Knee Case Study Objective Week 3
14 year old boy called James has bilateral knee pain right worse than left worsening over the last 12 months
History of Presenting Condition
12 month history of bilateral knee pain. James initially started to notice pain in his right knee after doing sport, he would find that it ached quite a lot, but the next morning it would be pain free again. Approximately 3 months after he started to notice that both knees would be hurting after he had played a football game or done a physical education session at school.
His mother took him to the doctors 6 months ago and was diagnoses with normal ‘growing pains’ and was advised that this would pass. His knee pain has now become so painful that he really struggles to do any form of physical activity, therefore his mother took him back to the doctor who has now referred him to Physiotherapy.
- Pain over the anterior aspect of both knees, has noticed there is some swelling the right again is worse than left.
- Right and left pain are symmetrical but James reports the pain in his right to be 8/10 during sport and the left 6/10 these pains settle with rest but are now taking longer to settle and can keep him awake at night time if he has done a lot of sport in the day.
- Aggravating factors; playing football, running up and down the stairs, touching the fronts of his knees.
- Easing factors: Rest, paracetamol and ice.
- Diurnal pattern - nil just activity dependant
- No locking / clicking / giving way
Past Medical History
Nil no childhood illnesses, has grown from 4 foot 10” to 5 foot 8” in the last 12 months
At school, enjoys PE and maths, plays for a local football academy and the local football team. He trains Tuesday and Thursday evenings with the academy and a Wednesday evening with the school team. His school games are on a Monday evening and academy games are on a Saturday and his local team have games on a Sunday. He plays in goal and has no substitute. He is hoping to become a professional football player.
- No valgus / varus deformities seen at the knee,
- Patella’s facing anteriorly
- Right foot mild decreased medial arch - more noticeable during gait
- Right swelling to anterior aspect of tibial tubercle.
Active Range of Movement:
- Full flexion extension at the knee Right and Left
- Full hip flexion, MR and LR right and left
- Only achieve neutral extension at right and left hips
Passive Range of Movement:
- Full Flexion extension right and left with soft end feel (mild discomfort EOR flexion right)
- Full hip flexion, MR and LR right and left.
- Hip extension Tight end feel and discomfort anterior aspect hips right and left, with knee flexion increases knee pain.
Resisted Range of Movement:
- Mild weakness into flexion and extension, pain on resisted extension sat on the edge of the bed.
- Mild hip extension and MR weakness.
MCL,LCL, ACL,PCL -ve
- Medial and Lateral joint line - no pain
- Patella glide - no apprehension, no pain on compression
- Patella tendon pain on tibial insertion
- Quadriceps tendon no pain
- Tibial tubercle pain right worse than left++
- Squats - increases knee pain, poor knee alignment with knees coming anterior to toes. Right and left
- Single leg squat - right and left poor control knee translates medially and has a posterior ipsilateral pelvic shift. Right worse than left.