----- Original Message -----From: [log in to unmask] href="mailto:[log in to unmask]">John WillenbruchTo: [log in to unmask] href="mailto:[log in to unmask]">[log in to unmask]Sent: Thursday, March 03, 2005 4:55 AMSubject: Re: Lateral knee pain!>patella to track properly. This also stretches the lateral retinaculum. >Iontophoresis with a steroid should give symptomatic relief. I would also >r/o a lateral meniscus tear. > > > >******************************************************* > >Dr. Douglas M. White > > > > > >Confidential: > >This email, including attachments, may contain information that is >privileged, confidential, and/or exempt from disclosure under applicable law >(including, but not limited to, protected health information). It is not >intended for transmission to, or receipt by, any unauthorized persons. If >the reader of this message is not the intended recipient you are hereby >notified that any dissemination, distribution or copying of this >communication is strictly prohibited. If you believe this email was sent to >you in error, do not read it. Reply to the sender informing them of the >error and then destroy all copies and attachments of the message from your >system. Thank you. > > _____ > >From: - for physiotherapists in education and practice >[mailto:[log in to unmask]] On Behalf Of John Willenbruch >Sent: Wednesday, March 02, 2005 4:02 AM >To: [log in to unmask] >Subject: Re: [PHYSIO] Lateral knee pain! > > > >Nabil, > >Have you looked at the way the patellar tracks in the trochlear groove? >What will commonly be seen is that the affected knees patellar will track >laterally when compared to the non affected patellar. > >This can be associated with Clarkes sign being positive and weakness when a >straight leg raise is performed in external rotation of the hip. >Theoretically this would indicate a weakness in VMO, a tightness in ITB or >both. If modified Obers test is positive start ITB stretches/mobilisation, >if not straight leg raise in external rotation can be used to increase VMO >strength. > >Hopefully someone will come up with some evidence to back this up, I >remember a US study looking at this but can't remember a reference. > >Cheers, > >John > > >From: nabil keshavjee <[log in to unmask]> > > >Reply-To: - for physiotherapists in education and practice ><[log in to unmask]> > > >To: [log in to unmask] > > >Subject: Lateral knee pain! > > >Date: Tue, 1 Mar 2005 20:54:04 -0500 > > > > > >Hi All! > > >A case I hope you can all help me with in regards to > > >treatment, and possible other diagnosi. > > >Female, 40s, came in with lateral knee pain. Pain has > > >been getting worse, and started about 5 months back. > > >Started during her runs, and gradually she had to > > >reduce her runs distance wise. She is now at a point > > >where walking even aggravates the pain. Pain is very > > >irritable. Aggravated with stairs, running, rising. > > >No real easers, other than rest. Although she feels > > >she is unable to find a comfortable spot for her knee, > > >and needs to move it. > > >No locking or giving way. > > >Repeated lumbar movements (flexion/extension), do not > > >provoke pain. Any knee movement does. > > >Valgus/Varus Stress Tests were negative. ACL/PCL > > >drawer were negative. At this point was very sore, so > > >meniscal tests were painful, but no locking or > > >increase in pain. > > >On palpation, very tender only ITB insertion, and > > >along band. > > >I would assume this ITB, but am stuck due to the > > >irritablity. I have used only pain relief > > >modlalities, with limited results. Have thought of > > >possible orthotics (destress ITB) but her feet look to > > >be doing pretty good. > > >Any helpful hints would be greatly appreciated. > > > > > >Nabil K. > > > > > >______________________________________________________________________ > > >Post your free ad now! http://personals.yahoo.ca >Dr. White
Why do you use iontophoresis for pain relief in anterior knee pain (AKA latertally tracking patellar, runners knee) does not involve an inflammatory process why would you choose a pro-inflamatory modality with an anti-inflamatory drug?
At present we don't use iontophoresis at our hospital
Thanks for any help with this,
John
>If the patella is tracking laterally I have had success with taping the