformities = minta pasien
untuk berbaring untuk melihat lebih lanjut. Lihat
kesimetrisannya, kemerahan, pengecilan otot. Bekas luka,
ruam, atau deformitas flexi
  palpate the knee joint, start by assessing the temperature
using the back of your hands and comparing with the
surrounding areas. Palpate the border of the patella for any
tenderness, behind the knee for any swellings, along all of
the joint lines for tenderness and at the point of insertion of
the patellar tendon = palpasi sendi lutut, dimulai dari
menilai suhu dengan menggunakan punggung tangan dan
membandingkan dengan daerah sekitar. Palpasi batas
patella untuk tenderness, belakang lutut untuk
pembengkakan, sepanjang garis sendi untuk tenderness dan
titik insersi dari tendon patella

4.
Tap the patella to see if there is any effusion deep to the patella
The main movements which should be examined both actively
and passively are: = tepuk patella untuk melihat adanya efusi
dalam di patella. Pergerakan utama dimana harus diperiksa secara
aktif dan pasif

◦ flexion = fleksi
5.
◦ extension = ekstensi

A full range of movements should be demonstrated and you

should feel for any crepitus = berbagai pergerakan harus di
demonstrasikan dan kamu harus merasakan crepitus
6. perform the specialist tests which assess the cruciate ligaments. =
melakukan tes spesialis untuk menilai ligament cruciatum

Anterior drawer test: Flex the knee to 90 degrees and sit on the
patient’s foot. Pull forward on the tibia just distal to the knee.
There should be no movement. If there is however, it suggests
anterior cruciate ligament damage. = test drawer anterior :
fleksikan lutut 90 derajat dan duduk di kaki pasien. Tarik kedepan
tibia dari disal lutut. Seharusnya tidak ada pergerakan. Jika ada,
itu menandakan adanya kerusakan ligament cruciatum anterior
Another test for ACL damage is Lachman’s test. = tes lain untuk
ACL adalah tes Lachman

Posterior drawer test: With the knee in the same position,

observe from the side for any posterior lag of the joint, this
suggests posterior cruciate ligament damage = test drawer
 posterior : dengan lutut posisi yang sama, perhatikan dari sisi
posterior lag sendi, ini menandakan kerusakan ligament
cruciatum posterior

perform the specialist tests which assess the collateral ligaments.

= lakukan tes spesialis menilai ligament collateral

Do this by holding the leg with the knee flexed to 15 degrees and
7.
place lateral and medial stress on the knee. Any excessive
movement suggests collateral ligament damage = lakukan ini
dengan memegang kaki dengan lutut difleksikan 15 derajat dan
letakkan di lateral dan medial dari lutut. Adanya pergerakan yang
berlebihan menandakan kerusakan ligament corrateral
8. Ucapkan terima kasih kepada pasien, dan persilakan memakai pakaian/
celana
9.
Sampaikan resume hasil pemeriksaan

Keterangan :
0 = Tidak dilakukan Nama Instruktur :
1 = Dilakukan dengan perbaikan
2 = Dilakukan dengan sempurna
NIP :
SKENARIO SOAL

Laki-laki 20 tahun datang periksa karena lutut kanan nyeri.

Riwayat jatuh saat bermain futsal, 2 minggu yang lalu.
Sudah dibawa ke pengobatan alternatif ( sangkal putung ) 3 kali.
Knee Examination
Knee complaints are very common presentations to A&E, general practice as
well as orthopaedic clinics. Some hospitals even have special “knee” clinics.
Common presenting complaints are pain in the knee, the knee locking or giving
way. Common conditions that cause these symptoms include arthritis, ligament
and/or cartilage injuries.

The knee examination, along with all other joint examinations, is commonly
tested on in OSCEs. You should ensure you are able to perform this confidently.
The examination of all joints follows the general pattern of “look, feel, move”
as well as occasionally special tests, in which this station has many.

Subject steps
2.Start by washing your hands and introduce yourself to the patient. Clarify the
patient’s identity and explain what you would like to examine, gain their
consent. Ensure both knees are appropriately exposed, in this case the
patient will probably be wearing shorts.

3.To begin, ask the patient to walk for you. Observe any limp or obvious
deformities such as scars or muscle wasting. Check if the patient has a
varus (bow-legged) or valgus (knock-knees) deformity. Also observe
from behind to see if there are any obvious popliteal swellings such as a
Baker’s cyst.

◦
◦ Ask the patient to walk
4.
5.Next ask the patient to lie on the bed to allow a further general inspection.
Look for symmetry, redness, muscle wasting, scars, rashes, or fixed
flexion deformities.
◦ Perform a general inspection

◦ Note the scar over the left knee of

this patient
6.
7.Now palpate the knee joint, start by assessing the temperature using the back
of your hands and comparing with the surrounding areas

◦ Assess knee joint temperature

8.
9.Palpate the border of the patella for any tenderness, behind the knee for any
swellings, along all of the joint lines for tenderness and at the point of
insertion of the patellar tendon.Finally, tap the patella to see if there is
any effusion deep to the patella.
◦ Palpate the border of the patella

◦ Palpate the joint lines

◦ Palpate the point of insertion

◦ Tap the patella

10.
11. The main movements which should be examined both actively and
passively are:

◦ flexion
◦ extension
12. A full range of movements should be demonstrated and you should feel
for any crepitus.

◦ Knee flexion movement

◦ Knee extension movement

13.
14. Now perform the specialist tests which assess the cruciate ligaments.

◦ Anterior drawer test: Flex the knee to 90 degrees and sit on the patient’s
foot. Pull forward on the tibia just distal to the knee. There should
be no movement. If there is however, it suggests anterior cruciate
ligament damage. Another test for ACL damage is Lachman’s test.
◦ Posterior drawer test: With the knee in the same position, observe from
the side for any posterior lag of the joint, this suggests posterior
cruciate ligament damage.
15.
◦ Draw test

◦ Posterior lag test

16.
17. Now perform the specialist tests which assess the collateral ligaments. 
Do this by holding the leg with the knee flexed to 15 degrees and place
lateral and medial stress on the knee. Any excessive movement suggests
collateral ligament damage.

◦ Lateral stress
◦ Medial stress
18.
19. Perform McMurrays test to assess for meniscal damage.  Hold the knee
up and fully flexed, with one hand over the knee joint itself and the other
on the sole of that foot.  Stress the knee joint by medially and laterally
moving the foot.  Pain or a click is a positive test, confirming meniscal
damage.

◦ McMurray's test
20.
21. Allow the patient to dress and thank them.  Wash your hands and report
your findings to the examiner.
 
- See more at: http://www.osceskills.com/e-learning/subjects/knee-
examination/#sthash.vChRAAxS.dpuf