Knee injury

[sanagupta]

Hello!
i have a patient 35 years old with post 6 months right knee injury.
MRI Fracture of interspinous region od tibia with avulsion of tibial attahment of PCL.anterior horn of lateral meniscus and posterior horm of medial meniscus,sprain of medial ligament....
O/E Knee flexion 70 degrees
Extension lag 30 degrees
pain at medial aspect of knee.
Patellar movements free
What ever i give either active movements of passive or mobilisation pain is always on the medial aspect.
Please suggest how can i proceed?at present i m giving her US to the painful area,SF to Quads,physiological mob.in flexion and extension..acive movements..and strenghening in available range
Is mobilistion esp.glides safe in meniscal injuries..????
Regards
Sana

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[Physiobase]

Has this personal already undergone any surgery? This will have some impact on the suggestions we might give

[sanagupta]

Hello!
Thanx for ur reply..
No, the personal had not undergone any surgery.She wants to improve by conservative means and her Orthopadician also feels she can recover.
At present her status have changed to Knee extension lag 20 degrees.
Regards
sana

[wernerspine]

Hi
You could apply Mulligan techniques, there is a technique avocated in his training.
Soft tissue massage to the mcl, possible some adhesions
Also, you could use some traction, to free up the adhesions.
Muscle stimulation to the quadriceps to facilitate contraction.

[sanagupta]

Hello!
thanx for ur suggestion..can u please elaborate a little on Mulligan concept for this.....
I'll try the other things u suggested
Regards
Sana

[Vigliano]

Hi sana,
mobilization is permitted even with a meniscal injury.
If you don't know the mulligan tecnique I'd suggest you to work hard on flex and ext of the knee(expecially on the ext because 90 degree in flex and 10 degree in ext are the minimum to keep on doing normal activities such as walking for example). Don't overstress the knee with fast and rude movement but act gently with decision because Pain could be caused by adhesions or inflamations.WOrk on the rotations with the knee bend at 70 degrees because knee,during the movement of flex-ext ,does a little rotation that you can help with.I hope to have been helpful.Don't hesitate to write me for everything: [email protected]
Bye

[sanagupta]

Hello !
Thanx for ur suggestion.I''ll try it .in her next visit.At present the status is 90 flexion and extension ia almost full with lots of force...But...she complains of pain in medial aspect of knee which she describes as 'Catching up .'and it raelly prevents her from going into the range..can meniscus be blamed for that..though orto feels that torn meniscus is not coming in the way..and stresses aggressive Physio..does not take into consideration the pain factor.
Regards
Sana

[alophysio]

Hi Sana,

A Mulligan technique for this problem would be to glide the tibia one way against a stabilised femur. The flex or extend the knee whilst maintaining this pressure.

You will know if it works.

You will also know whether to push medially or laterally buy trying both!

All the best!

[uy1]

Hi Sana

for the pain in the medial side u can use p.r.t

[positional release therapy]

ther are some good technik for medial miniscus m.c.l

good luck uy1

[dsahi]

Hello Sana ,
Be careful during the mobilization , knee should be exercised in an arc upto -170 degree or 10 degree short of extension .Full arc of extension should be avoided during exercising.

[sanagupta]

Hi!
Could u please explain me why terminal knee extension shd be avoided during exercising.
Regards
Sana

[hillfiend]

I would think 90 degrees flexion 6 months post injury will qualify the patient to be a surgical candidate. At least for an arthroscopy to ascertain the size of the meniscal tear if the restriction has not come from an impingement.

[Fisiotek]

Hi,
They patients is using (904nm) wavelength with 30 Wpk power Low Level Laser.
you`ll see the results in less time than the ultrasound or conventional treatment.
because first of all you have to diminish the pain before to move. remember that the body is proctenting himself from any other thing that may increase thi injury.

[alophysio]

Hi

What will the laser do and how will it help???

If there is a structural problem (i.e.meniscus in the way, fracture of the interspinous region, etc), will it be able to blast it out of the way?

If the pain has been there for >3/12, it is chronic and starts to go down the central sensitisation pathway.

To me, in my humble opinion, treating the cause, not the pain, is going to be the best option...it seems like a surgical problem - why is it taking so long to get them surgery since conventional physio does not seem to be helping (not because of the physio but because of the condition)

[physioo]

is laser going to hit the targeted area, when this area is approx 5 cm deep underneath the skin?

????

electro for meniscal injuries?? nahhh

strengthen
stabilize
retrain
recruit

[tomc90]

i really think this is a mechanical problem that needs an invasive proceedure too.

the name of physiotherapists is damaged when practitioners do not know the scope of their treatment and delay appropriate management because of self indulgent use of 'faith' based techniques. at least get a repeat opinion with a musculo-skeletal physician.

tomc90

[Latrobe2000]

Hello,
I totally agree that this patient needs to go have arthroscopic surgery to acertain the extent of the meniscal/pcl injury/joint injury.. No amount of physio is going to affect the meniscus/pcl if they are torn/detached. And pain will limit the strengthening this person will be able to do with physio. Ive had bilateral menisectomys/knee surgery and am a physio so I know how frustrating it can be...both for therapist and patient.The surgeon needs to sort out the anatomical stuff first. Treat the cause and then rehab this persons knee.

[whalewatcher]

Sana,
Have you sent this person off for surgery yet?? probly should have been done long before this. With an MRI report like you state, and minimal improvement over 9 months, he will likely need surgery.

Whalewatcher