CASE PRESENTATION INTEGRATED IN MUSCULOSKELETAL SCIENCES I

(PTM 3053) NAME: NURUL FARHANA BT IBRAHIM

ID NO: 01BF-201101-00095BSC IN PHYSIOTHERAPY

INTAKE 201101LECTURER NAME: MR HARRI

ANTERIOR CRUCIATE LIGAMENT

The anterior cruciate ligament (ACL) is a cruciate ligament

 which is one of the four major ligaments  of the human knee.

Medial collateral ligament (MCL) runs along the inside of the knee

and prevents the knee from bending out.

Lateral collateral ligament (LCL) runs along the outside of the knee

and prevents the knee from bending in.

Anterior cruciate ligament (ACL) is in the middle of the knee. It

prevents the shin bone from sliding out in front of the thigh bone.

Posterior cruciate ligament (PCL) works with the ACL. It prevents

the shin bone from sliding backwards under the femur.

The ACL originates from the deep within the notch of the distal

femur.

 Its proximal fibers fan out along the medial wall of the lateral

femoral condyle.. There are two bundles of ACL which is anteromedial

and posterolateral named according to where the bundles insert into

the tibial plateu.

The ACL attaches in front of the intercondyloid eminence of the

tibia, being fused with the anterior horn of the medial meniscus.

Musculoskeletal assessement

Name: Mr F

Age: 28 years old

Sex: Male

Occupation: Technologist laboratory

Marital status: Married

Dr diagnosis: ACL tear

Dr management: Conservative

Chief complaints: Patient complains of pain when bending the knee and do

the squatting activity.

Present history: History of twisting the knee when playing a futsal on

2/6/2013 . Patient went to hospital for the MRI on 7/6/2013. Then dr

diagnosed as ACL tear.

Past history: Nil

Medical history: Nil

Surgical history: Nil

Personal history: Non smoking and alcoholic

Socioeconomic history: Stable financial status

Pain history:

:- Duration of pain: Intermittent

:- Types of pain: Dull, aching

:- Side : Right

:- Site: Anterior aspect of knee

:- Aggravating factor: Bend knee and squatting

:- Relieving factor: Rest

:- 24 hours: More in morning

:- VAS Scale: 6/10

On observation:

Built of patient: Mesomorphic

Gait: Normal

External appliances: Nil

Deformity: Non abnormality detected

Scar: Right and left knee

On palpation:

Edema: Nil

Mild warmth at right knee

No tenderness

No swelling

On examination:

Range of motion

Knee Right Left

Flexion 0-100⁰ AFROM

Extension AFROM AFROM

Muscle power

Knee Right Left

Flexion 4/5 5/5

Extension 4/5 5/5

Limb girth measurement (supine)

Knee Right Left Difference

5cm 42.5cm 42.5cm 0cm

10cm 45.0 cm 45.6cm 0.6cm

15cm 49cm 48.5cm 0.5cm

Problem listing:

• pain during bending the knee and do squatting

•Pain due to ligament tear at the right knee

•Reduced range of motion at the right knee

Short term goals:

•Reducing pain

•Improve range of motion

Long term goals:

•Maintaining functional activity

•Prevent 2nd complications

Treatment plans:

•Ultrasound ( 5mins )(0.9w/cm2)( 1 Mhz)

•Faradic stimulation ( 15 min) ( 20ms) (pulsed mode)

•TENS ( 15 mins)

•SLR exercise ( 10 reps)

•Static quadriceps exercise (10 reps)