Knee Case Study Week 2

Referral

Right Knee pain 32 year old female  

Subjective

History of Presenting Condition 

6 months insidious onset right anterior knee pain, had an x-ray NAD
Slowly getting worse, went to A+E with the pain 3/52 ago d/c 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

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

Active range of movement:
Knee -

• Flexion full
• Extension full

Passive range of movement:
Knee -

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

Resisted range of movement

Knee

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

Active range of movement:

Hip  - 

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

Passive range of movement:

Hip -

• 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:

Hip -

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

MCL/ LCL/ ACL/ PCL stress testing -ve

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