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Week 10 PCP Workbook Qs

This document provides a study guide and questions for students to complete a case study analysis of a patient presenting with medial knee pain. It includes 1) a precis of the differential diagnosis and assessment of medial collateral ligament sprain versus chondromalacia patellae, outlining relevant history questions, physical exam findings, special tests, and imaging for each. 2) A table for students to interpret various special tests and the tissue structures they load. 3) The case of an 18-year-old female swimmer with increased training volume and medial knee pain. Students are to create a differential diagnosis and management plan for this patient.

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57 views

Week 10 PCP Workbook Qs

This document provides a study guide and questions for students to complete a case study analysis of a patient presenting with medial knee pain. It includes 1) a precis of the differential diagnosis and assessment of medial collateral ligament sprain versus chondromalacia patellae, outlining relevant history questions, physical exam findings, special tests, and imaging for each. 2) A table for students to interpret various special tests and the tissue structures they load. 3) The case of an 18-year-old female swimmer with increased training volume and medial knee pain. Students are to create a differential diagnosis and management plan for this patient.

Uploaded by

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© © All Rights Reserved
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Week 10 Workbook

questions
Study Guide Questions: 10.4

The questions for this week will focus on a case study that will require students
to formulate a series of questions in the history and complete the table below
with details to assist you with your diagnosis for this patient, similar to Table
12-15 from Magee D, Orthopedic Physical Assessment, 6th Edition (2014),
page 876- 877 provided as an exemplar for this activity and create a
management plan for this patient.

Using the precis of knee assessment as shown below create your own
differential diagnosis and management plan for an 18-year-old female
swimmer who presents to you with medial knee pain. She has just increased
her training to 10,000m per day. Describe your assessment plan for this patient
(medial collateral ligament sprain verses chondromalacia patellae)
Differential Diagnosis Medial Collateral Ligament Sprain Verses Chondromalacia Patella
Syndrome

Medial Collateral Ligament Sprain Chondromalacia Patellae Syndrome


History Ask if there was a blow or knock to Ask of any recent trauma/injury.
Questions the lateral knee or thigh prior to Ask if the pain is constant, or just
the pain/complaint. during movement.
Ask if there were any twisting Ask to point to where the pain is -
mechanisms involved when pain/ likely to be inferior or superior to
complaint started. patellar.
Ask to point where the pain is - Ask if pain proceeds from sitting for
likely medial aspect of joint line. long periods.
Pain is deeper, achy.
Observations Age is a contributing factor, tends Age is a contributing factor, tends to
to affect younger, athletic people. affect older people.
Pain and tenderness at medial Check Q-angle,
aspect of joint line. Quadriceps atrophy and hyper-
Gait compensation/limp. tonicity.
Feeling of instability. Observe any mal-positioning of the
Knee gives way into valgus patellar, swelling or signs of
motion. inflammation.
Medial swelling if severe sprain. Observe if any J sign in knee
extension.
Active Pain in knee flexion, typically no Pain in knee flexion, crepitus may
Movements crepitus. Inability to completely also be felt.
extend the knee (can be due to Observe their squat - pain in full
swelling). squat/knee flexion.
Passive Pain with most PROM’s, NAD.
Movements especially rotations and varus/
valgus motions.
Resisted May present with pain and Muscle testing of VMO and other
Isometric weakness in quadricep muscles.
Movements
Special Tests Appley’s test, varus stress test, Clarke’s sign, compression test,
abduction stress test, Thessaly’s step up test, McConnell test, VM
test, McMurray’s test, Lachman’s coordination test, stroke test.
test.
Sensation NAD. NAD.
Reflexes NAD. NAD.
Joint Play Instability/laxity in varus stress of Crepitus may be felt during Motion
Movements the knee palp.

Diagnostic MRI is golden standard. X-ray -Only useful in later stages,


Imaging when arthritic condition is set in.
MRI.
Management Plan:

Patellar taping (for Chondromalacia Patellae Syndrome)


Kinesiology tape (for acute stage of MCL tear/sprain) and Heat/RICE.
NSAID’s where required.
Exercise program strengthening the quadriceps, hamstrings and other supporting
muscles.

Test INTERPRETATION/WHAT TISSUE


STRUCTURE DOES THIS TEST
LOAD? For you to complete
Anvil Test Soft tissues - cartilage, ligaments and
other joint tissues such as synovium.
Indiciative of joint pathology such as
arthritis, femoral neck/head fracture and
infection
Scour Test Soft tissues - adductor longus,
pectineous, illiopsoas, sartorius and TFL
tendons and joint tissues.
Bone - femoral neck is stressed
Ober’s Test Soft tissue - TFL/ITB, muscle/tendon.
Lachman’s Soft tissues - predominantly the anterior
Test cruciate ligament

Apley’s Soft tissues - cartilage, ligaments and


Grind Test other joint tissues such as meniscus.
Used for differentiation between
ligamentous sprain and meniscal
damage.
Thessaly Soft tissues - cartilage, ligaments and
Test other joint tissues such as synovium.
Indicative of meniscus damage.
Anterior Soft tissues - predominantly the anterior
Drawer Test cruciate ligament

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