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    Osteoarthritis Genu: Short Case Wahyu Sita Wardani

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    wahyu_sita
    1. The patient is a 73-year-old male who presented with right knee pain and stiffness for 3 weeks. He has a history of right ankle injury from a motorcycle accident 10 years ago. 2. Physical examination revealed genu varus deformity, tenderness over the right medial knee, and crepitus bilaterally. Range of motion was full except for right knee extension. 3. The clinical diagnosis was osteoarthritis of the right knee with genu varus deformity. Treatment included SWD, TENS, isometric and isotonic exercises, cycling,

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    Osteoarthritis Genu: Short Case Wahyu Sita Wardani

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    wahyu_sita
    61 views52 pages
    1. The patient is a 73-year-old male who presented with right knee pain and stiffness for 3 weeks. He has a history of right ankle injury from a motorcycle accident 10 years ago. 2. Physical examination revealed genu varus deformity, tenderness over the right medial knee, and crepitus bilaterally. Range of motion was full except for right knee extension. 3. The clinical diagnosis was osteoarthritis of the right knee with genu varus deformity. Treatment included SWD, TENS, isometric and isotonic exercises, cycling,

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    short case

    Original Title

    Knee OA

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    1. The patient is a 73-year-old male who presented with right knee pain and stiffness for 3 weeks. He has a history of right ankle injury from a motorcycle accident 10 years ago. 2. Physical examination revealed genu varus deformity, tenderness over the right medial knee, and crepitus bilaterally. Range of motion was full except for right knee extension. 3. The clinical diagnosis was osteoarthritis of the right knee with genu varus deformity. Treatment included SWD, TENS, isometric and isotonic exercises, cycling,

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    61 views52 pages

    Osteoarthritis Genu: Short Case Wahyu Sita Wardani

    Uploaded by

    wahyu_sita
    1. The patient is a 73-year-old male who presented with right knee pain and stiffness for 3 weeks. He has a history of right ankle injury from a motorcycle accident 10 years ago. 2. Physical examination revealed genu varus deformity, tenderness over the right medial knee, and crepitus bilaterally. Range of motion was full except for right knee extension. 3. The clinical diagnosis was osteoarthritis of the right knee with genu varus deformity. Treatment included SWD, TENS, isometric and isotonic exercises, cycling,

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 52

    Osteoarthritis Genu

    Short Case
    Wahyu Sita Wardani

    1
    Anatomi

    Sendi lutut dibentuk oleh :


    • Bagian distal Femur
    • Bagian proximal Tibia
    • Patella
    • Sendi : Femurotibial &
    Patellofemoral
    • Meniskus : Medialis
    dan lateralis
    • Ligamentum kolateral :
    Medial dan lateral
    • Ligamentum krusiatum:
    Anterior dan posterior
    • Otot – otot sekitar lutut
    2
    ANATOMI
    • Sendi lutut  artikulasi distal femur & bagian
    proximal tibia & meniscus.
    • 2 permukaan di distal femur  permukaan
    ant. Patella & permukaan inf.tibia.
    • Permukaan Patella  sadel & asimetris. Fx
    mekaniknya: me(+) rotatory movement
    extensor.
    • Tibial plateau  2 permukaan artikuler,
    medial (oval, >dalam &> konkaf serta >
    bundar)dari lateral.
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
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    19
    OT 4 0 Kinesiology- Lower extremity kne locking mechanism.mp4

    20
    CASE REPORT

    21
    Patient Identity
    Name Mr. M
    Age 73 years old
    Sex Male
    Address Krakah Selatan Surabaya

    Religion Islam
    Ethnic Javanese
    Occupation Pensioner from

    22
    History Taking
    • Referred from Orthopedic Department
    Outpatient Clinic with OA Genu Dextra

    • Chief Complaint: Nyeri lutut kanan

    23
    History of Present Illness

    • He felt pain at both knee since 3 weeks ago, with VAS


    5. Pain is described as such a dull pain. It didn`t
    radiate.
    • The pain increase especially when he bent his knee for
    praying activity, when he do the tahiyat sitting
    position.
    • The Pain decrease when he take a rest.
    • He also felt stiffness on his both knee when he wake
    up in the morning and it last about five minutes. It was
    relieved when he started to walk.
    • No radiating pain, no tingling sensation, no numbness
    History of Past Illness
    • About 10 years ago, the patient had an accident, he
    got hit by a car from backside, when he’s riding a
    motorcycle.
    Patient said by the orthopedic doctor he should be
    given casting, but the patient take the casting out by
    himself,
    After that he felt stifness at his right ankle until now
    • History of HT (+), routinely controlled in Cardiology
    Outpatient Clinic
    treated by Micardis 80mg 1x1
    • History of DM (-)
    Physical Examination
    • General State
    Consciousness: CM Ambulation: Independent Gait: Antalgic

    Right Handed W: 78 kg H: 179 cm BMI: 24,3


    Vital Signs: BP: 130/80 mmHg RR: 18x/min
    HR: 88 x/min
    Head and Neck Anemic/Jaundice/Cyanosis/ -
    Dyspneu
    Thorax Heart/Lung N
    Abdomen N
    Extremities Warm at all extremities
    Barthel Index 100
    26
    • Neurological State

    Cranial Nerves I-XII N


    Muscle Tone N
    Deep Tendon BPR +2 | +2 KPR +2 | +2
    Reflexes
    TPR +2 | +2 APR +2 | +2
    Pathological Hofmann - | - Babinski - | -
    Reflexes
    Tromner - | -
    Sensory Deficits No sensory deficits

    27
    • Musculoskeletal State
    Region Movement ROM MMT
    Neck Flex. Full (0-45°) 5
    Ext. Full (0-45°) 5
    Lat. Flex. Full (0-45°)/Full (0-45°) 5/5
    Rot. Full (0-60°)/Full (0-60°) 5/5
    Trunk Flex. Full 5
    Ext. Full (0-30°) 5
    Lat. Flex. Full (0-35°)/Full (0-35°) 5/5
    Rot. Full (0-45°)/Full (0-45°) 5/5 28
    Region Movement ROM MMT
    Shoulder Flex. Full (0-180°) Full (0-180°) 5 5
    Ext. Full (0-80°) Full (0-80°) 5 5
    Abd. Full (0-180°) Full (0-180°) 5 5
    Add. Full (0-45°) Full (0-45°) 5 5
    Int. Rot. Full (0-55°) Full (0-55°) 5 5
    Ext. Rot Full (0-45°) Full (0-45°) 5 5
    Elbow Flex. Full (0-150°) Full (0-150°) 5 5
    Ext. Full (150-0°) Full (150-0°) 5 5
    Pro. Full (0-80°) Full (0-80°) 5 5
    Sup. Full (0-80°) Full (0-80°) 5 5
    29
    Region Movement ROM MMT
    Wrist Flex. Full (0-80°) Full (0-80°) 5 5
    Ext. Full (0-70°) Full (0-70°) 5 5
    Rad. Dev. Full (0-20°) Full (0-20°) 5 5
    Ulnar Dev. Full (0-30°) Full (0-30°) 5 5
    Finger Flex. Full (0-90°) Full (0-90°) 5 5
    MCP Ext. Full (0-15°) Full (0-15°) 5 5
    Abd. Full (0-20°) Full (0-20°) 5 5
    Add. Full (20-0°) Full (20-0°) 5 5
    PIP Flex. Full (0-100°) Full (0-100°) 5 5
    Ext. Full (100-0°) Full (100-0°) 5 5
    DIP Flex. Full (0-90°) Full (0-90°) 5 5
    Ext. Full (90-0°) Full (0-180°) 5 5 30
    Region Movement ROM MMT
    Thumb Flex/Ext Full (0-50°) Full (0-50°) 5 5
    MCP Abd/Add Full (0-50°) Full (0-50°) 5 5
    Opposition 5 5
    IP Flex/Ext Full (0-90°) Full (0-90°) 5 5
    Hip Flex. Full (0-125°) Full (0-125°) 5 5
    Ext. Full (0-30°) Full (0-30°) 5 5
    Abd. Full (0-45°) Full (0-45°) 5 5
    Add. Full (0-20°) Full (0-20°) 5 5
    Int. Rot Full (0-80°) Full (0-80°) 5 5
    Ext. Rot Full (0-80°) Full (0-80°) 5 5
    Knee Flex. Full (0-135°) Full (0-90°) 5 5
    Ext. Full (135-0°) Full (135-0°) 5 5 31
    Region Movement ROM MMT
    Ankle Inver. Full (0-35°) Full (0-35°) 5 5
    Ever. Full (0-25°) Full (0-25°) 5 5
    Dorsal Flex. 0-10° Full (0-30°) 5 5
    Plantar Flex. Full (0-45°) Full (0-45°) 5 5
    Toes Flex. Full (0-30°) Full (0-30°) 5 5
    MTP Ext. Full (0-80°) Full (0-80°) 5 5
    IP Flex. Full (0-50°) Full (0-50°) 5 5
    Ext. Full (0-80°) Full (0-80°) 5 5
    Big Toe Flex. Full (0-25°) Full (0-25°) 5 5
    MTP Ext. Full (0-80°) Full (0-80°) 5 5
    IP Flex Full (0-25°) Full (0-25°) 5 5
    32
    • Local State, Knee region

    Inspection Deformities Genu Varus


    Inflammation Signs -/-
    Redness, Rash -/-
    Palpation Tenderness + medial MTP/-
    Crepitus +/+
    Warmth -/-

    33
    34
    • Special Tests
    Right Left
    Patellar Grinding + +
    Anterior Drawer Test - -
    Posterior Drawer Test - -
    Valgus Stress Test - -
    Varus Stress Test - -
    Compression Test - -
    Distraction Test - -
    Mc Murray Test - -
    35
    Right Left
    Q Angle
    - Non WB 16° 25°
    - WB 18° 28°
    Leg Length
    - Apparent 86 cm 86 cm
    - True 79 cm 79 cm

    36
    Supporting Examinations

    37
    38
    Assessment
    Clinical Diagnosis OA Genu Dextra + Genu Varus
    Deformity + Hypertension

    Functional Impairment -OA Genu Dextra


    Diagnosis -Genu varus deformity
    -Edema ankle D

    Disability Difficulty to do tahiyat sitting


    position during Sholat

    Handicap
    Problem List
    – Surgical:
    – -Medical: OA Genu Dextra + Genu Varus Deformity + Hypertension
    39
    R1 (Mobilization)
    Rehabilitation
    Antalgic gait
    R2 (ADL)

    R3 (Communication) No problem
    R4 (Psychology) Worry about her disease

    R5 (Social Economy) -
    R6 (Vocational) Couldn’t do Sholat properly
    R7 (Other) Pain on right knee VAS 5
    Genu Varus Deformity
    Hypertension

    40
    Therapeutic Modality: Therapeutic Exercise:
    -SWD contraplanar -Isotonic stregthening exercise : Quadriceps and
    27,12 MHz Hamstring D/S as tolerate
    Continues, -Endurance Exercise : Static Cycle , intensity THR
    intensity : 94,2-102x/minute,or Borg Scale 11-13, duration
    Comfortable 15—20 minute, 3-5x/week
    warmth, duration :
    15-20 minutes Orthesa :
    -TENS at Knee Brace
    tenderpoints right
    knee ( frequency
    100 Hz, intensity
    as patient
    tolerance, duration
    20 minutes,
    3x/week)

    Monitoring Clinical, VAS


    Education Health Education/Home Exercise Programs
    -Explain about patient condition
    -Explain about knee joint conservation
    -Continue Exercise at Home
    -Icing at the tender area for 15-20 min 3-4x/day
    -Elevasi, Ankle Pumping, Gentle Stroke Massage Ankle D
    41
    SUMMARY
    • Male, 73 yo, referred from orthopedic outpatient clinic with
    CC pain at right knee especially when sitting in Tahiyat
    position for 3 weeks. Felt like dull pain, eased with resting .
    Stiffness in the morning <30 minutes. No radiating pain, no
    tingling sensation, no numbness, no fever. She worked as
    housewife, had difficulty go to the second floor of her house
    by stairs. Had accident 4 months ago and had done pinning on
    her left ankle.
    • Physical exam finding were: genu varus deformity, crepitus,

    42
    • Plan for this patient were:
    – SWD Contra Planar at right knee, TENS at tender
    point, isotonic strengthening exercise: quadriceps and
    Hamstring D/S, Endurance exercise with static cycle,
    ankle pumping
    – Monitor px complain, VAS, circumference, edema,
    – Educate the px about her condition, about knee
    conservation, to continue exercise at home, icing at
    the tender area. Ankle pumping and gentle stroke
    massage

    43
    Thank You

    44
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