1. CASE STUDY
BY-NAVEEN AGGARWAL

2. DEMOGRAPHIC DATA
NAME-
AGE/SEX- /
OCCUPATION-
ADDRESS-
MARITAL STATUS-

3. CHIEF COMPLAINT
 PAIN IN B/L KNEE SINCE LAST 6MONTHS
 DIFFICULTY IN STAIR CLIMBING & USING
INIAN STYLE TOILET
 DIFFICULTY IN CROSS LEG SITTING
 UNABLE WALK CONTINOUSLY MORE THAN
HALF KILOMETER DUE TO PAIN
 PAIN OCCUR WHEN STANDING
CONTINOUSLY MORE THAN 10 MINS

4. H/O PAST ILLNESS
MEDICAL HISTORY
ASTHMATIC TREATMENT IS ONGOING
SINCE LAST 5 YEARS.
SURGICAL HISTORY
H/O VALVE REPAIR SURGERY 3 YEARS
BACK.

5. H/O PRESENT ILLNESS
 DIABETIC TREATMENT IS ONGOING
 H/O HYPERTENSION
 PAIN AT KNEE SINCE LAST 6 MONTHS(DULL
ACHING TYPE OF PAIN )
VAS-7 |--------------*------|
 ONSET OF PAIN –CONTINOUS
 AGGREVATING FACTOR-CROSS LEG SITTING,
SQUATTING,STAIR CLIMBING, LONG DISTANCE
WALKING LONG TIME STANDING.
 RELIEVING FACTOR-REST AND HWF

6. OBSERVATION
 SWELLING PRESENT ON B/L KNEE (L>R)
 REDNESS PRESENT ON LEFT KNEE
 GAIT –LURCHING GAIT (LURCH PRESENT
RIGHT SIDE MORE AS COMPARE TO LEFT
SIDE)
 GENU VARUS DEFFORMITY IS PRESENT
 FLAT FOOT (ON THE GROUND)BUT SLIGHTLY
PRONATED FOOT (OFF THE GROUND)

7. EXAMINATION
 ACTIVE MOVEMENT
 KNEE EXTENSION LEG-10 DEGREE(IN RIGHT KNEE) &
15 DEGREE (IN LEFT KNEE)
 KNEE FLEXION-NORMAL
 HIP FLEXION-70 DEGREE (ALL OTHER
MOVEMENT ARE NORMAL)
 ANKLE AND SPINE ARE NORMAL
 PASSIVE MOVEMENT- NORMAL AT KNEE ANKLE HIP &
SPINE
 END FEEL-NORMAL AT ALL NOTED JOINT EXCEPT SOFT
END FEEL ON LEFT KNEE EXTENSION

8.  MMT(RIGHT LL)
-KNEE FLEXION: 4
-KNEE EXTENSION: 3(-)
-HIP FLEXION:3(-)
-HIP INTERNAL ROTATION :3
ALL OTHER MOVEMENTS ARE NORMAL
 MMT (LEFT LL)
-KNEE EXTENSION :3(-)
-HIP FLEXION :3+
ALL OTHER MOVEMENTS ARE NORMAL
 TENDERNESS PRESENT ON MEDIAL SIDE OF RIGHT
LL
 INCREASED IN TEMP AT LEFT KNEE
 HAMESTRING SPASM(CAUSING STRECH PAIN IN
SLR AFTER 70 DEGRR OF HIP FLEXION)IN RIGHT
KNEE
 CREPITUS PRESENT IN RIGHT KNEE

9. SPECIAL TEST
 BALLOTMENT TEST IS [POSITIVE AT LEFT KNEE
 MC.MURREY IS POSITIVE IN RIGHT KNEE
INVESTIGATION
 X-RAY –DEGENERATIVE CHANGES(SHOWS
DECREASE JOINT SPACE ON MEDIAL SIDE OF
KNEE JOINT (R>L) ,OSTEOPHYTE PRESENT IN
RIGHT KNEE ,IRREGULAR JOINT SURFACES)

10. PROVISIONAL DIAGNOSIS
B/L OSTEOARTHRITIS OF KNEE JOINT

11.  MODALITIES
 HOTPACK-15 MINS(BD)
 TENS-15 MINS BIPOLAR (IN RIGHT KNEE-
CONTINOUS & IN LEFT KNEE-PULSED)
 US-IN RIGHT KNEE FOR 7 MIN
CONTINOUS MODE,0.8 INTENSITY,FOR 10
DAYS AT TENDER POINT(MEDIAL SIDE OF
KNEE)

12. EXERCISES
o ISOMETRICS-QUAD,HAMES,ADDUCTORS OF HIP
o DYNAMIC-QUAD IN SITTING
o SLR-30 DEGREE IN SUPINE,SIDE LYING AND PRONE &
MOBILISATION –RIGHT KNEE
o VMO STRENGTHENING-END RENGE KNEE EXTENSION,QUAD DRILL
o HAMES CURL
o HAMES STERCHING
o GAIT TRAINING WITH CANE
o PRECUATION ARE EXPLAINED-AVOID(LONG TIME STANDING,LONG
DISTANCE WALKING,CROSSLEG SITTING,SQUATTING & STAIR
CLIMBING USE OF CANE WHILE WALKING)

13. HAMSTRING CURLS DYNAMIC QUAD MINI SQUAT
SIDE LYING SLR SUPINE SLR PRONE SLR
( 30-DEGREE WITH 10 SEC HOLD,10 REP.-BD)

14. ISOMETRICS-ADDUCTOR ISOMETRICS QUAD,HAMS,RESPECTIVELY
VMO STRENGTHENING HAMSTRING STRECH

15. PROGNOSIS
 15% RELIEVE ON 3RD VISIT
 25% RELIEVE ON 5 DAY (RESISTED EXS ARE STARTED WITH
HALF KG OF WEIGHT)
 35% RELIEVE ON 8TH VISIT AND IMPROVEENT IN GAIT
PATTEREN AND ADL PERFORMANCE(RESISTENCE INCREASED
TO 1 KG)
 55% RELIEVE ON 10 DAY, US IS DISCONTINUE AND VAS IS
DROP DOWN TO 4.
(Some exercises are add-on with theraband & mini squat is
also added)
 80% RELIEVE ON 15TH DAY TENS IS DISCONTINUEHOME
TREATMENT PROGRAME ARE EXPLINED.