Locking and painful knee for 2-3 days - nil trauma

Hi all,

I have a patient with what I think is an unusual presentation

Healthy 31 year old female working full-time at a supermarket, squatted down to stack fruit and was not able to get up again as Left knee had completely locked and was not able to be further flexed or extended.

For the last few months this has happened with very innocuous movements (event standing up) and she reports it locks for 2-3 days and there is nothing she can do to unlock it. She has had no trauma to the knee. She has presented to the emergency department - they did an MRI which cleared of ACL, PCL or meniscal damage.

From my Ax I've found:
- very tender posterior lateral aspect of L knee
- full ROM knee
- reduced length and strength of hamstrings

So far I am treating her as though she has a popliteus tear, however she has no pain with walking (which is usually apparent with a popliteus tear).

Anyone else have any ideas?

hello,
I had a similar case some time ago, I conculded it was a dysfunction of the curtiate ligaments at the knee.
treating for popliteus tear will work.. due to the proximity of the popliteus muscle to these ligaments.
I will appreciate if you could inform me of the patient's progress and you specific treatment

thank you

Hi there,

This seems to be a classic case of bucket-handle tear of the medial meniscus on that side. Although 31 is a bit young for degenerative tear, there may have been some remote trauma to that knee which is remote enough to have been forgotten if there were no immediate sequelae. I recently had a patient with no remembered trauma, no pain on weight bearing or walking, slight pain on going down stairs, but intermittent locking. Arthroscopy revealed a meniscal tear, as we thought from her symptoms. Good luck!

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Originally Posted by spaceangelz

Hi all,

I have a patient with what I think is an unusual presentation

Healthy 31 year old female working full-time at a supermarket, squatted down to stack fruit and was not able to get up again as Left knee had completely locked and was not able to be further flexed or extended.

For the last few months this has happened with very innocuous movements (event standing up) and she reports it locks for 2-3 days and there is nothing she can do to unlock it. She has had no trauma to the knee. She has presented to the emergency department - they did an MRI which cleared of ACL, PCL or meniscal damage.

From my Ax I've found:
- very tender posterior lateral aspect of L knee
- full ROM knee
- reduced length and strength of hamstrings

So far I am treating her as though she has a popliteus tear, however she has no pain with walking (which is usually apparent with a popliteus tear).

Anyone else have any ideas?

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Dear Spaceangelz:

Please do not overlook the action of the popileus and planterius muscles.

While a meniscus tear is possible or probable, most in therapy forget to check the muscles behind the knee which rotate and pull the knee to a home or lock position in standing. I have found that most do not consider the action of these two muscles. Try pressure into the muscles. Therapy is trigger point if the patient can stand the tenderness or cortisone injection for those who cannot.

Even when the "bucket handle tear" of the meniscus is corrected by sugery, many have this tear reoccur if the poplitus and planterius are not addressed.

Best regards,

Nueromuscluar.

Hi you have mentioned that hams length is less I think you can try releasing biceps femoris along with popliteus, and give her hams taping.have you checked for rice bodies in knee