I HUMAN CASE WEEK #2 57 YEARS OLD REASON FOR ENCOUNTER: ACUTE LEFT KNEE PAIN FOR 2 DAYS I HUMAN CASE STUDY LATEST REVIEW FROM EXPERT FEEDBACK .LATEST

I HUMAN CASE WEEK #2 57 YEARS OLD REASON FOR ENCOUNTER: ACUTE LEFT KNEE PAIN FOR 2 DAYS I HUMAN CASE STUDY LATEST REVIEW FROM EXPERT FEEDBACK .LATEST

HPI: A 57 year old male came in referred by Orthopedic Surgeon with left knee pain post
patella tendon injury repair. Pt fee and sustained a patella tendon tear, came to the hospital, put
on back slab and was admitted same day at Male Orthopedic Ward. Pt did the operation.
Discharged and was put on a backs lab and removed. Complains of localized knee pain which
gets worse when he tries to bend the knee and when walking. Pain eases with rest and
painkillers.
PMH-nil significant
Social hx- Non-smoker, non-alcoholic
Family hx- stays in sefhare with wife and children
On examination
• Pt came using a walker-FWB
• Knee not on knee brace
• Sutures in place, would clean and healing well
• Mild swelling on left knee
AROM
• right knee flexion - 145°
• Right knee extension full
• Left knee flexion - 70° â„… pain
• Left knee extension-nil-limited by left quads weakness
PROM
• Left knee flexion 75°-limited by pain
• Left knee extension full and pain-free
Muscle power
• Left quads â…•
• Left hamstring â…˜
On Palpation
• Pain on inferior-medial aspects of left patella
• Slight effusion Problem List
• Pain
• Swelling
• Left quadriceps weakness
• Decreased ROM of left knee
Week 3-5 Treatment Goals
Short term goals
Post op pain control
• Reduce swelling
• Promote good scar healing
• Improved quadriceps strength
lOMoAR cPSD|46020670
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• Maintain hamstring strength
• Maintain patella mobility
• Begin knee ROM exercises – to attain knee flexion of 0-90 as per Orthopaedic
Surgeon instruction. Next Ortho Review Long term goals
• Protect the tendon from overstress
• Stimulate knee control
• Gait training – wean from walker to elbow crutches to 1 elbow crutch
• Tolerate full weight bearing at week 5
Treatment session
• Cryotherapy on the left knee for 10 mins
• Soft-tissue manipulation left knee, left quads, left hams
• Gentle patella mobilizations- medial & lateral
• Ankle pumps 10 reps, 3 sets
• Isometric left quads exercises 10 reps, 3 sets, 10 secs hold
• VMO stimulation 10reps, 3 sets, 5 secs hold
• Heel slides in supine and sitting 10 reps, 3 sets
• Prone knee bending exercises 10 reps, 3 sets, 10 secs hold
Treatment Outcome
1. AROM
• Left knee flexion-75°>limited by pain
• Left knee extension – 1/5>limited by left quads weakness 2. PROM: Left knee
flexion-83°> limited by pain
 Left knee extension full >c/o mild pain on suture site
Plan:
• Gait training next session and wean from walker to elbow crutches
• Continue with Quads sets, Gluteal sets, and heel slides on a knee brace as HEP
• Refer to Orthotics for adjustable knee brace
• Review weekly
Second Physiotherapy Session
Diagnosis: Left knee patella tendon injury post repair
S: pt reports to be much better, no new complaints
O/E using a walker for ambulation
Knee brace in situ
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Mild swelling left knee
AROM: left knee flexion – 82°>limited by pain
Left knee extension lag of 20°
PROM: left knee flexion 85°>limited by pain
Left knee extension full
Muscle Power: Left quads 3/5
Left hamstring 4/5
Treatment Goals
• Control swelling
• Maintain patella mobility
• Improve knee extension- quadriceps strength
• Initiate knee control
• Gait training FWB Treatment
• Soft tissue manipulation left knee, left quads and left hams
• Left patella mobilisations
• Quadriceps strengthening exercises with a red theraband 10 reps, 5 sets, 10 secs hold
• VMO stimulation 10 reps, 4 sets, 7secs hold
• Hamstring curls in prone, with 1kg weight 10 reps, 5 sets
• Straight Leg raises with brace on, in supine, prone and right side lying
• Heel slides in supine & sitting 15 reps, 5sets,10 secs hold
• Pedal exercises 10 mins, resistance of 5
• Heel raises in standing and hands supprted, brace on and locked in extension 10 reps, 3
sets, 10 secs hold Treatment Outcomes
• AROM: Left knee flexion 90°>limited by pain
Left knee extension lag of 17°>limited by pain at the suture site and weakness of the left
quads
• PROM: Left knee flexion- 93°>limited by pain Left knee extension full
• Last 2 sets of quads strengthening were done with a grey theraband- pt copes but c/o
fatigue on the anterior thigh
Pt adhering well to rehabilitation 

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