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Medial Collateral Ligament Sprain Chondromalacia Patellae Syndrome History Questions

This document provides information on evaluating and managing medial collateral ligament sprains and chondromalacia patellae. It includes questions to ask patients, observations to make, active and passive movement tests, special tests like McMurray's test and Thessaly test, and management plans focusing on exercises and bracing for MCL sprains and exercises, education, and potential treatments like acupuncture for chondromalacia patellae. Special tests are described that load specific tissues like the Lachman test for the ACL and Apley's grind test for the meniscus.

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63 views4 pages

Medial Collateral Ligament Sprain Chondromalacia Patellae Syndrome History Questions

This document provides information on evaluating and managing medial collateral ligament sprains and chondromalacia patellae. It includes questions to ask patients, observations to make, active and passive movement tests, special tests like McMurray's test and Thessaly test, and management plans focusing on exercises and bracing for MCL sprains and exercises, education, and potential treatments like acupuncture for chondromalacia patellae. Special tests are described that load specific tissues like the Lachman test for the ACL and Apley's grind test for the meniscus.

Uploaded by

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We take content rights seriously. If you suspect this is your content, claim it here.
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Medial Collateral Ligament Sprain Chondromalacia Patellae Syndrome

History Questions - Age? - Age?


- Type (sharp/dull/radiating) - Type (sharp/dull/radiating) and
and location of pain location of pain
- Is it trauma or non-trauma - Is it trauma or non-trauma
related related
Injury related - Is there pain after sitting for
- Mechanism of injury long periods of time (theatre
- Any “clicking” or was there a sign)
“pop” when injury occurred - Is there pain after ascending
- What aggravates the and descending stairs
condition - Is squatting painful
- When did injury occur? - Does the knee give way
- Impact of movement, - Any sounds/crepitus in the
activities, position? joint.
- What aggravates condition?
- Condition improving,
worsening, or staying
same?
- Usual activities?
- Past medical and/or surgical
history?
- Previous injury?
- What type of shoes does
patient wear?
Non injury related
- Does the pain come on after
walking jogging or other
activity.
- How much kneeling do you
do
- Does your knee lock or
catch
- Does swelling develop in
the knee
- Does it grate when you
move
- Does pain come on at rest
and is there morning
stiffness

Observations - Tenderness and Soft-tissue - Observe for swelling


swelling (more than - There may be a slight effusion.
chondromalacia patella - Observe for increased Q angle
syndrome) will also be and excessive pronation of the
present on the inside of the feet
knee.
- Gait Changes (limping)

Active Movements - Most of the time they have - Mobility and range of motion of
difficulty flexing the knee. the joint are tested, which can
- Difficulty fully extending be limited.
- Repeated extension of the
knee from flexion will produce
pain and a grating feeling
underneath the patella,
especially if the articular
surfaces are compressed
together.

Passive - Difficulty going into flexion - Passive movements are


Movements and extension usually fully and painless, but
repeated extension of the
knee from flexion will produce
pain and a grating feeling
underneath the patella

Resisted Isometric - When the knee is stressed, - Loss of power in the affected
Movements patients complain about leg may also be present on
pain, moderate laxity in the isometric testing. May be weak
joint and a significant due to inability to contract
tenderness on the inside of quadriceps
the knee.

Special Tests - Heal and Toe walking - Squat Test


- Valgus stress test - Step-up Test
- McMurray’s test (if - Patella Grind Test
meniscus is involved) - Vastus medialis co-ordination
- Lachmann test for ACL Test
stability - Standing Meniscal
- Thessaly Compression Test (Thessaly
- Apley’s compression test Test)
- Apley’s Compression Test
- McConnell Test

Sensation - None - None


Reflexes - None - None

Joint Play - Pain - Pain and crepitus will be felt if


Movements the patella is compressed
against the femur, either
vertically or horizontally, with
the knee in full extension.

Diagnostic Imaging - MRI imaging (gold standard) - X-ray: an AP view of the


patellofemoral joint is needed
to detect any radiological
change.
Management Plan:

MCL:
- Grade dependant ; 1 = pain may subside after 3-5 days, whereas 2 = may continue for 2
weeks.
- The day after the injury, quadriceps isometric strengthening exercises with co-contraction of
hamstrings and quads with knee flexed to 20 degrees and heal pressure directed towards
the floor. Knee should be placed in a short, hinged brace that allows for full flexion but
blocks terminal 20 degrees of extension to protect healing.

Chondromalacia patellae:
- Exercise and education are two important aspects of a treatment programme. Education
helps the patient to understand the condition and how they should deal with it for optimal
recovery. Exercise focus is on stretching and strengthening appropriate structures, such as:
hamstrings, quadriceps, and gastrocnemius length of the gluteal muscles. Fire needling and
acupuncture may also relieve clinical symptom.

Test INTERPRETATION/WHAT TISSUE STRUCTURE DOES THIS TEST LOAD?


For you to complete;

Hip Telescope This maneuver assesses for hip joint laxity (Paediatrics).
Test
Anvil Test This maneuver is designed to provoke symptoms by striking the heel of the
foot, which sends a large vibratory/compression force through the limb and
stimulates the injured site.

Scour Test The purpose of this test is used to determine if there is a nonspecific hip
pathology and a change in ROM. This test does so by completing the ROM
from flexion and adduction to flexion and abduction. This test is also capable to
detect early hip degeneration.

Ober’s Test Ober’s test accesses the tensor fasciae latae (iliotibial band) for contracture.

Lachman’s This procedure is used to test the integrity of the anterior cruciate ligament
Test
(ACL). The test is designed to assess single and sagittal plane instability.
Pulling the tibia anteriorly, a torn ACL will create a forward translational
movement of the tibia on the femur.
Apley’s Grind This test is a maneuver that is performed to evaluate for meniscus injury.
Test
Increased knee pain on compression/rotation suggests a meniscus tear or
coronary ligament sprain.

Thessaly Test This test is used for detecting meniscal tears/lesions of the knee.

Anterior This procedure is used to test the integrity of the anterior cruciate ligament
Drawer Test
(ACL). Knee pain without instability is equivocal, but may indicate a mild
anterior cruciate sprain; excessive anterior translation from neutral (more than
6mm) suggests anterior cruciate tear.

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