Case Summary

Patient Name: CG Intern Name: Kristen

New Patient Case Write Up Supervisor Comments

This section must be completed and presented to
the clinical supervisor within seven days of the
completion of the examination 

1.Pertinent History (chief complaint, history,

past medical history, psychosocial, and family
history)

 24-year-old female patient presents with

right anterior medial knee pain.
 Insidious onset, no injury, slow
progression in severity over two years
 Quick and sharp pain when ascending
from deep squat or when lunging deeply
with right leg forward and then knee has
a general ache for a couple of hours
afterwards
 3.4 pain on a bad day which occurs
roughly once a month, no pain on a good
day
 mild pain/ difficulty on squatting,
jumping, twisting/pivoting on the injured
knee and kneeling
 no swelling, no asymmetries or weakness
or stiffness
 no family History
 No other associated symptoms
 yoga helps

2. Differential Diagnosis
Patellofemoral pain syndrome (PFPS)
Patella Tendinitis
Meniscus Tear

3. Pertinent Physical Examination

Full AROM and PROM
Weak VMO, tight ITB and T
Gait - foot pronation, weak hip abductors and
external rotators
Pain aggravated by flexion under load
Crepitation during knee flexion and extension
was palpable
Squat test - crepitus on decline
Anterior and Posterior Draw Test - negative
Waldron's Test -> + with crepitus initially and
went away but came back after six squats
Thessaly - negative, not a meniscus problem
Stroke Test - negative, no joint effusion
McMurry Test -> Negative
Clark Sign/ Patella Grind Test - able to hold
contraction but pain in the patellofemoral joint
McConnell Test - positive, knee felt more stable
and pain was reduced by the medial patella
glide

4. Diagnosis
Chronic patellofemoral Pain syndrome causing
abnormal Patellofemoral kinematics,
crepitation and pain in the right knee

5. Treatment plan including Interventions

PFP Management Plan

Treatment Rehabilitation Progression PROMs and

Home Advice
Weeks 0-2 For Chronic Targeted Hip As strength of Stretching/
treatment of exercises: hip adductors, rolling out the
the knee 2 Standing internal and hip abductors
sessions a exercises external such as tensor
week for six *use a cable rotators fasciae latae,
weeks plus at column to increase slowly iliotibial band
home provide external increase and gluteal
stretching will resistance to the resistance. muscles
likely help hip abductors
patients and hip internal
improve their and external
PROMs a rotation
benefit. musculature.
Combined
interventions Quadriceps
consisting of (particularly
adjunctive vastus medialis
interventions, oblique) should
such as ART, be targeted to
dry needling, strengthen.
tissue scaping,
foot orthoses,
manual
 therapy, or
patellar taping,
with exercise
therapy

Weeks 2-4 Mobilise foot Targeted Knee Show patients Incorporate

and ankle in exercises: the intended core stability or
the sagittal Non–weight- exercises and trunk
plane and bearing make sure they strengthening
minimise any exercises can do them exercises and
dorsiflexion included properly focus on
restriction in isometric engaging core
order to limit quadriceps during exercises
compensatory exercises and such as
pronation and knee extension squatting and
internal tibial exercises running.
rotation, and
subtalar joint
to optimise
shock
absorption.
Weeks 4-6 Knee weight- Slowly add Incorporate
bearing weight to the further lower
exercises increase limb stretching,
included step- resistance particularly the
downs, the SLS hamstring and
and double-leg calf in order to
squats, and optimise knee
forward lunges. and ankle
biomechanics.

6. Prognosis including barriers to recovery

As the patient is a young, healthy individual who is

already exercising regularly but finding her chronic
knee pain tiresome and wanting it solved, I do not
have any concerns that they might not comply with
treatment plan and therefore think it is a good
prognosis.
7. Outcome Measures

Will be using Knee injury and Osteoarthritis

Outcome Score (KOOS) to assess knee pain, ADL’s
function and knee related quality of life. The KOOS is
a patient reported joint-specific score. This can be
useful for assessing changes in knee pathology over
time, with or without treatment.
8. Further Investigation (if relevant)
If initial treatment isn’t successful look
 into getting an x-ray of the knee is a
sunrise view to look at the height of
patella on the condyles and the patella
tendon

Possible chondromalacia patella consider

biopsy to properly diagnosis with mild
degeneration of the patella and femoral
condyles complicated by weak VMO and
tight ITB and TFL

Possible scoliosis complication and may

need to look a posture and spine further

9. Suggested References and further

reading

Willy R, Hoglund L, Barton C, Bolgla L, Scalzitti D,

Logerstedt D, Lynch A, Synder-Mackler L & Mcdonough C.
Patellofemoral Pain: Clinical Practice Guidelines Linked to
the International Classification of Functioning, Disability
and Health From the Academy of Orthopaedic Physical
Therapy of the American Physical Therapy Association. J
Orthop Sports Phys Ther [Internet]. 2019 September
[cited 2021 April 6]; 49(9): 34-44. Available from:
https://www.jospt.org/doi/pdf/10.2519/jospt.2019.0302

Barton C, Lack, S, Hemmings S, Tufail S & Morrissey D. The

‘Best Practice Guide to Conservative Management of
Patellofemoral Pain’: incorporating level 1 evidence with
expert clinical reasoning. British Journal of Sports
Medicine [Internet]: 2015 September [cited 2021 April 6;
49(14): 23-34. Available from:
https://bjsm.bmj.com/content/49/14/923

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