Physio Knee Appointment

Subjective: Patient presents with a primary complaint of right knee pain, which began approximately 2 weeks ago following a fall while running. The pain is located primarily in the anterior aspect of the knee, described as a sharp, stabbing sensation that worsens with weight-bearing and activity. It is partially relieved by rest and ice. There is no radiation of pain. Associated symptoms include occasional clicking and a feeling of instability. Patient reports no prior injuries to the right knee. No previous treatments have been attempted. Medical history is unremarkable, with no known allergies. Patient reports difficulty with walking, squatting, and climbing stairs. These limitations impact her ability to perform her job as a teacher and participate in her usual recreational activities, such as running and hiking. Patient's goals include reducing pain, restoring full range of motion, and returning to her pre-injury level of activity, including running. Objective: Observation: Mild swelling is noted around the right knee joint, particularly in the suprapatellar region. No bruising or skin changes are observed. There is no muscle atrophy. Gait analysis reveals a slight limp on the right leg. Weight-bearing is guarded. Patient's posture is normal, with no obvious malalignment of the lower extremities. Palpation: Tenderness is elicited upon palpation of the medial joint line and the patellar tendon. No warmth or crepitus is noted. There is a small amount of effusion. Range of Motion (ROM): Active ROM: Flexion: 110 degrees (limited by pain) Extension: 0 degrees Passive ROM: Flexion: 120 degrees Extension: 0 degrees Strength: Knee flexors: 4/5 Knee extensors: 4/5 Hip abductors: 5/5 Hip adductors: 5/5 Special Tests: Anterior Drawer Test: Negative Lachman Test: Negative Posterior Drawer Test: Negative Valgus Stress Test: Negative at 0 and 30 degrees of flexion Varus Stress Test: Negative at 0 and 30 degrees of flexion McMurray Test: Positive for medial meniscus Apley's Compression/Distraction Test: Negative Patellar Apprehension Test: Negative Ballotable Patella Test (Patellar Tap Test): Positive for effusion Quadriceps Active Test: Negative Pivot Shift Test: Negative Neurological: Sensation is intact throughout the lower extremity. Patellar reflex is 2+ and symmetrical. Motor function is intact. Vascular: Peripheral pulses are palpable and equal bilaterally. Capillary refill is less than 2 seconds. Assessment: Key findings include right knee pain, swelling, limited range of motion, and a positive McMurray test. Provisional diagnosis: Medial meniscus tear. Rationale: The patient's symptoms, including pain on the medial joint line, clicking, and a positive McMurray test, strongly suggest a meniscal tear. The mechanism of injury (fall) is also consistent with this diagnosis. Prognosis is good with appropriate treatment, including physical therapy and possible surgical intervention. Contributing factors include the patient's activity level and age. Plan: Treatment plan includes: therapeutic exercises to improve range of motion and strength, manual therapy to address joint restrictions, and patient education on activity modification. Modalities such as ice and heat will be used for pain management. Goals: Reduce pain to a level of 2/10 within 2 weeks. Increase knee flexion to 130 degrees within 4 weeks. Improve quadriceps strength to 5/5 within 6 weeks. Referral to an orthopaedic surgeon for further evaluation and possible MRI. Physical therapy sessions will be scheduled twice a week for the first 4 weeks, then as needed. Patient is instructed to avoid activities that aggravate the knee pain. Home exercise program will include range of motion exercises, quadriceps sets, and hamstring curls.