Members do not see these Ads.
Sign Up.
Dear All,
I have a patient who has a peculiar presentation with whom I would welcome any comment.
Without going into full assessment (as I have provided an orthotic solution which is helping the problem), I want to get an idea of the mechanism of the pathology
PC
Rt knee pain on more vigourous activity, particularly at the start of propulsion to sprint(after a runaway grandchild as it happens!)
Loaded flexion of the knee is painful
RMH
Rt knee scoped 12/09. ?partial meniscectomy. Discomfort in knee since
Was fairly OK after surgery but has deteriorated over the past 2/12
SH
Active 60+
Plays tennis and wears anti pronation runners
Walking no problem
OE
Knee pain
difficult to illicit today. palpation not painful. 1/3 knee bend test caused discomfort at the anterior of th knee, at heh distal border of the patella. Pain more like a muscular pain a opposed to grinding
Mild excessive internal rotation at the knee on 1/3 knee bend test by comparison to sound Lt side.
No knee instability and no sign of any meniscal problems
Med rotated STJ axis Rt
Hallux limitus - only 15 degrees d/f non WB and increased dorsiflexion stiffness again WB (functional hallux rigidus - to coin Mike's phrase)
RECTUS FEMORIS CONTRACTURE BILAT RT>LT. A Duncan Ely test did not allow full flexion of the knee - 90 degree flexion only
Probs
1. WB flexion in single limb stance causes pain
Treat
1. Reduction of the internal rotation moments at the knee seem to cause reduction in pain - orthoses provided to correct excessive pronation at the foot and reduce medial rotaiton of the STJA.
Pt also given hip abductor strengthening exercises as a result of the paper discussed on the thread about internal rotation at teh knee and power flow
Diagnosis
Sounds like patella tendinopathy
This is where I am stuck. I feel sure that the Rectus tightness is responsible. So my question is this:-
Can rectus femoris act as an external rotator when the knee and hip are in slight flexion ie similar to midstance in single limb stance?
Thus, if contracted, can it cause excessive traction at the distal patella tendon as a result of the internal rotation moments occurring at the knee ?
I hope what I am asking is clear, I'm not sure I have relayed it very concisely
Many thanks for any help given
Robin