nabil keshavjee wrote:
>Hi!
>I'm really greatful there is someplace where I can
>seek informed opinions regarding injuries I see and
>have difficulty in treating.
>Here are two that I have come across in recent weeks.
>1. 42yo female, with left buttock pain. Intermittent
>and sharp in nature, brought on when kicking during
>high kicks in kickboxing, or in touching toes during
>yoga. The pain does not occur on any normal daily
>activities. Over the last 4 months this pain has not
>changed. Pain does not radiate. No pins and needles
>and no numbness.
>On objective examination, lumbar flexion in standing
>reproduces the pain, but repeated has makes no worse.
>No effect from lumbar flexion. Squats do not
>reproduce pain. Hip movements are normal. Pain is
>reproduced at 95 degrees SLR. Resisted knee flexion
>in sitting does not reproduce pain. Resisted knee
>flexion in 95 degree SLR produces pain. Pain on
>palpation of ischial tuberosity.
>Any thoughts on possible treatment, or what else to
>look at?
>2. 30 yo female, with right medial knee pain. Pain
>located around medial menisci. Pain produced most on
>downhill runs, or walks. She is an avid runner, who
>continues to try running but avoids running downills.
>She has also found the walking in golf to also cause
>alot of pain.
>On postural observation, I have noticed pes cavus
>bilaterally, but otherwise normal looking. I have
>been unable to notice any oddities during her running
>stride on treadmill.
>Active, passive, and resisted movements do not
>reproduce pain. Apprehensive during the mensical
>tests but no pain or locking. Negative on all other
>special tests.
>Pain on palpation of right medial knee joint line
>(just medial of patella).
>My conclusion is meniscal tear, but is there something
>else I should be looking at?
>
>All your help would be greatly appreciated.
>
>Nabil K.
>
>______________________________________________________________________
>Post your free ad now! http://personals.yahoo.ca
>
>
>
Hi Nabil,
For your second case, I would suspect injury of the medial collateral
ligament. Warren Hammer's book has a good section on this.
Please let us know what you discover to work w/ this patient.
Sarah Fern Striffler, PT
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