The Knee and Ankle – Assessment andConservative Management.ppt

The Knee and Ankle – Assessment and Conservative Management Dr. Alice B. Aiken, PhD, PT School of Rehabilitation Therapy Queen’s University alice.aiken@queensu.ca Outline Knee Meniscal Injuries Collateral Ligaments Crutiate Ligaments Patellofemoral disorders Bone / cartilage Muscle / Tendon Ankle Fractures Sprains Muscle / Tendon Menisci Signs and Symptoms: ? Pain – typically along the joint line, worse with weight-bearing and flexion/extension overpressure ? Joint effusion ? ‘locking’ and/or ‘giving way’ ? +ve Apley’s compression, McMurray’s, Bounce home test Menisci – Special Tests McMurray’s Test: ● Patient lies supine, hold the heel (or distal shin) of injured leg with the hip flexed to 90° and knee flexed ~80° ● The thumb and middle finger of the cephalad hand is placed over the joint line ● To test the medial meniscus, scour the joint by repeatedly internally and externally rotating the distal shin (with the knee in ~80° flexion) then straightening the knee with the leg externally rotated; repeat using internal rotation to test the lateral meniscus ● +’ve test = pain and/or a click over the corresponding joint line indicating a meniscal tear Menisci – Special Test Apley’s Compression ● Patient lies prone with the knee bent at a 90° angle ● PT repeatedly rotates distal shin internally and externally while applying a downward force through the foot ● +’ve test = pain in the joint Menisci – Special Tests ● Squat test ● Bounce Home Test ● Palpation Menisci – Conservative Rx ? If pain and effusion only then conservative treatment (hope the tear or injury is in the vascular region): RICE; modalities – U/S, IFC Protected weight-bearing Isometrics (quads/hams) Painfree ROM exercises General hip and ankle strengthening exercises Isotonic quads (OKC progressing to CKC as weight-bearing increases (4-6 weeks)) ? If conservative treatment is unsuccessful then MRI or CT scan is recommended to determine if arthroscopic surgery is required Ligaments - Collaterals Cla