SCS Knee
A 32-year old male was referred to your therapy department by a family practice
physician with a prescription to evaluate and treat including a diagnosis of left knee
pain. He had a traumatic onset secondary to a kiteboarding injury resulting in left knee
valgus and rotatory stresses while under leg compression. His chief complaint was left
knee instability with decreased strength and function. Additional complaints include low
back and left hip discomfort. He is an avid snowboarder, mountain biker and
kiteboarder. Past medical history includes a T11/12 compression fracture S/P MVA in
1995; Anaphylaxis shock from a bee sting in 1999; Left knee bone bruise and meniscus
tear (patient did not recall which meniscus) in 2003 as a result of a snowboarding crash.
He is currently taking Ibuprofen per M.D. instruction. Observation reveals no apparent
distress or gross gait deviations; no ecchymosis, discoloration, minimal lef -
ANS-Anterior cruciate ligament Grade II sprain, MCL Grade II sprain, medial meniscus
tear
Correct: The MOI of a valgus stress and rotational injury are consistent with the "Terrible
Triad." Additionally, the moderate quad atrophy, instabilty, and intrarticular swelling are
consistent with the triad.
A 32-year old male was referred to your therapy department by a family practice
physician with a prescription to evaluate and treat including a diagnosis of left knee
pain. He had a traumatic onset secondary to a kiteboarding injury resulting in left knee
valgus and rotatory stresses while under leg compression. His chief complaint was left
knee instability with decreased strength and function. Additional complaints include low
back and left hip discomfort. He is an avid snowboarder, mountain biker and
kiteboarder. Past medical history includes a T11/12 compression fracture S/P MVA in
1995; Anaphylaxis shock from a bee sting in 1999; Left knee bone bruise and meniscus
tear (patient did not recall which meniscus) in 2003 as a result of a snowboarding crash.
He is currently taking Ibuprofen per M.D. instruction. Observation reveals no apparent
distress or gross gait deviations; no ecchymosis, discoloration, minimal lef -
ANS-Recommend to primary care physician to refer to an orthopedic surgeon
When rehabilitating a patient with excessive lateral pressure syndrome of the patella,
open kinetic chain exercises should be performed in what range?
0-90 degrees of knee flexion
0-50 degrees of knee flexion
50-90 degrees of knee flexion
0-20 degrees of knee flexio - ANS-50-90 degrees of knee flexion
, Exercises in this range would lead to excessive compressive force through the patella.
If OKC exercises are indicated, exercising in 50-90 degrees of knee flexion would be
ideal. For more information, review your weekly readings, specifically Reinold
(2010)Links to an external site..
Based on the current understanding of patellar taping, which of the following is a valid
assumption?
An assessment of patellar position after exercise with taping is critical
A goal of taping is to improve the medial position of the patella
A goal of taping is to improve the amount of patellar tilt present
An assessment of the patellar tracking is not critical prior to taping - ANS-An
assessment of the patellar tracking is not critical prior to taping
Which of the following is not one of the key principles described by Reinhold in the
treatment of patellar dysfunctions?
Mobilization of the IT band
Restore volitional muscle control of the quadriceps
Emphasize quadriceps strengthening
Normalize gait mechanics - ANS-Mobilization of the IT band
Incorrect: Mobilization of the IT band is important for laterally tracking patella; however,
there are many more reasons why people get patellofemoral pain. Please review Mike
Reinold's e-book: Reinold (2010).
The subsequent 2 questions will be based on the following scenario:A 33 y/o male is
referred to your clinic for knee pain that started 2 weeks ago after an initial injury that
occurred during a soccer game. He reports a 'step and twist' mechanism. He was able
to walk off the field and his knee became swollen over the next couple of hours. With ice
and rest he is improving but still having pain when he walks prolonged distances and
has been unable to return to sports. He has mild effusion. His range of motion is as
follows: full extension but has increased pain with flexion at end range. Resisted
motions are mildly painful but strong, knee flexion is more painful than knee extension.
Functionally squatting is painful. His knee is tender to palpation, particularly along the
joint line and he also has pain with patella compression. Given the above scenario what
is the most likely diagnosis?
Patellofemoral pain syndrome - ANS-Medial meniscal tear
A 32-year old male was referred to your therapy department by a family practice
physician with a prescription to evaluate and treat including a diagnosis of left knee
pain. He had a traumatic onset secondary to a kiteboarding injury resulting in left knee
valgus and rotatory stresses while under leg compression. His chief complaint was left
knee instability with decreased strength and function. Additional complaints include low
back and left hip discomfort. He is an avid snowboarder, mountain biker and
kiteboarder. Past medical history includes a T11/12 compression fracture S/P MVA in
1995; Anaphylaxis shock from a bee sting in 1999; Left knee bone bruise and meniscus
tear (patient did not recall which meniscus) in 2003 as a result of a snowboarding crash.
He is currently taking Ibuprofen per M.D. instruction. Observation reveals no apparent
distress or gross gait deviations; no ecchymosis, discoloration, minimal lef -
ANS-Anterior cruciate ligament Grade II sprain, MCL Grade II sprain, medial meniscus
tear
Correct: The MOI of a valgus stress and rotational injury are consistent with the "Terrible
Triad." Additionally, the moderate quad atrophy, instabilty, and intrarticular swelling are
consistent with the triad.
A 32-year old male was referred to your therapy department by a family practice
physician with a prescription to evaluate and treat including a diagnosis of left knee
pain. He had a traumatic onset secondary to a kiteboarding injury resulting in left knee
valgus and rotatory stresses while under leg compression. His chief complaint was left
knee instability with decreased strength and function. Additional complaints include low
back and left hip discomfort. He is an avid snowboarder, mountain biker and
kiteboarder. Past medical history includes a T11/12 compression fracture S/P MVA in
1995; Anaphylaxis shock from a bee sting in 1999; Left knee bone bruise and meniscus
tear (patient did not recall which meniscus) in 2003 as a result of a snowboarding crash.
He is currently taking Ibuprofen per M.D. instruction. Observation reveals no apparent
distress or gross gait deviations; no ecchymosis, discoloration, minimal lef -
ANS-Recommend to primary care physician to refer to an orthopedic surgeon
When rehabilitating a patient with excessive lateral pressure syndrome of the patella,
open kinetic chain exercises should be performed in what range?
0-90 degrees of knee flexion
0-50 degrees of knee flexion
50-90 degrees of knee flexion
0-20 degrees of knee flexio - ANS-50-90 degrees of knee flexion
, Exercises in this range would lead to excessive compressive force through the patella.
If OKC exercises are indicated, exercising in 50-90 degrees of knee flexion would be
ideal. For more information, review your weekly readings, specifically Reinold
(2010)Links to an external site..
Based on the current understanding of patellar taping, which of the following is a valid
assumption?
An assessment of patellar position after exercise with taping is critical
A goal of taping is to improve the medial position of the patella
A goal of taping is to improve the amount of patellar tilt present
An assessment of the patellar tracking is not critical prior to taping - ANS-An
assessment of the patellar tracking is not critical prior to taping
Which of the following is not one of the key principles described by Reinhold in the
treatment of patellar dysfunctions?
Mobilization of the IT band
Restore volitional muscle control of the quadriceps
Emphasize quadriceps strengthening
Normalize gait mechanics - ANS-Mobilization of the IT band
Incorrect: Mobilization of the IT band is important for laterally tracking patella; however,
there are many more reasons why people get patellofemoral pain. Please review Mike
Reinold's e-book: Reinold (2010).
The subsequent 2 questions will be based on the following scenario:A 33 y/o male is
referred to your clinic for knee pain that started 2 weeks ago after an initial injury that
occurred during a soccer game. He reports a 'step and twist' mechanism. He was able
to walk off the field and his knee became swollen over the next couple of hours. With ice
and rest he is improving but still having pain when he walks prolonged distances and
has been unable to return to sports. He has mild effusion. His range of motion is as
follows: full extension but has increased pain with flexion at end range. Resisted
motions are mildly painful but strong, knee flexion is more painful than knee extension.
Functionally squatting is painful. His knee is tender to palpation, particularly along the
joint line and he also has pain with patella compression. Given the above scenario what
is the most likely diagnosis?
Patellofemoral pain syndrome - ANS-Medial meniscal tear
