General Information

Patient’s name: BM
Age: 21 y/o (1)
Sex: Female (Miller and Thompson, 4th edition, p. 349)
Address: 146 Brgy. Somewhere in antipolo
Civil status: Single
Handedness: Right
Occupation: Marathon Runner (Fulkerson, 4th edition, p. 154)
Referring unit: Orthopedic Department
Referring MD: Dr. N.P
Date of Consultation: September 21, 2016
Date of Referral: September 24, 2016
Date of IE: September 25, 2016
MDDx: Left and Right Patellofemoral Pain Syndrome
History of Present Illness
Patient’s condition started 6 weeks prior to Physical Therapy IE (2). BM, a 21 y/o
marathon runner, started preparing last August 11, 2016 for her first local marathon
competition. Being a novice on the training drills, BM does not follow strictly the
plan schedule exercises as part of the training program. On the first two weeks,
patient mentioned of skipping 10 minute warm up brisk walking exercises and
immediately proceeds to moderate intensity running for about 20 miles per week on
a flat surface. On the third week, due to the patient’s attitude of winning, BM
decided to add one day of running on her 5 day regular routine and save one day
for rest. Concurrent to this, patient also mentioned of increasing her running
intensity and distance from 20 miles to 50 miles weekly and move from flat surface
to hilly areas (3)(4). Initially, BM started having pain graded 5/10 on the anterior
aspect of both knees following these routine changes. BM ignore the discomfort and
just take Panadol whenever pain occurs. On the sixth week, while on her third mile
of running, BM was force to stop because of an intense anterior knee pain she felt
and decided to discontinue the training plan temporarily to seek medical assistance
(5).
Patient described pain as dull, aching type with a grade of 7/10 and reported
an increase in pain on arising after sitting for 4 to 6 hours of having movie marathon
during her rest day. Patient also had difficulty ambulating especially when
descending stairs due to pain. Patient then went to see a doctor and was asked to
undergo radiography (see ancillary procedures). After physician examination,
patient is now referred to physical therapy rehabilitation for management.
*REF HPI
Anterior Knee Pain: Papadakis (CMDT), 55th edition, p. 1693
Bilateral Knees: Colyar, 1st edition, p. 2228
Dull, aching pain: Anderson (Fundamentals of sports injury management), 2 nd edition, p. 208
Radiography: Biedert (Patellofemoral disorders: Dx and Treatment), 1st edition, p. 13
Pain on arising after sitting, descending stairs, ambulation: Magee, 5 th edition, p. 798

Past Medical History
(+) Appendectomy, 1999
(-) HTN
(-) DM

Patient's older brother drives her to the training ground. Patient does not use illegal drugs. 5 day (Tuesday to Saturday) regular running routine with 2 day (Sunday and Monday) rest.  Using door as a reference: Living area: 4m Kitchen: 8m Dining area: 7m Comfort room: 8m Bed room: 9m Theatre area: 6m Work  Patient’s training ground has a flat surface and a hilly. 100% of rehabilitation expenses will be paid from patients's personal savings.  All rooms are well lit with marble floors. Ancillary Procedure/Laboratory Procedure . uneven terrain  Patient uses low arch shoe support when training Ref: Mode of transportation  Patient travels 20 minutes from her house training ground. Patient is currently on her 16-week training course. Patient is non-smoker and non-alcoholic. Patient spends 4-6 hours watching movies in sitting. Home Situation Patient lives with her parents and older brother. Patient likes to do movie marathon during rest days from training. Patient does minimal household chores when needed because her family has a house helper. Environmental Assessment Home  Patient lives in a 1-story house.(-) Cancer (-) Asthma (-) Arthritis Family Medical History Disease HTN DM Asthma CA      Paternal + - Maternal + - Personal Social History Patient is a novice marathon runner. Patient has a balance and healthy diet.

Pt. c/o localized dull.’s goal “I need to return to my training as soon as possible. 5th edition.Procedure Date Result Radiography on the L Knee September 22. 2016 (+) Patellar maltracking (-) joint demineralization (-) joint space narrowing Ref: Manske (Postsurgical Orthopedic Sports Rehabilitation: Knee & Shoulder). 164 HR: 68 bpm (Goodman. 2016 (+) 5mm Lateral Patellar Displacement (-) joint demineralization (-) joint space narrowing Radiography on the R Knee September 22. aching pain on the anterior aspect of both knees graded 7/10 making it difficult to ambulate and perform her running training routine. p.7°C (Goodman. 170) .” O: VS: BP: 110/70 mmHg Goodman. p. 5th edition. 5th edition. 424 Medications taken Meds Panadol Multivitamins Route Orally taken Orally taken Dosage 500mg. prn 500mg. 1st edition. 163) Temp: 36. p. 161) RR:15 cpm (Goodman. 5th edition. p. p. 1x/day Indications Pain reliever Supplements Reference S: Chief complaint: Pt.

Findings: All VS are normal Significance: For baseline purposes OI: Patient arrived at the rehab center without any AD and independently walking. Patient is alert. p. 1st edition. 38) Swelling: France (Introduction to Sports Medicine and Athletic Training). Mesomorph Skin conditions: (+) Trendelenburg (+) Hyperpronation of foot (?) (-) swelling (-) wound (-) scar Ref: Trendelenburg (West and Colvin. p. 375 Palpation: Normothermic on exposed areas of the body (+) Grade 1 Tenderness (-) Edema Ref: Tenderness: Frontera. coherent and cooperative. Rizzo. 385 ROM All major joints of the UE/LE and spine assessed using goniometer are within normal limits actively and passively done except: Motion L Knee Flexion L Knee Extension L Hip ER L Hip abduction R Knee Flexion R Knee Extension R Hip Abduction R Hip ER Ref: AROM 0-100° 0-5° PROM 0-105° 0-6° Normal 0-135° 0-10° Dif 0-35°/0-30° 0-5°/0-4° Endfeel Empty Empty 0-38° 0-35° 0-42° 0-40° 0-45° 0-45° 7°/3° 0-10°/0-5° Firm Firm 0-100° 0-5° 0-105° 0-7° 0-135° 0-10° 0-35°/0-30° 0-5°/0-3° Empty Empty 0-40° 0-42° 0-45° 0-5°/0-3° Firm 0-41° 0-43° 0-45° 0-4°/0-2° Firm . 3rd edition. Silver. p. 2nd edition.

Modalities can be safely use. p. Norkin. has difficulty ambulating d/t limitation of motions on the knee and hip 2° to pain MMT All muscles of UE/LE and spine are graded 5/5 except: Muscle (L) Grad e 2/5 3/5 2/5 3/5 Muscle (L) Grad e 2/5 3/5 4/5 4/5 Daniels and Worthingtham’s. Rho. 122 Findings: There is a significant weakness on the L and R quads muscle as compared to hamstring and hip muscles. 243 L Hamstring (Hams) L Gluteus medius (6) Daniels and Worthingtham’s. 249 (Quads) L Quadriceps Daniels and Worthingtham’s. p. 9th edition. reports retropatellar pain and cannot hold contraction of the quadriceps muscle . 798 (+) Patellofemoral dysfunction Findings: Pt. Ref: Special Tests  Patellar grind test Magee. 235 (ExtRot) L L L L Quadriceps Hamstring Gluteus medius (6) Hip ER (6) Ref: Casey. edition. 9th edition. edition. 205 211 244 249 (Hip Abd) (Hip ER) (Knee Flexion) (Knee Ext) Findings: Pt. p.Norkin. Norkin. 4th 4th 4th 4th edition. p. p. has decreased range of motion on bilat hip and knee Significance: Pt. Med) Daniels and Worthingtham’s. edition. LE and Spine are intact Findings: No sensory deficit Significance: There is no nerve afectation and sensation is intact. p. 9th edition. cannot tolerate applied resistance thus limiting her ambulation Sensory testing: All sensations of the UE. 1st edition. Significance: Pt. p. 5th edition. 223 L Hip ER (6) (G. Norkin. p. p. 9th edition. p. Press.

p. Rehabilitation Potential Pt. Also half of the expenses of PT management will be handled by the company she is working with. Significance: Pt. has good rehab potential because she is very willing to undergo PT rehab and her family is supporting her with ADLs that she couldn’t do by herself. Physical therapy Impression Prognosis Pt. Pt. . physically and financially stable with no other co-morbidities present.'s condition and cause of pain is due to patellofemoral joint dysfunction  Mital Hayden Test Magee. has moderate difficulty in ambulation and in tolerating prolonged sitting due to pain upon standing. weakness of knee ext. pt.Significance: Pt. ocasionally requires minimal assistance in ascending and descending stairs. 795 (-) Mediopatellar Plica Syndrome Findings: No clicking or pain elicited upon pinching the edge of the plica Significance: To rule out plica syndrome Gait Assessment**** Reference leg: (Trendelenburg) Phase Hip Knee Ankle ADL Assessment Findings: Pt. Pt is consistent on going to her therapy sessions and is cooperative in all treatment sessions emotionally. 5th edition. has a good prognosis in terms of returning to normal function.’s condition afects her ADLs mostly during ambulation due to pain A: Physical Therapy Diagnosis: Patient's MDDx of Patellofemoral Pain Syndrome on bilat knees further defined by difficulty running. tightness of knee flexor muscles and LOM of the joint present on bilateral knees. ascending and descending stairs and tolerance to prolonged sitting 2˚ to pain. presents with no red flags. able to do tasks not involving the knees by herself and shows muscle weakness mostly in knee extensors only.

5. will be able to perform ADLs. return to training course and decrease pain from grade 7/10 to 1/10 from after ~ 2 months of PT session Problem list 1. Pain of the anterior aspect of bilat knees Weakness of hips and knees during ambulation LOM of the joints of bilat knees 2° to pain Tightness of the vastus medialis obliquus muscle Decreased ADL performance due to pain Short Term Goal 1. 1. . has good rehab potential in terms of her willingness attitude and compliance to undergo PT rehab and has a strong family support physically with stable financial assistance. 2. Long Term Goal Pt. 3. Sources: Patient Education: Proper joint positioning Energy conservation techniques Wear of brace support prn such as when walking for long distances Avoid strenous LE activities continuously without adequate rest ~2days Wearing of proper fitting shoes for running such as putting of orthotics Home Exercise Program: . 4.Pt. Pt. 2. P: Patient will be seen and treated 4x a week for 6 weeks. 3.

nih.ncbi. http://www.com/symptomsconditionsdetail.nlm.nih. http://www.nih.nih.ncbi.gov/pubmed/3578639 3.**https://books.researchgate. http://www.ncbi. http://www.gov/pubmed/17549951 . http://www.gov/pubmed/? term=Taunton+JE+a+retrospective+case+control 6.ncbi.nlm.gov/pmc/articles/PMC3625796/ REFERENCES: 1.net/publication/264434530_Efectiveness_of_Exercise_T herapy_in_Treatment_of_Patients_With_Patellofemoral_Pain_Syndrome_A_Systematic _Review_and_Meta-Analysis 2.moveforwardpt.nlm.ph/books? id=ZSkODAAAQBAJ&pg=PA122&dq=q+angle+in+pfps&hl=en&sa=X&ved=0ahUKE wiu-Yu-roTPAhVKFZQKHfIeD08Q6AEIJzAC#v=onepage&q=q%20angle%20in %20pfps&f=false **http://www.gov/pmc/articles/PMC3497945/ 5.com.nlm.ncbi.https://www.aspx?cid=f6dfe5972f7d-4f1e-9af-67694dca085f 4.nlm.google.nih.