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The Knee
Differential Diagnosis and Treatment
Capsular
• More loss of flex than ext
OA of the knee
Signs and Symptoms
• Pain
• Stiffness –reduced ROM, morning
• Swelling
• Muscle wasting
• Varus deformity /osteophytes/ crepitus
• Locking and giving way
• Altered Gait & Function
Treatment
• Grade B mobs
• Strengthening ex and rehab
• Electrotherapy
• acupuncture
• Injection – steroid or hyaluronic acid
• Advice
RA
• Heat, swelling and synovial thickening
• Positive bloods
• Medication
• Injection at 4/12 intervals maximum
• Rehab ex’s
Traumatic arthritis
• Cause – trauma
• If rapid swelling post trauma then aspirate
• Treatment as ligament
Non - capsular
Loose Body
• Twinges of pain
• Locking in flex or ext
• Springy end feel
• Ref to surgeon
Meniscus• Rotation injury• Lock in flex• Gives way• Squat +ve• Meniscal test +ve
• Treatment – ref to surgeon
• May try DTF’s to coronary ligs
Ligaments
MCL• Impact • Pain – joint line• +ve valgus test and LR• Capsular pattern in acute
stage• ACUTE – AIM • Accelerate healing process• DTF’s – ext & flex• Ice• Electrotherapy• Strapping• Gentle ROM ex’s
MCL cont• CHRONIC – AIM• Lig healed but
tethered therefore rupture adhesions and encourage mobility and healing of lig.
• Sup – DTF’s to numb +10 in ext and manip
• Deep – DTF’s to numb +10 in flex and manip
LCL
• Varus impact
• Varus test +ve• Palp in 4 position
• DTF’s to numb + 10
ACL and PCL
• Draw test +ve
• Ref to surgeon
• Rehab strength, ROM and propn pre op
Medial coronary
• Overuse
• Meniscus
• Pain on passive LR or palp
• DTF’s
Muscle lesions
• Q + H muscle belly
• ACUTE
• Ice, electrotherapy, STM, inner range active exercise and strapping
• CHRONIC
• DTF’s, electrotherapy, inner range active exercise, stretching, PNF and rehab +++
Quads Expansion
• Medially – treat with DTF’s with patella pushed medially
• Superiorly – treat with DTF’s with patella tilted proximally
Patella Tendon
• Jumpers knee• Biomechanics• ? Eccentric ex• Strapping• Acupuncture• DTF’s with patella
tilted distally• ???injection
ITB friction syndrome
• Runners knee• Bursitis• Biomechanics/
technique• STM to ITB or roller• Stretches• Ice• ?inject