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• NAME-XYZ
• AGE/SEX- 60/MALE
• ADDRESS- SHRESHTH VIHAR
• CONTACT NO. – 981*******
• OCCUPATION – HOMEMAKER
• DOMINANCE- RIGHT
• Date of assessment- 13.12.2018
• CHIEF COMPLAINT- PAIN IN KNEE WHILE STRAIGHTENING AND
BENDING , WALKING AND CLIMBING STAIRS.
PRESENT MEDICAL HISTORY
PATIENT REPORTED OF HAVING PAIN IN BOTH THE KNEES
ESPECIALLY OVER THE MEDIAL JOINT LINE OF THE KNEE
WITH PAIN IN BILATERAL PATELLA WHICH STARTED FOUR
YEARS BACK AND HAS INCREASED SIGNIFICANTLY SINCE
PAST TWO MONTHS . HE CONSULTED THE ORTHOPAEDICIAN
WHO ADVICED HIM FOR PHYSIOTHERAPY.
1. PAIN HISTORY
PAIN ASSESSMENT
MECHANISM OF INJURY – NO MECHANISM OF
INJURY IS FOUND.
ONSET – GRADUAL
DURATION – CHRONIC (4 YEARS)
SITE/ LOCATION – PAIN AT THE MEDIAL ASPECT OF
THE KNEE[BILATERALLY]
• Radiation- No radiation
• TYPE OF PAIN – DULL ACHING PAIN THAT INCREASES WITH MOVEMENT OF THE KNEE
• DIURNAL VARIATION – MORE STIFFNESS AND PAIN FELT IN THE MORNING THAT SLIGHTLY
REDUCES WITH MOVEMENT AS THE DAY PROGRESSES.
SCAR-NOT PRESENT
EXTERNAL APPLIANCES/ORTHOSIS –
PATIENT USES CANE FOR AMBULATION.
• Posture
• Anterior View
• OEDEMA –NON PITTING OEDEMA AT MEDIAL JOINT LINE OF BOTH KNEES AND PITTING
EDEMA AT RIGHT LOWER LEG AROUND MEDIAL MALLEOLUS.
FIRM 0-17deg 0-17 deg Hip exten. 0-17 deg 0-17 deg FIRM
FIRM 0-45 deg 0-40deg Hip abduct. 0-40 deg 0-45 deg FIRM
FIRM 0-22 deg 0-20 deg Hip adduc. 0-20 deg 0-20 deg FIRM
FIRM 0-53 deg 0-50 deg Inter.Rot 0-45 deg 0-50 deg FIRM
FIRM 0-30 deg 0-25 deg External rotation 0-27 deg 0-30 deg FIRM
SOFT 0-100 deg 0-90 deg Knee flex. 0-100 deg 0-110 deg SOFT
HARD 130-0 deg 125-0 deg Knee extn 130-0 deg 135-0 deg HARD
FIRM 0-22deg 0-19deg Ankle dorsi. 0-19deg 0-22deg FIRM
FIRM 0-45deg 0-40deg Ankle plant. 0-40deg 0-45deg FIRM
Manual muscle testing(MMT)
JOINT RIGHT LEFT
HIP FLEXION (3+) 3+
HIP EXTENSION 3 3
HIP ABDUCTION (3+) (3+)
TIBIOFEMORAL JOINT-
o ANTERIOR GLIDE- GRADE 2
o POSTERIOR GLIDE –GRADE 2
Girth and Oedema Measurement
• Right Left
14CM ABOVE THE BASE OF PATELLA 49CM 49CM
MEDIAL MALLEOLUS LEVEL 29CM 28CM
14CM BELOW MEDIAL KNEE JOINT LINE 34CM 33CM
LIMB LENGTH
RIGHT LEFT
TOE OFF
QUANTATIVE ANALYSIS
PARAMETERS FINDINGS NORMAL
BASE OF 15 cm 5-10 cm
SUPPORT
STEP LENGTH 24 cm 35-41cm
6.PIRIFORMIS TIGHTNESS -
Present
Differential diagnosis
OSTEOARTHRITIS KNEE
PATELLOFEMORAL SYNDROME
Investigation
Probable diagnosis
- SWELLING IN THE KNEE JOINT [ MEDIAL JOINT LINE] AND RIGHT LOWER LEG[ ANKLE NEAR MEDIAL
MALLEOLI]