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Old 11-08-2014, 01:16 PM   #1
Nick Efthimiou
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Default Persistent Knee Pain In 61 y.o. non-English Speaker

I am trying to help out a friend's mother with treatment of her long term knee pain.

I haven't be able to discern how long it has been going for, but it is years, though less than 10.

It has recently become much worse, impacting her gait noticeably.

She has seen her GP (who speaks her native language) and was referred for X-rays, which revealed suspected intra-articular loose bodiea and suggested and MRI to follow up, which confirmed some loose bodies around the patella and posterior aspect of the joint if I recall correctly.

Too me the MRI looked fine, only very mild DJD (to be expected d at 61 I'd say), whilst the loose bodies don't account for her presentation.

There doesn't seem to be catching and giving way, but rather constant pain.

I did some manual therapy to her yesterday and there was some pitting oedema around the inferior aspect of the knee.

Main resistance is in to extension passively, although the is some extra med+lateral "play".

She feels the pain primarily posterior, around the popliteal fossa.

What further questions should I be asking (I have someone to translate, but explaining things is difficult)?

What are the DDx that come to mind?
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Old 11-08-2014, 02:58 PM   #2
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If it is long term indeed, her posterior knee pain may well be getting contributions from neuromuscular defensive patterns (hams limiting extension);
- "does pain worsen after immobility? (i.e. after long sitting)" May indicate persistent protective tension
- look at how her feet point when lying supine (ditto)
- when you support her knee posteriorly, is it able to slowly sink into extension? ditto.

I'd worry much less about actual tissue diagnostics right now.
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Old 12-08-2014, 01:19 AM   #3
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Thanks Bas, I suspect there is some defensive h/string behaviour. I'll test out the passive knee extension and see what happens.
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Old 31-08-2014, 01:40 PM   #4
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After the second treatment, it seems to have improved somewhat.

Lots of passive rhythmic articulation, some gentle soft tissue work, particular around the distal lateral quadriceps and superior medial gastrocs coupled with some traction.

Prescribed a pendulum exercise for the knee - sitting on the edge of the table and swinging it into flexion/extension, in order to encourage a) synovial fluid pump to nourish the joint which she hasn't been using well and b) to inhibit any protective behaviour by interesting non-threatening novel movement.

Will keep you updated.
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Old 12-09-2014, 01:38 PM   #5
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ncie post


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Old 04-10-2016, 04:49 AM   #6
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Thought I'd post a long term follow up.

The woman's pain improved from what it was, now she still experiences pain regularly, but I think she can cope.

Her knee function is not as good as the other, which leaves her walking with an altered gait pattern.

Most importantly, she can live the life she wants to, relatively uninterrupted.
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