lateral knee pain

please help!
I have a 15 year old who trains in a youth academy for football presenting with lateral knee pain. On testing restisted quads illicit pain and on a meniscal test the lateral meniscus with compression and rotation into flexion nearly made him jump off the couch. The knee joint seems stable and his cruciates appear in tact. Collaterals were negative. when palpating around the meniscus i was unable to localise tenderness. there was no swelling. The history is of periods of flaring up and then healing but this episode has caused him to seek treatment. range of movement there is full extn with no lack or lag flxn is limited to 100deg due to pain.
My initial thoughts were a lateral meniscus tear but don't know if i have missed anything out. If it is a meniscal tear what would the management be?Since i'm not trained in manipulation of this type at present i have advised rest and ice and refer back to the GP.
any suggestions?
thanks Laura

anybody?????

Hello Laura :

Hope for you catching job soon .Uk seems to catching 3d world countries through that burcracy .

As for your patient ,It is better to advise your patient seeks for an Orthopedist consultation for you to be on the safe side legally . You are so correct regarding rest is the main method here . I would like to raise one point regarding your Evaluation handling ...My view is to applying any provactive test gently as possible to avoid detrioration .I believe re-testing is not appropriate , just give it one trial .
Cheers
Emad

If you have any doubt or unsure about your diagnosis, then it is better to have an MRI of Knee to clarify the diagnosis. After a proper diagnosis, proceed further to the management.

Hi Laura:

did u think about chondromalacia, or being ur patient have a knee cyst(posteriorly) !!:cool:

have you ruled out PFJS? What is his VMO, glut med etc like??

He is with the youth academy - ask them to get an MRI thru their doctor. Tell them that they may lose a valuable asset the longer they wait!

Sound like you have been thorough enough.

Hi Laura,

Diff diagnosis ? OCD ? is there an effusion ? All the other replies are correct keep away from agg activities and referral for the appropriate investigations and management. I believe that you need to work on strength work initially NWB --> PWB --> BW as they are able. Because regardless of their management (conservative vs surgical) they will need to strengthen!!

Cheers

Konrad

Perhaps your kid works too strong.
You may try with a boiled cabbage leaf applied on his knee to reduce the pain and advise to work less.
Please, pardon my English: I'm a 58 years old italian PT.

Cecco

Quote:

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Originally Posted by physioceccus

Perhaps your kid works too strong.
You may try with a boiled cabbage leaf applied on his knee to reduce the pain and advise to work less.
Please, pardon my English: I'm a 58 years old italian PT.

Cecco

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just out of interest, but how is a boiled cabbage going to help in this instance?

Hi,

I too thought the same thing - maybe the smell will prevent him from taking the field and he will get good rest without too much trouble from his coaches!

But seriously, perhaps it is like how cabbage leaves help breastfeeding women with mastitis - anti-inflamm?

it's meant to be good for horses with swellings on thier legs....no idea why though!:)

Hi Laura ,
I strongly believe that what you think is right. The posterior horn of the lateral meniscus should have been effected. Do you know the mechanism of injury, i mean, if he remembers an instance in the field that he got an injury. How long is the pain now, flare-up causes, and what relieves the pain. Check at the level of the joint line between the femur and tibia for tenderness. MRI is highly indicated.
RICE protocol that you have initiated is well with the same as Konradslavinskis says; strengthening program (all exercises to be performed within the pain limits)


hi hi hi boiled cabbage, why not potatoes (sarcastic):mad: a slice of raw potato applied to a black eye will reduce swelling. An old-fashioned treatment for chilblains is a poultice of mashed potatoes and turnips mixed with a little turpentine. The raw juice, or the water used to boil potatoes, can help to relieve painful joints when applied as a compress.:eek:

Im not an Italilan physio and doesn't speak Italain too.

Cheers
Rahid

Have you assessed muscle length? ITB, Glut med, quads etc. It does sound suspiscious of a lateral meniscal injury, and in this instance, I think a more clear history would clarify a few things...how long ago was the injury (acute or chronic), what was the mechanism of the injury? What are the aggravating factors for his condition? If infact he has sustained a nasty acute meniscal injury causing some nociceptive pain mechanisms, then the principles of acute management would apply (PRICE), graduated exercise - mobility, increasing weight bearing, proprioceptive, anti-inflammatory modalities might also be helpful in this instance. Radiographic investigations like MRI will help to confirm the presence of a tear but would this make much difference in the management of the problem at this stage? I don't think your appropach in the acute stages would change irrespective of what the MRI finds. If in fact there are some postive muscle findings (tightness etc)...you may be able to address other biomechanical factors contributing to the problem.

Hi Laura,

Simple get MRI scan>>> a) meniscal tear>orthpod>arthroscope>rehab>fixed
b) wait and see what MRI says
c) get the kid on some anti-inflams to see if it settles down.

C