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CASE ASSESSMENT 1

Name

P. Sujatha

Age

40 years

Gender

Female

Occupation

House wife

Address

Rapur

Chief complaints

Pain around right knee joint


Pain increases during night
Difficulty in walking and stair
climbing
Presence of Swelling around right
knee joint

History
Present History

Pain around right knee joint and


increases during night

Past History

She had a fall from height and got


direct injury to knee

Medical History

She has taken analgesics for pain


relief

Surgical History

No Surgical history

Personal History

No history of Hypertension and


Diabetes Mellitus

Pain Assessment
Site

Around knee joint

Side

Right Side

Duration

One Month

Character of pain

Not Radiating

Aggravating Factors

During movement and walking

Relieving Factors

At Rest

VAS Scale:

On Observation
Built

Moderate

Attitude of Limb

Slightly flexed

Skin Colour changes

No Changes Seen

External Appliances

No usage

Tenderness

Grade II

Muscle Spasm

Present

Warmth

Present

Swelling

Present

On Palpation

On Examination
Range of motion of knee joint.
Passive:
Movemen
t
Flexion

Right knee

Left knee

0-110 Degrees

0- 130 degrees

Extension

110- 0 Degrees

130- 0 Degrees

Movemen
t
Flexion

Right knee

Left knee

0-100 Degrees

0- 130 degrees

Extension

100- 0 Degrees

130- 0 Degrees

Active:

Manual muscle testing


Muscles

Right knee

Left knee

Flexors
Extensors
Deep Tendon Reflexes

Grade 4
Grade 3

Grade 5
Grade 5

Jerk
Knee

Right
+

Left
++

Ankle
Plantar

++
++

++
++

ADL

Activities like walking and stair


climbing is difficult

Special Test

Apleys grinding test Positive


Mcmurray test- Positive
Lachmans Test Negative
Anterior Drawer Test - Negative

Investigations
X- Ray

Bony abnormalities are seen

MRI

Meniscal tear

Provisional Diagnosis

Meniscal Injury

Pain

Ultra Sound, TENS, Cryotherapy

Swelling

Crep bandage, Elevation of limb

Joint Movement

Limb mobilization

Muscle strength

Isometrics to hamstrings,

Treatment

Isometrics to Quadriceps
Straight Leg Raises
Leg Extension exercises
Home Programme
Static and dynamic quadriceps exercises are taught

Stair climbing is advised to avoid.


Prognosis
Pain get decreased
Range of motion get increased
ADL activities like walking and stair climbing are improved.

CASE ASSESSMENT - 2
Name

K. Arjun

Age

35 Years

Gender

Male

Occupation

Sports Master

Address

Podalakur

Chief complaints

Pain around left knee during


walking
Weakness is felt
Difficulty in Walking
Difficulty in stair climbing
Decreased movement

History
Present History

Pain around left knee during


walking
Weakness is felt
Decreased movement

Past History

He had a slip during foot ball play


and under gone surgery before two
months

Medical History

Analgesics for pain relief

Surgical History

He had surgery before two months

Personal History

No History of hypertension and


Diabetes Mellitus

Pain Assessment
Site

Around Knee

Side

Left side

Duration

Two months

Character of pain

Not Radiating

Aggravating Factors

During movement and at work

Relieving Factors

At Rest

VAS Scale:

On Observation
Built

Moderate

Attitude of Limb

Slightly flexed

Skin Colour changes

Not Seen

External Appliances

No Usage

Tenderness

Grade II

Muscle Spasm

Positive

Warmth

Positive

Swelling

Positive

On Palpation

On Examination
Range of motion of knee joint.
Passive
Movemen
t
Flexion

Right knee

Left knee

0-130 Degrees

0-110 Degrees

Extension

130-0 Degree

110-0 Degrees

Movemen
t
Flexion

Right knee

Left knee

0-130 Degrees

0-100 Degrees

Extension

130-0 Degree

100-0 Degrees

Active

Manual muscle testing

Muscles
Flexors
Extensors
Deep Tendon Reflexes

Right knee
Grade 5
Grade 5

Left knee
Grade 3
Grade - 3

Jerk
Knee

Right
++

Left
+

Ankle
Plantar

++
++

++
++

ADL

Activities like walking, stair


climbing, jumping are difficult.

Investigations
Provisional Diagnosis

Post operative Knee pain

Pain

Ultra Sound, IFT, Cryotherapy

Swelling

Crep bandage, Elevation of limb

Treatment

Week 0-1 after surgery :

Static Quadriceps
Static hamstrings
Straight leg raises
Calf raises
Hip abduction
Hip Flexion

Week 1-2 after surgery :

Half way squats


Lunges
Single Calf raises
Proprioceptive exercises

Week 2-3 after surgery :

Full squats
Full lunges

Proprioceptive exercises
Single leg squat
Week 3-5 after surgery :

Full squats
Full lunges
Proprioceptive exercises

Home Programme
Static and dynamic quadriceps exercises are taught
Stair climbing is advised to avoid.
Prognosis
Pain get decreased
Range of motion get increased
ADL activities like walking, stair climbing and jumping are improved