Patient Case Study - 60 Year Old Bus Driver with Fractured Patella

Case Study Two Overview

Patient Profile

  • Age: 60 years old

  • Occupation: Bus driver

  • Medical History:
      - Mild asthma
      - Type II diabetes

Subjective Information

  • Current Condition:
      - Patient suffering from a fractured patella, which has now healed.
      - Injury occurred 8 weeks ago following a fall on ice.
      - The fracture was conservatively managed with a cast fixed in full extension for 6 weeks.
      - Cast was removed 2 weeks ago, and gentle movement has begun.
      - Patient is now able to mobilize and fully weight-bear.

  • Symptoms:
      - Knee feels generally ‘tender’ during movement, particularly when walking or using stairs.
      - Experiences fatigue when upright for longer than 30 minutes.
      - Reports soreness over the patella during increased activity, which settles quickly with rest.
      - Stiffness in the knee upon rising after prolonged periods of rest.
      - Noteworthy swelling after substantial activity.
      - Difficulty in flexing the knee or moving it freely.
      - Sensation that the knee might give way when standing.

Objective Assessment

  • Active Range of Movement (AROM):
      - Measured at 5 - 90 degrees (compared to 0-150 degrees on the non-injured leg).

  • Passive Range of Movement (PROM):
      - Measured at 0 – 100 degrees (compared to 0-160 degrees on the non-injured leg).

  • Pain Assessment:
      - Pain felt anteriorly over the patella during active range of motion and during passive range.
      - Mild discomfort and considerable apprehension noted at the terminal flexion of PROM.

  • Patello-femoral Accessory Movements:
      - Limited range with mild tenderness during manipulation.

  • Muscle Testing:
      - Resisted isometric muscle tests for hamstrings: Pain-free, rated 5/5 on the Oxford Scale.
      - Resisted isometric muscle tests for quadriceps: Mild discomfort over the patella, evident apprehension.

Problem List

  • General treatment strategies needed to alleviate symptoms and promote recovery.

  • Focus of treatment session: Increasing range of movement through joint mobilization techniques.

Proposed Treatment Strategies

  • Joint Mobilization Techniques:
      - Apply gentle mobilization techniques to enhance the passive range of motion of the knee joint while considering patient comfort.
      - Focus on patellar mobilization to alleviate anterior knee pain and improve mobility.

  • Range of Motion Exercises:
      - Start with passive and then progress to active-assisted exercises aiming to increase angles gradually towards the normal range.

  • Strengthening Protocol:
      - Avoid stressing the injured area; enable strengthening of the hamstrings and quadriceps through controlled, low-impact exercises.

  • Pain Management:
      - Use modalities such as heat therapy before exercises and ice applications post-activity to manage pain and swelling.

  • Education and Activity Modification:
      - Advise the patient on activity modifications to minimize strain on the knee, especially during the rehabilitation phase.
      - Encourage frequent breaks and gradually increasing standing time to increase endurance without exacerbating pain.

  • Follow-Up Plan:
      - Monitor progress through scheduled reassessments to adjust treatment plans as required.