Knee Case Study 2 : Arthritis Of Knee

Anatomy & Pathology

Vastus lateralis + lateral patellar femoral ligament give lateral support to knee.
Vastus Medialis + medial patellar femoral ligament give medial support to knee.

The patella glides in trochlear groove – the quads attach to the superior patella tendon
– the inferior patellar tendon attaches to the tibial tuberosity.

Danger is imbalance => lateral movement of patella is most common from relative
hypertrophy of lateral muscles and or laxity of lateral ligaments.

OA can be cause by trauma/genetic or “wear and tear”. Cartridge lines where bone
meets joint and acts as a cushion on articular surface – can become rough, fissured
and even shred – these parts can float – oseophytes make matters worse. OA affects
weight-bearing joints such as the knee.

Subjective Examination
Where\What: anterior knee – expected in p.f.s – p.f.s is also known as anterior knee
pain – in O.A. expect restricted movement, stiffness, swelling – ask has there been
creaking?

When: 9 months

How: nothing goes to gym

0-10 rating: degeneration

24-hour cycle: ask

Better for: ask

Worse for: stairs kneeling – for p.f.s ask if it is painful from prolonged sitting – in the
case of OA expect acute pain – pain on climbing stairs and stiffness from too much
rest?

Type of pain: ask

Past Medical History/ General History: family history of OA?

Red Flags and general concerns: no weight loss?

SH: stairs in house?

DH: N.A.

Patient’s main outcome: ask

Objective Examination

Working Hypothesis: OA with patella femoral syndrome (anterior knee

pain)

Advice & Consent: give and obtain

General Observations: how do they walk – do they avoid knee flexion

Acute Observations:
Skin colour – N.A.
Swelling – some?
Posture- knock-knee problem?
Muscle bulk – vastus medialis weak?
Deformity – lateral patella?

Active Tests:
Flexion – prone
Extension – sitting on bed
Medial – feet on floor
Flexion – OA shows sign of restricted movement – (p.f.s & o.a.) – pain in flexion
Extension – watch for lateral movement of patella
Medial & lateral rotation

Passive Tests: movements as in active. But feel for the characteristic grating
noise ( PFS & or OA) – any restriction through stiffness or swelling (O.A.)

Resisted Tests: movements as in active. But observe for any muscle

imbalance between medial and lateral quads.

Special Tests: Fairbanks test – knee at 30 degrees glide laterally – excessive

movement if p.f.s
Patella tap test – patella bounce if swelling (O.A)

Functional Tests:
Walk - sign of medial wastage (p.f.s) = pronation excessive & knock-knee? – How do they
walk – do they find it difficult to climb stairs pain? (O.A.)

Palpation: heat -> indicates inflammation (use back of hand) feel for muscle
atrophy

Measurements: measure restricted movement in active flexion (for O.A.)

measure quads – 5cm above patella – 15cm above patella

Advice & Possible Treatment:

O.A – chronic pain and loss of knee function, walking may produce significant
discomfort -> weight gain / activity declines
Management – NSAIDS – ice for swelling – heat for aching, stiffness

P.F.S – strengthening exercise to reduce p.f.s – improve quad strengthening and quad
and hamstring flexibility