Study Guide Questions: 10.

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
History Questions - Age
- Type and location of pain
- Traumatic or non-traumatic
event
- Mechanism of injury
- Any plopping of clicking
- Anything aggravate it
- How and when did it occur
(angle of impact or activity
when it happened)
- Is it getting worse or better
- Past medical or injury history
- What shoes do they wear
- Is it worse at any time during
the day
- Is there any other issues that
have developed since the
injury (Knee pain, swelling
Observations Tenderness and soft tissue
swelling will also be present
on the inside of knee
Active Movements - Often difficult to bend knee
Passive - Grade of injury determines
Movements the amount of pain or the
range of the opening of the
joint space during stress test
of the patients knee
Resisted Isometric - When knee is stressed
Movements patient will complain of pain,
moderate laxity in the joint
and significant tenderness on
the inside of the knee
Special Tests - Valgus stress test
- McMurry
- Lachmanns ACL stability
- Thessaly
- Apleys compression
Sensation - Unaffected
Chondromalacia Patellae Syndrome
- Age
- Type of pain
- Traumatic or non-traumatic
event
- Is there pain after sitting for
extended periods of time
- Is there pain going up and
down stairs
- Is there any knee issues
- Pain when squatting
- Possible presence of effusion
(accumulation of fluid –
swelling
- Repeated extension of the
knee from flexion will cause
pain and grating feeling
underneath patella (especially
when articular surfaces are
compressed
- Extension of the knee
- Pain on resisted extension
- Toe and heel walking
- Squat test
- Step up test
- Patella grind
- Vastus medialis coordination
test (Thessaly)
- Apleys compression
- McConnell
- Unaffected
Reflexes - Unaffected - Patella reflex L3-4

Joint Play - NA - Pain and crepitus felt if patella

Movements is compressed against femur
(vertically or horizontally) with
the extension of the knee

Diagnostic - MRI - X-ray (AP view)

Imaging

Management Plan:

- 6 week management plan

- 1st reassessment after two weeks
- Another reassessment after completion of the management plan
- Nutrition
- Reasons for presenting now
- Lifestyle, movement habits (Active care plan)
- Posture hygiene
- Water activities
- PIR
- Mobilisation Soft tissue work
- Stretching exercises PNF
- Trigger points therapy work (correction of factors that perpetuate trigger points)

Test INTERPRETATION/WHAT TISSUE STRUCTURE DOES THIS TEST

LOAD? For you to complete

Hip Telescope Assess the hip joint for laxity (pediatrics)

Test

Anvil Test Designed to provoke symptoms by striking the keel and foot, which
send vibrating/compressing force through the limb and stimulated the
injured site

Scour Test Stressed and compresses the femoral neck against the acetabulum,
or pinches adductor longus, pectineus, iliopsoas, sartorius or TFL.
Test approximates the acetabulo-femoral joint structures which may
be irritated in the presence of pathologies

Ober’s Test Accesses the TFL (iliotibial band) for contracture

Lachman’s Test Tests integrity of the anterior cruciate ligament. By pulling the tibia
 anteriorly, torn ACL will create a forward translating movement of the
tibia on the femur

Apley’s Grind Designed so that in distraction of the knee, pressure is taken off the
Test meniscus, while putting strain on the collateral ligaments and vice-
versa during compression

Thessaly Test Used to detect meniscal injury. Knee with meniscal tear will produce
the symptoms when using this test

Anterior Drawer Used to test the integrity of the anterior cruciate ligament
Test