PT 700- Outpatient Setting - R Antero-Lateral Knee Pain

1. Patellar Chondromalacia

1.1. Tests and Measures: Clarke's Test

1.2. Expected Findings: Pain in the Patellofemoral Joint

1.3. Possible treatment: Vastus Lateralis Stretching, Vastus Medialis Strengthening, Mini Squats, Lunges

2. Pes Anserine Bursitis

2.1. Tests and Measures: Palpation distal to tibial tubercle, tight hamstrings, resisted internal rotation

2.2. Expected Findings: Spontaneous knee pain when climbing or descending stairs, swollen or tender to touch

2.3. Possible treatment: Rest, ice cup application, stretching, ultrasound

3. Patellar Instability Syndrome

3.1. Tests and Measures: Patellar Glide Test

3.2. Expected Findings: Lateral glide of the patella greater than 1/2 the width of the patella

3.3. Possible treatment: Straight Leg Raises, Stationary Bike, Quadricep Strengthening

4. Patellar Tendonitis

4.1. Tests and Measures: Passive Extension- Flexion Sign

4.2. Expected Findings: Tenderness at the inferior pole of the patella

4.3. Possible treatment: Standing Hamstring Stretch

5. Illiotibial Band Syndrome

5.1. Tests and Measures: Ober's Test, palpation

5.1.1. Positive Test findings

5.2. Expected findings: Inflammation of the Lateral Epicondyle, acute pain on the Lateral Epicondyle during exercise, tight IT band, Medial knee pain

5.2.1. Tight IT Band

5.2.2. Pain on Anterio-Lateral Epicondyle

5.2.3. Medial Knee Pain

5.3. Possible Treatment: Strengthen Hip ABD, decrease inflammation and pain, Strengthen Quads

5.3.1. Ckamshells with theraband progression

5.3.2. Ultrasound

5.3.3. IASTYM IT Band

5.3.4. Shuttle Press

5.3.5. Supine Rolling

6. Co-morbidities or complicating factors: Decreased ROM with Hamstrings, Hip Flexor Weakness, LBP, anterior pelvic tilt, cervicogenic neck pain

6.1. Effect on treatment: Minimal effect on treatment, pt performed exercises with correct form and no pain

6.2. Effect on Outcome: Due to chronic hamstring tightness, pelvic musculature tightness, and unequal muscle stabilization and pull on patella, the treatment was minimally responsive and the pt. needed more aggressive hamstring stretching, core strengthening, quad strengthening, IT Band stretching to see more substantial results

7. Patient Goals: Pt will decrease his subjective level of knee pain to a 2/10. Pt. will be able to ascend/ descend stairs without difficulty.

7.1. How to address: Modalities to decrease swelling and knee pain, LE and Pt. education to ascend/descend stairs without difficulty

7.2. Correspondence to treatment findings: Antero-Lateral & medial knee pain, swelling, and tenderness while ambulating, tight IT band