Who needs yoga? OSCE by Michael

 
You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.

Scenario:

An 18-year-old female is brought to your minors area after a reported left "knee dislocation". The injury occurred during a yoga manoeuvre. The ambulance crew report the first-on-scene responder handed over that he had reduced a knee dislocation. The left leg is neurovascularly intact and has no gross deformities. Her pain is currently controlled.

Instructions for the candidate

You are the consultant on. You are to assess the patient's injury, focusing on examination, and formulate a management plan.

Domains being examined

  • Medical Expertise
  • Communication
  • Health Advocacy
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

You are a fit and well university student. You have no medical problems and no allergies.

You were doing yoga and during an exercise where you twisted on your flexed left knee. You heard a pop and there was immediate severe pain. Your knee appeared deformed, with the kneecap off to the side and standing up on its edge. The good-looking ambulance officer gave you pain killing drugs through a drip and reduced the kneecap into position. You have never had this happen before.

When examined, you are very nervous about the knee being touched or moved. You are tender over the medial border of the knee. You can bend you knee fully and straight leg raise. Sensation and movement are intact.

You work as a waitress and have just started a new job. You don't want to miss your work, with your next shift in 2 days time.

"Did I dislocate my knee?" "Do I need an x-ray" "Do I have to wear the splint?" "Can I go to work?"

For the examiner

The examination is unremarkable with good range of movement. There is no joint effusion and the leg is neurovascularly intact.

X-rays, if requested, are normal with good alignment.

Domains Assessment Objectives

Medical Expertise
Examination of the knee
Management of first patella dislocation

Communication
Establish rapport, good explanation of injury and management

Health Advocacy
Ensuring best possible care for your patient

Other Assessment Notes

1. History
-Adequately explore injury mechanism and important past history

2. Examination
- Hand hygiene
- Compare legs
- Assess neurovascular
- Assess joint effusion
- Palpate for tenderness
- Active and passive movement, straight leg raise
- Cruciate and collateral ligaments
- Cartilage (McMurray's)
- Apprehension test
- Gait

3. Investigation
- x-rays may be appropriate - reasoning should be provided

4. Management
- Clear diagnosis
- Splinting and ROM exercises
- Follow up
- Return to sport/yoga/work
- Risk of recurrence

Bonus points
- offer analgesia prior to examination


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