Al-Najah National University

Faculty of Medicine and Health Sciences

Physiotherapy Department
Second Semester 2020

Assessment ( 1 )
Diagnosis: LT knee osteoarthritis

Done by : Manar Thameen Ahmad

Student Number : 11714690
Supervisor: Haneen Dhaidel

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 Personal Information:

Name : L/J Age: 50

Gender: F Occupation: Housewife

Marital Status: Married Address: Tulkarem

First Admission: 1/2/2020 Date of Assessment: 19/2/2020

Source of information: Patient herself

Assessment of Subjective Examination:

 Chief complaint:
.LT lateral knee pain and sometimes inside the LT knee joint since 2 months
 Medical diagnosis:
.LT knee osteoarthritis

 Present history:

L/J , 50 y/o female suffers from pain on the lateral aspect of her LT knee joint
and sometimes inside the joint since 2 months. She was diagnosed by an
orthopedist last month with LT knee osteoarthritis. He advised her to take
.physiotherapy sessions rather than medications as soon as possible

 Past history:
She suffered from frequent faints along with severe headaches due to irregulation
of heart beats which led to several injuries, RT wrist fracture, face laceration 17 years
ago and LT ankle fracture 2 years ago. She underwent a surgery for arrhythmia 5
years ago in Jordan and currently her heart status is stable. She suffers from insomnia
since 2 years. She reported that she isn’t able to sleep without hypnotic drug.
.Otherwise, she doesn't suffer from any chronic illnesses

 Family history:

Her eldest son died in an open heart surgery when he was 17. However, no other
.members of her family suffered from cardiac issues or other significant illnesses

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 Drug history:
.Hypnotic drug, one pill every night since 2 years until now

 Social history:

She is married and a mother of 3 girls and 2 boys. Both of the boys are
married and they live close to her. 2 of the girls are married and one is a 2nd
year university student. Her youngest daughter and her daughter-in-law do most
of the chores. She has a garden around her house that she takes care of herself.

 Systems review:
 Integumentary system : Intact
 Cardiovascular system : Stable post surgically.
 Respiratory system : Intact
 Digestive system : Intact
 Nervous system: Intact
 Urinary system : Intact

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  Pain Assessment:

1. Location of pain

2. Severity :

At rest
After long standing
and frequent squatting

3. Quality: Dull pain.

4. Onset/ Frequency /Duration: Gradual onset since 2 months. Pain is intermittent

and lasts for few minutes.

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5. Sitting : No direct traumatic incidents in LT knee joint or related soft tissues.

6. Aggravating Factors: Long standing, squatting, walking up stairs or uphill

and gardening.

7. Relieving Factors: Rest.

8. Associated Symptoms : No relevant associated symptoms along with pain.

Objective examination:

 Observation:

- General observation :
Patient is alert and oriented. She walks comfortably and doesn’t use any
walking aids or wears any orthotic devices. Her overall health seems well.
.She is overweight

- Specific observation :
Right Left Difference
5 cm cephalic from mid-patella 48.7cm 49cm 0.3cm
Mid-patella 44.7cm 46cm 1.3cm
5cm caudally from mid-patella 41.2 41.8cm 0.6cm
5cm caudally from previous 41.5cm 42.8cm 1.3cm
point
5cm caudally from previous 43.6cm 44cm 0.4cm
point
Foot girth ( 8 figure) 56.5cm 59cm 2.5cm
Normal color, temperature and texture of skin. No signs of scar tissue.
Swelling around LT knee joint and LT ankle.

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  Sensory Assessment :

Left Right Sensation

: Superficial
1. Pain
2 2
2. Temperature
3. Light touch
4. Pressure
:Deep
___ ___ 1. Movement sense
2. Position sense
: Combined
1. Two point
discrimination
___ ___ 2. Vibration
3. Stereognosis
4. Barognosis
5. Graphesthesia

Key grading: 2-normal , 1-impaired, 0-absent

Right Left

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Joint Action ARO PRO End Muscle ARO PRO End feel Muscle Norma
M M feel strengt M M strengt l range
h h
Knee Flexion 120º 130º Norma 5 120º 130º Empty 4 120º
l soft

Knee Extension 120-0º 0º Norma 5 120-0º 0º Empty 4 120-0º

l hard

Ankl Dorsiflexion 20º 30º Norma 5 15º 20º Abnorma +4 20º

e l l soft

Ankl Plantarflexio 50º 55º Norma 5 50º 55º Normal +4 50º

e n l

Ankl Inversion 35º 38º Norma 5 30º 36º Abnorma 4 35º

e l l firm

Ankl Eversion 15º 18º Norma 5 15º 18º Normal 4 15º

e l
 Range Of Motion & MMT:-

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 Reflexes

Score
Level RT LT
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 Deep Tendon Patellar(L2-L4) 2+ 2+
Reflexes Achilles(L5-S3) 2+ 2+
Key grading: 0 = no response ,1+ = a slight , 2+ = (normal), 3+ = a very brisk , 4+ = (clonus)
abnormal

 Posture:

Anterior view Posterior view Lateral view

Slight lateral head Slight lateral head Slight forward Head
bending to RT bending to RT head
On level On level Normal Shoulders
Normal Scapulae
- -
- Normal Slightly decreased Thoracic
curvature spine
- Normal Slightly increased Lumbar
curvature spine
- Slight anterior tilt Normal Pelvis
Slightly laterally Hip
rotated - -
Slight valgus in LT Slight valgus in LT Normal Knee
Mild supination and Mild supination and Mild supination in Ankle
slight eversion in LT slight eversion in LT LT

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 Gait Assessment:

Findings
Phase Right Left

Ankle supinates and tibia

Stance Phase Normal pattern slightly externally rotates.

Swing phase Normal pattern Normal pattern

 Functional Status:
 Used outcome measure: Lower Extremity Functional Scale (LEFS)
 Final Score: 61/80
 Conclusion: Good functional level, independent.

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61/80

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  List of problems:
- LT lateral dull pain at end range of LT knee flexion.
- LT lateral dull pain at end range of LT knee extension.
- Swelling around LT knee joint.
- Swelling around LT ankle joint.
- Decreased LT ankle dorsiflexion due to swelling in the LT ankle joint ( -5º).
- Decreased LT ankle inversion due to postural abnormality in the LT ankle (-5º).
- LT knee flexors and extensors muscles weakness.
- LT ankle dorsiflexors, plantarflexors, evertors and invertors muscles weakness.
- Mild postural abnormalities:
 Slight forward head and lateral head bending to the RT.
Slightly decreased thoracic curvature.
 Slightly increases lumbar curvature.
 Slight anterior pelvis tilt.
 Slight LT hip lateral rotation.
 Slight valgus in LT knee.
 Mild supination and eversion in LT ankle.
- Ankle supinates and tibia slightly externally rotates in the stance phase of gait
in the LT ankle and tibia.
- Mild disruption in functional performance.

 Short Term Goals:

- To decrease LT knee pain.
- To reduce swelling around the LT knee joint.
- To reduce the swelling around the LT ankle joint.
- To increase LT ankle dorsiflexion and inversion ROM.
- To strengthen muscles around the LT knee joint.
- To strengthen the muscles around the LT ankle joint.
- To maintain RT lower extremity strength and prevent it from overload
consequences.
- To enhance posture.
- To enhance gait pattern.
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 Long Term Goals:
- To relief pain as much as possible.
- To gain maximum ROM of LT ankle joint.
- To gain maximum strength of muscles around the LT knee joint.
- To gain maximum strength of muscles around the LT ankle joint.
- To prevent RT lower extremity from fatigue or other overload consequences.
- To gain normal postural appearance.
- To regain normal gait pattern.
- To enhance overall functional status and well-being.

 Treatment Plan

Modality Goals Parameters,Intensity, Frequency

Duration
- Decrease pain. - 15 minutes.
Cold pack - Reduce swelling.

- 1 channel( between medial Every session.

Electrical - Decrease pain. and lateral aspects of LT
stimulation - Prevent muscle atrophy. knee) 1sec/2sec/1sec/4sec ,
21.3m.A, 23 min.

.Every session
Shockwave - Decrease pain. .beats 2000
- Prevent muscle
atrophy.

- To increase ROM.
Exercise - To increase muscle 20 repetitions each exercise Every session and at
strength. for both RT and LT lower home; once in the
- To reduce swelling extremities. morning and once at
- To prevent muscle night.
atrophy.

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