My Knee

Hey all!

In this blog I wanted to bring up the issue of reliability of some of the musculo special tests and reliability between therapist. This isn’t directly related to the clinic I am on right now (musculo outpatients), but it does bare an influence in clinical reasoning and decision making.

I recently hurt my knee whilst playing netball, I was in a lunge position ( R leg in front), and turned to get out of the position. I cant remember which way I turned, but there wasn’t a large amount of movement. I felt an instant excrutiating sharp pain on the lat aspect of my R knee and also heard a click/pop, I was unable to put weight thru it for atleast 5 mins. But was gradually able to SLS on the R without too much effort. However initially everytime I straightening my knee, there was clicking. First aid consisted of rest and ice.

Over night there was no significant swelling, or bruising. However I had 10deg quads lag (normally I have very hyperextended), and was only able to flex my knee to 80deg due to the sharp pain. Everytime I tried to straighten my leg, I just felt there was sumthing that kept blocking the movement. My initial diagnosis was either LCL or lat meniscal involvement.

I saw the physio the next day, who told me, no significant damage had been done, it was just maltracking of the patella. I was told it would get better in no time, and just to continue to ITB stretches, esp before games. As I complained of pain on my lat side, no pain was provoked on palpation of lat aspect, and a Mcmurrays wasn’t done, because I didn’t have full range flexion as it was too painful. Later on that day, whilst I was at work (working in a private practice), I was explaining to some of the other physio what had happened. Just by listening to mechanism of injury, and what my knee felt like, they all suspected there was ligamentous involvement. So all 3 physios re-tested my knee, and confirmed it was partial MCL and meniscal involvement. There was some swelling, I was TOP on the medial aspect, had partially lax MCL on the R, and Mcmurrays was tested in prone, which ended up being positive. There advice was conservative management, rest next 4-6 weeks.

As the physio earlier hadn’t done some of the test, I thought the second diagnosis was more viable. Being on musculo prac, its always fun to test things out on eachother, so one of the student and superviser tested out my knee, almost all the tests ended up being negative and the patella compression test being the only positive one, so this backed up what the original physio thought. Of course none of the physios are willing to admit they maybe wrong, all convinced they have the right diagnosis. To throw another spanner in the works, 4th day post injury, another physio disagreed with everyone, and said it was most probably popliteus!
So 3 different days, 4 different diagnosis.
Day 1: Maltracking of patella OR MCL/meniscal
Day 2: Patellofemoral
Day 3: Popliteus strain (!)

As a patient and physio student, I’m concerned that special tests are giving false positive results, and that diagnosis keeps changing on a daily basis! This as made me realize the importance of testing & retesting all aspects of the knee, not just where pain is or relying on the mechanism of injury, and making assumptions, testing both sides (turns out I’m lax on both my MCLs), and taking into consideration the effect of swelling, on giving false positive results (ie. McMurrays).

As for my knee, its certainly gotten a lot better, have both full range flexion and extension, though there is still pain at the EOR with overpressure. Pain is no longer on the lateral aspect, more a dull ache posterior aspect of knee.

So…anyone know whats wrong with my knee??