Study Guide Questions: 10.

The questions for this week will focus on a case study that will require students to
formulate a series of questions in the history and complete the table below with details to
assist you with your diagnosis for this patient, similar to Table 12-15 from Magee D,
Orthopedic Physical Assessment, 6th Edition (2014), page 876- 877 provided as an
exemplar for this activity and create a management plan for this patient.

Using the precis of knee assessment as shown below create your own differential
diagnosis and management plan for an 18-year-old female swimmer who presents to
you with medial knee pain. She has just increased her training to 10,000m per day.
Describe your assessment plan for this patient (medial collateral ligament sprain verses
chondromalacia patellae)
Differential Diagnosis Medial Collateral Ligament Sprain Verses Chondromalacia
Patella Syndrome
Medial Collateral Ligament
Sprain
History Questions Was there any trauma and
where was the trauma?
Was the trauma to the side of
your knee (valgus force)
Was there any clicking or
popping when the injury
occurred?
Observations Swelling
Active Movements Difficulty and restriction to
extending fully.
Passive Restriction/pain on extension
Movements
Chondromalacia Patellae
Syndrome
Any repetitive movements
do you do?
Does the knee stay in the
same place for a long
time?
If so, does it ache?
Painful after sitting for a
long time then trying to
walk?
Does your knee lock or
catch?
Does swelling develop in
the knee?
Swelling, is the patella
sitting in the middle?
Full ext difficulty
Restriction of the
movement of the knee at
full extension and flex of
the knee.
As above
Resisted Isometric Weak Weak tracking issue with
Movements quadriceps
Special Tests Apleys grid test, MacMurray’s, Squat test, patella grid
Valgus stress Test, McConnel’s test, stroke test, step test,
test VMO, Connel test
Sensation Possibly diminished over area of NA
injury
Reflexes
Joint Play Painful medial – lateral and Restricted and painful
Movements lateral – medial movement of patella.

Diagnostic x-ray, ultrasound, MRI CT arthrography

Imaging

Management Plan:

If not associated with an injury management of the issue. STT, soft traction and activator.
If associated to an injury, manage/self-manage use of REST, anti-inflammatory medication/creams for STT.