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