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Created with Fabric.js 1.4.5 Cheif Complaint Knee Pain your artboard start from scratch[clears the canvas] History -USC men's rugby player-general knee P! after match Observation -slight limp Palpation -All surfaces and main aspects of the knee-No notable differences Range of Motion -tight hamstrings-Within normal limits Manual Muscle Test L R-glut max 5/5 5/5-glut min 5/5 5/5-glut med 3/5 3/5-hamstring 4+/5 4/5-abductors 4+/5 4+/5 -adductors 4+/5 4+/5-gastroc 4+/5 4+/5-soleus 4+/5 4+/5 L R-Anterior Drawer - --Slocum Drawer - --Posterior Drawer - --Varus + bilateral laxity +-Valgus - --Lachman's - --McMurray P! in lat. knee - -Apley - "feels weird compared to L" Special Tests Palpation History Observation Palpation Special Tests Neurological -Tingling in legs in high school and went away undiagnosed -Excessive lordosis of the lumbar spine -L4-L5 Spinous process TTP-L4-L5 Transvers process TTP **Patient mentions numbness and tingling radiating from knees, to feet, then backup to hips. Takes 30 second breaks to "wake his feet up". -Bowstring: L+, R+, recreates symptoms-Tension: L+, R+, recreate symptoms-Burdunski: recreates symptoms bilaterally-Bilateral SLR: L recreates symptoms and P!, R--Sitting root: recreates symptoms bilaterally-Quadrant: P! with back extension, lateral knee P! L4 and L5, "worst P!"-Toe touch: Lateral knee P! recreates symptoms-Stork Standing: Lateral knee P!, L4-L5 P! -Numbness, tingling, almost complete loss of function in L4,L5, and S1. Re-checked by preceptor Palpation: Step-off deformity where erector spinae attaches when back is extended (@L4-L5) Differential diagnosis Nerve root impingementHerniated disk -Nerve root impingement-Herniated disk SpondylolisthesisSpondylolysis -Spondylolisthesis-Spondylolysis Stem, ice, X-ray MRI TX/Imagery No sports participation Outcome SPONDYLOLISTHESIS SPONDYLOLISTHESIS
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