Thanks for all the suggestions.
As a few of you told me about the possiblity of an
avulsion at the ischial tuberosity. I have
recommended to my patient to get an x-ray.
As for the knee, the possibility of medial menicus
lesion is still probable, and this young lady is
seeing the orthopedic specialist next week. Due to
constant nature over her trying to run and aggravating
the area, I had given her some quads exerc, to
maintain the VMO.
We'll see!
Again thanks for all your support.
Nabil
> >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.
> >
>
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