Knee Case Study Week 2

Referral from Physician

Right Knee pain 32 year old female  

Subjective

History of Presenting Condition 

6 months insidious onset right anterior knee pain, had an x-ray but nothing abnormal detected (NAD).  Slowly getting worse, went to A+E with the pain 3/52 ago, diacharged with advice on taking paracetamol and naproxen regularly. Went to the GP as pain not easing and finding it difficult to cope with pain. GP referred to Physiotherapy.

Presenting Condition

  • Pain anterior knee - constant dull ache 4/10 which increases to 8/10 sharp intermittent pain when walking down stairs or squatting, can hear knee cracking on flexion / extension occasionally.
  • Diurnal pattern activity dependent
  • Aggravated by walking up and down stairs, walking for more than 30 mins, wearing heels for work, standing after sitting at work for a long time. Driving
  • Eased: Not much, Paracetamol take the edge off
  • Not waking at night
  • No locking / clicking / giving way

Past medical History 

Asthma - controlled not using inhalers now, cesarean section 2 years ago for birth of child

Drug History 

Paracetamol PRN, Oral Contraception

Social History

  • Full time office worker
  • Has 2 year old son
  • Lives with husband
  • Started the gym 8 months ago to lose weight, liked doing high intensity interval training classes - stopped now due to knee pain

Objective

Observation

  • No visible swelling to the joint
  • Gait - nil significant

Knee

Active range of movement (AROM):

  • Flexion full
  • Extension full

Passive range of movement (PROM):

  • Full slight discomfort normal soft end feel
  • Extension - + 10 degrees of hyperextension soft end feel slight discomfort

Resisted range of movement:

  • Flexion -5/5 no pain
  • Extension -5/5 increases sharp pain anterior knee

Hip Active range of movement:

  • Flexion full
  • Extension neutral
  • IR ½
  • ER ½

Passive range of movement:

  • Flexion - full
  • Extension + 5 from neutral tight end feel especially with knee flexion
  • IR ¾ tight end feel
  • ER ¾ tight end feel

Resisted range of movement:

  • Flexion 5/5
  • Extension -5/5
  • IR 5/5
  • ER -5/5

Special tests:

  • MCL/ LCL/ ACL/ PCL stress testing -ve

Palpation:

  • Palpation medial and lateral joint line not painful
  • Patella slight stiffness into medial and lateral glide
  • Palpation quadriceps tendon no pain
  • Palpation patella tendon reproduces sharp pain.

Functional tests:

  • squat = decreased weight bearing on right leg, adduction of right leg more than left on squat increases right anterior knee pain