Case Study- Patellofemolar Osteoarthritis and it's Physiotherapy Management

1. MADE BY: HEMANT AGGARWAL
BPT (4TH YEAR)
24TH BATCH

2. SUBJECTIVE ASSESSMENT
 GENERAL INFORMATION:
 PATIENT NAME: LOKHI ROY
 AGE/SEX:50/FEMALE
 OCCUPATION:CLERK(CHAIR SITTING JOB)
 ADDRESS:B-50,UTTAM NAGAR,DELHI(4th floor)
 DATE OF EXAMINATION:20th Sept. 2016

3.  CHIEF COMPLAINT:
 Pain in both knee joint(Left>Right) since 1 month
 Morning Stiffness for 15 to 20 mins.
 Pain in stairs ascending & decending

4.  HISTORY OF PRESENT ILLNESS:
 MODE OF ONSET: Gradual Onset
 NATURE OF PAIN: Aching Pain
 QUALITY OF PAIN:Continuous Pain
 INTENSITY(VAS):Left knee -7
Right knee-5

5. C0NT.
 RELIEVING FACTOR:
i)Hot Fermentation & Pain Killer for PAIN
RELIEF
ii)Walking for MORNING STIFFNESS
 AGGREVATING FACTOR:
i)Stair Climbing
ii)Chair Sitting for than 1 hour

6. HISTORY OF PAST ILLNESS:
 Medical History:
 Non- Diabetic
 Non-Hypo/Hypertensive
 No Thyroid Problem
 No Surgery
 Other:
 B/L knee pain 8 years ago,relieved with
medication

7. OBSERVATION:
 POSTURE:
 Anterior View :
 Shoulders:Almost Level
 Left ASIS lower
 Left patella higher
 Foot Arches Normal
 Lateral View :
 Thoracic kyphosis:slightly incresed
 Lumbar Lordosis:Incresed
 Anterior tilt of left pelvis
 Posterior View:Left PSIS higher

8. CONT.
 Inspection:
 Swelling:No Swelling
 Colour: Normal
 Redness:No
 Muscle Atrophy:No
 Mobility: -Left patellar mobility decreased in
inferior & medial direction
-Right patellar mobility decresed in inferior
direction

9. OBJECTIVE ASSESSMENT:
 Palpation:
 Crepitus:Present at superior aspect of
Patella with Knee Extension
 Tenderness:Superior aspect of Patella
 Temperature:Normal
 Sensation:Normal

10. RANGE OF MOTION:
LEFT
KNEE
RIGHT
KNEE
ACTIVE
ROM
PASSIV
E
ROM
ENDFEE
L
ACTIVE
ROM PASSIV
E
ROM
ENDFEE
L
FLEXIO
N
0-110 0-115
(PAIN-
FUL)
FIRM 0-120 0-125
(PAIN-
FUL)
FIRM
EXTEN-
SION
110-0 115-0 HARD 120-0 125-0 HARD

11. MUSCLE STRENGH:(IN PAINFREE RANGES)
 KNEE:
FLEXION:Grade 4
EXTENSION:Grade 5
 HIP:
FLEXION:Grade 5
EXTENSION:Grade 4
ABDUCTION:Grade 4
ADDUCTION:Grade 5
MEDIAL ROTATION:Grade 4
LATERAL ROTATION: Grade 5

12. X-RAYS FINDINGS:
 Patellofemoral joint space is reduced
 Osteophyte at superior aspect of patella
 Slightly medial joint space reduced in
tibiofemoral jt.
 No Osteophyte at tibiofemoral jt.

13. SPECIAL TEST:
 Ober’s Test:Negative
 Clark Sign:Present
 Ely’s Test:Positive

14. PROBABLE DIAGNOSIS:
 Patellofemoral Osteoarthritis with
Quadriceps tightness

15. AIMS FOR MANAGEMENT:
 Relieve Pain
 Incresed ROM with reducing muscle
tightness
 Strengthen Muscles
 Teaching maintenance of joint ROM
 Teaching maintenance of muscle power

16. MANAGEMENT:
 SWD: Continuous Mode
 Hold-Relax :Direct method relaxing Quads.
 Exercises:
 Hams. Strengthening(Towel @ Knee,press @
ankle jt.)
 G.Maximus Strengthening(Prone SLR)
 G.Medius Strengthening(Side Leg Raising)
 Abdominal Strenthening(In Crook Lying
position)
 VMO Strengthening

17. FOLLOW UP:
 On 26th Sept.:
 Intensity(VAS):Left Knee-4
Right Knee:3
 ROM:
i)Left:
ACTIVE ROM:- PASSIVE ROM:-
Knee Flexion:0-120 Knee Flexion:0-125
Knee Extension:120-0 Knee
Extension:125-0

18. FOLLOW UP:
ii)Right:
ACTIVE ROM:
Knee Flexion:0-129
Knee Extension:129-0
PASSIVE ROM:
Knee Flexion:0-134
Knee Extension:134-0

19. FOLLOW UP:
 On 3rd Oct.:
 Intensity(VAS):Left Knee:3
Right Knee:2
 ROM:
i)Left:
ACTIVE ROM:- PASSIVE ROM:-
Knee Flexion:0-130 Knee Flexion:0-135
Knee Extension: 130-0 Knee Extension:135-
0

20. FOLLOW UP:
ii)Right:
ACTIVE ROM:-
Knee Flexion:0-135
Knee Extension:135-0
PASSIVE ROM:-
Knee Flexion:0-138
Knee Extension:138-0

21. ADVICE & PRECAUTIONS:
 Avoid Squating
 Use western Toilet
 Walk after every 20-30 mins. of chair sitting
 Avoid Crossleg sitting
 Use Hot fermentation
 Exercise Daily,etc.