Simulated Patient Instructions
Sam / Samantha Cooper
For proper examination of the knee there really needs to be an examination couch, so this case is
ideally suited to mock CSA in a GP surgery, rather than White Hart.
Part of this case is for the assessor to observe and mark the performance of a knee examination.
Please wear loose clothing that will allow you to easily expose your knees.
Opening statement - “I’ve come about my knee, doctor”. Walk in with a slight limp.
20s or 30s age male or female.
You noticed a pain in the outer (lateral) side of your left knee about 6 weeks ago and (only if specifically
asked) this pain is going about half way up the outer side of your thigh.
You did the great north run |(or a half marathon) recently and did a good time. You noticed the pain, like
a dull ache, the next day and managed to run through this initially but now unable to do this as the pain
has got much worse. You did increase your running distance a lot in the two weeks leading up to the
half marathon. You were running 5 miles on each training session and increased this to 10/12 miles.
You have taken the odd ibuprofen but it doesn’t seem to be helping.
It hasn’t affected your work in the local council office, but you aren’t able to run around with the kids.
You do pay for your prescriptions (you might be asked this, because the Dr might advise over the
counter medication which would be cheaper than a prescription charge).
You usually run 5–10 miles 3–4 times a week on varied terrain. But not recently, because of the pain,
and it’s getting to you now and you want it sorted.
There has been no locking or giving way.
You were previously obese and worked very hard to lose the weight and are really scared that you may
gain weight again.
You have no other significant past medical history.
You are concerned that it is a ligament that has caused the pain.
Your friend had something similar and he has mentioned physio, would it help?
Whatever solution you are offered, you are worried about how long it’ll take. You’ve already had a
period of rest, so “wait and see” is not acceptable to you. You want something done.
Your ICE (ideas, concerns, expectations) is you want to get back to training so you fear weight gain if
you aren’t active.
Please go through the clinical presentation and the physical examination below with your
assessor prior to the mock CSA.
D:\308866136.doc
Clinical Presentation
The primary initial complaint in patients with iliotibial band syndrome is diffuse pain over the lateral
(outer) aspect of the knee. These patients frequently are unable to indicate one specific area of
tenderness, but tend to use the palm of the hand to indicate pain over the entire lateral (outer) aspect of
the knee. With time and continued activity, the initial lateral achiness progresses into a more painful,
sharp, and localized discomfort over the lateral femoral epicondyle and/or the lateral tibial tubercle.
Typically, the pain begins after the completion of a run or several minutes into a run; however, as the
iliotibial band becomes increasingly irritated, the symptoms typically begin earlier in an exercise session
and can even occur when the person is at rest. Patients often note that the pain is aggravated while
running down hills, lengthening their stride, or sitting for long periods of time with the knee in the flexed
position.
Physical Examination
Patients with iliotibial band syndrome often demonstrate tenderness on palpation of the lateral (outer)
knee approximately 2 cm above the joint line. Tenderness frequently is worse when the patient is in a
standing position and the knee is flexed to 30 degrees. At this angle, the iliotibial band slides over the
femoral condyle and is at maximal stress, thus reproducing the patient’s symptoms. Swelling may be
noted at the distal iliotibial band
CSA EXAMINATION CARD
Sam / Samantha Cooper
Part of this case is for the assessor to observe and mark the performance of a knee examination.
Please wear loose clothing that will allow you to easily expose your knees.
You should role play the exam with the assessor as preparation for this case, so you know how to react
to being examined.
Obviously finding it painful to walk on his/her left knee.
Tender to palpate over the lateral joint line.
Pain reproduced on varus stress of knee
Rest of exam ok
D:\308866136.doc