Acute Knee Sprain Assessment - Research Paper Example

? Acute Knee Sprain Assessment 26-01-12 Acute Knee Sprain Assessment Pathophysiology: Being the largest joint in the body, the knee is extremely susceptible in certain individuals to injury from trauma, arthritis and degenerative changes. Being a hinge joint, the knee has a joint line that exists between the femoral condyles and the tibial plateaus. The lateral and medial miniscal cartilage is cushioned between the boney surfaces of femoral condyles and tibial plateaus. The miniscal cartilage has tremendous tensile strength and during weight bearing it functions as a shock absorber. Anterior to the joint line is a large sesamoid bone which is known as patella. The lateral collateral ligaments and the medial collateral ligaments stabilize the knee and provide protection from knee dislocation during stress compression. The anterior movement of the tibia is limited by the anterior cruciate ligament. The Bursae of the knees are sac like structures which have a synovial linning and are located between the skin and the bony prominences. Friction occurs when knee muscles and tendons slide over adjacent bony structures during movement. The function of the Bursae is to reduce the friction between the muscles and tendons. Knee pain precipitates due to a number of reasons but the most frequent reason is a tear of anterior curciate ligament. The determination of peri articular inflammation provides a way for differential diagnosis of acute knee sprain because of a ligamentous injury. (McPhee et al 2001). There are a wide variety of knee injuries and the ones associated with gross ligament damage are easy to diagnose. The commonly encountered mild knee sprain in most cases many indicate an underlying serious knee injury which is quite hard to diagnose with physical examination and ligamentous tests such as Lachman test and Anterior Drawer test. (The Journal of orthopaedic and sports physical therapy, Vol 60). Epidemiology: In the United States of American, one of the most reasons for consulting primary health care practitioners is knee complaints. The Acute Crucaite Ligament tear is the most frequent miniscal injury with an acute injury of the ACL. The study of 100 consecutive patients with recent acute ACL injury revealed a high percentage of medial collateral ligament injuries, 35% of lateral miniscal lesions, 12% medial miniscal lesions and 11% biocompartmental meniscal lesions. (European Society of Sports Traumatology 1993). In accordance with another study published in the Scandinavian Journal of Medicine and Sciences in Sports, it was revealed that 6% of all the acute injuries treated in the emergency unit are knee injuries of which 27% - 48% were related to compression stress from sports. (Scandinavian journal of medicine). Background: Jackson, aged 42, is a graduate from Ohio State University and is currently working in the accounts department in Walmart, San Diego. Last week at work, Jackson slipped off from the stairs on his way down to the cafeteria and injured his right knee and lower back. Jackson was first received by the Dr. Frederick Croft three days ago in the emergency unit, where he explained that his knee injury has rendered him totally unable to work since the last five days. The nurse questioned Jackson and recorded his statements regarding duration and rapidity of symptom onset. (Ethel BURNETT). Symptoms: Jackson has mild swelling on his right knee and he complains of experiencing slight “locking” and “catching” during walking. Jackson had a broad based gait and slightly favored his right leg more than his left. Due to intense pain, Jackson failed to assume even a partial squat. The patella is also tender and the right knee muscles are strained. Jackson experiences grating sensation in his knee and complains of back pain because the fall has also affected his spinal cord. (The Journal of orthopaedic and sports physical therapy, Vol 60). Physical Examination: Dr. Croft performed a Lachman test and noted the pain intensity at full extension and 60 degrees flexion of the right knee. Other tests of examining the anterior cruciate ligaments can also be performed such as the anterior drawer test and the pivot shift test. Expected Physical Examination Findings: The symptoms clearly indicate that Jackson is suffering from acute knee sprain. The lachman test would reveal excessive anterior translation of the tibia as compared to the other side. On the other hand, the pivot shift test would indicate a positive ligamentous laxity and simultaneously the anterior drawer test would also reveal a positive ligamentous laxity. The lateral meniscus tear is most likely to be revealed in arthroscopical assessment. The most frequent meniscal injury in acute injuries of anterior cruciate ligament is the lateral meniscus tear. (Ethel BURNETT). MRI Scans: Dr.Croft did not suspect a fracture on physical examination so he did not perform a plain radiography on Jackson’s right knee. Instead of plain radiography, a subacute MRI was performed. MRI scans of the lower back were performed which indicated first degree spondylolisthesis of the lumber spine. Therefore, the pain in the lower back was of little significance as there was only a slight forward displacement of L5 over S1 and there was no indication of a significant spinal stenosis. (Ethel BURNETT). Abnormal Findings: Physical examination did not reveal any signs and symptoms of fracture, however, subacute MRI revealed a fracture. The fracture is a minor depression, therefore, does not require complementary surgery or altered medical treatment. Medical History: Jackson also suffered an internal derangement of the right knee while playing a football match at a high school tournament in 1996. The injury to the menisci or ligaments due to compression from sports has weakened the knee muscles which is the reason why Jackson has an increased risk of right knee injury. In 1996, Dr. David Thompson examined Jackson’s right knee and ordered an x-ray. The report revealed the medial compartment had slightly narrowed and effusion of the joint was also evident. Jackson complained that the pain intensified during walking. Keeping in view the x-ray report and physical examination findings, Dr. Thompson diagnosed Chondromalacia of the patella. Jackson was prescribed an analgesic and physical therapy. Jackson received physical therapy from the Ohio State Physical Therapy Centre from December 1996 to May 1997. However, the discharge summary of Jackson’s physical therapist indicated that Jackson had “not progressed well”. At a follow up physical examination, it was revealed that the right knee was still significantly tender. However, Jackson returned to his daily school routine the following week. (Ethel BURNETT). Cultural, Ethnic differences: Jackson is a Caucasian and has a lean body structure. His case does not appear to have significant cultural and ethnic influences. He has been healthy and an active athlete throughout his academic and professional years. However, Jackson has never engaged in neuromuscular training which has increased the risk of acute ACL injury. Conclusion: Acute knee injuries are very common among young active individuals. Moreover, knee injuries particularly those associated with ACL are more common in women due to difference in hormonal levels and decreased ligament strength. In this particular case, the patient has a history of knee injury which is precisely the reason why acute ACL injury is associated with abnormal findings. Upon physical examination, the patient does not show any external signs of a fracture, however, MRI scan reveals a minor depression. The patient has also suffered a blow to the spinal cord which resulted in a slight forward displacement of L5 over S1. The forward displacement is minor, therefore, does not require complementary surgery or altered treatment regime. During physical examination, the Lachman test was positive which indicated a tear of the anterior cruciate ligament. The prescribed treatment falls into the category of “conservative management” and involves physical therapy and using a knee brace to support the joint. Once recovered, the patient is advised to engage in regular neuromuscular training to prevent further episodes of acute ACL injury. References: Scandinavian journal of medicine & science in sports. (n.d.). Volume 17, pages 109-114. American Orthopaedic Society for Sports Medicine. (1976). The American journal of sports medicine. Thousand Oaks, Calif. [etc.: by Sage Publications for the American Orthopaedic Society for Sports Medicine [etc.. European Society of Sports Traumatology, Knee Surgery and Arthroscopy. (1993). Knee surgery, sports traumatology, arthroscopy: Official journal of the ESSKA. Heidelberg: Springer. McPhee, S. J., & Papadakis, M. A. (2011). Current medical diagnosis & treatment 2011. New York: McGraw-Hill Medical. Ethel BURNETT, Appellant,,v. COMMISSIONER OF SOCIAL SECURITY ADMINISTRATION.(http://scholar.google.com.pk/scholar_case?case=17391477878134512236&q=acute+knee+sprain+assessment&hl=en&as_sdt=2,5). American Physical Therapy Association (1921- )., & American Physical Therapy Association (1921- ). (1979). The Journal of orthopaedic and sports physical therapy. LaCrosse, Wis: Orthopaedic and Sports Medicine Sections of the American Physical Therapy Association. Volume 60. Read More