This week I evaluated football player who was complaining of knee pain. He said he fell on his knee and it hurt on the spot of impact, but it also hurt on the back of his knee in the popliteal space. I started with history. The player said he fell on his knee, but it didn’t hurt on the back of his knee until later. The pain gradually got worse as he continued to play. He also mentioned it hurt to squat only in the first few degrees, and when he plants and cuts. Next I did an observation. There was a little bit of swelling over his patella, but I deduced it was from when he fell, and it was nothing more than a bone bruise. There was no deformity, swelling, or discoloration in the popliteal area. Then I palpated over the patella, the patella tendon, the quads, the hamstrings, the IT band, and the boney landmarks. There was point tenderness over the patella, lateral hamstring area, and around the insertion of the IT band. The IT bands also felt every tight. ROM was within normal limits, however there was pain with active knee flexion and extension. Strength for knee flexion and knee extension was 4/5. Then I started doing special tests. At this point I was between a hamstring strain and IT band friction syndrome. I had (+) Rene’s test, (-) Obers test, (-) Nobel’s compression test. I had the player do some functional tests, like the squatting and planting so he could show me when and where it hurt. At this point, I still felt stuck between IT band friction syndrome and Hamstring. I asked the preceptor to double check me and see what she thought. When I palpated I didn’t feel any roping or deformity between his two hamstring tendons. This was because I palpated on and then palpated the other, so I wasn’t able to differentiate the difference. When the preceptor palpated the hamstrings, she did both at the same time, and then had me feel it. It was obvious then that there was some serious roping and tearing of the tendon. AT this point, it was obvious he had a hamstring strain. What I learned from this evaluation was that I need to take my time when palpating and do a better bilateral comparison. I did palpate bilaterally; the only difference was I should have palpated them at the same time. This would have made my eval go a lot smoother.
This week I got 2 attempts and 1 to mastery
0 Comments
Your comment will be posted after it is approved.
Leave a Reply. |
This is where I do my weekly clinical blog assignment. There is either a prompt I am responding to, or I just talk about something exciting I saw during the week.
Archives
April 2019
|