Orthopedic Knee Evaluation with Paul Marquis PT

In this video called Orthopedic Knee Evaluation with Paul Marquis PT I do a knee eval on a patient with significant effusion, loss of motion, joint line pain and lateral patella pain. I'll talk you through this evaluation and explain why I am doing what I do and the management plan.
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[@royb1313]

thanks a lot for your job and your educational videos and podcasts!

[@tarasdeputat5343]

Thank you Doc

[@OrthoEvalPal]

You are very welcome

[@josephwhite4631]

Hey awesome video doctor! How long of a grace period would expect to give to let your symptoms and swelling come down before you make the call to try mri or arthroscopy? Thanks

[@leek617]

Hi, thank you for posting all of these videos. Very helpful! I know this patient appeared to have higher irritability but if she didn’t what meniscus tests would you have used? Thank you!

[@OrthoEvalPal]

Hi Lee, This is what I like to do kzbin.info/www/bejne/a5q8d3usrN-gkKs This lady did very well in PT just by re-strengthening her quad.

[@sanchithasudakar721]

Hello. Informative video. What is the diagnosis for this condition? Also, does arthroscopy help to clean up effusions like this completely and what is the prognosis for such a procedure?

[@OrthoEvalPal]

Not everyone needs surgery for this. She actually did very well with a couple weeks of PT. As soon as her quad became stronger, she did better.

[@jcmphys2143]

Hello, would you say the diagnosis is RA? Thanks for the great videos!

[@stevenson9605]

RA would likely be symmetrical and other systemic symptoms present

[@BIG3rn91]

What interventions did you end up doing for this pt? PROM into extension? Short arc quads? Maybe fibular PAs?

[@OrthoEvalPal]

Patella mobs, quad re-activation exercises, quad sets, SLR's, isometric wall sits, modified shuttle leg presses, st. bike etc... Once she turned her quads on, she did significantly better.

[@mohamedorayith4626]

As she is unable to fully extend the leg and therefore cannot contract her quadricep muscle. Does that mean that part of the treatment ill involve hamstring stretch because the hamstrings will constantly be in a slightly adaptively-shortened position??

[@OrthoEvalPal]

Yes. Often times by contracting the quads the hams will turn off and relax. Taking me back to my college days...reciprocal inhibition I believe.

[@DelphinoWilliams]

Hello Dr. Paul Thank you for all of this invaluable knowledge. If I may, with a bucket handle tear in my meniscus, should I refrain from walking on it until surgery, in order to prevent further cartilage damage? Thank you! SF,CA

[@UrviShah-hp7hq]

Hello, while checking lateral capsule and LCL(2.24min), pain should be on the outer side of the knee as you applied varus stress,then why she is complaining of inner/ medial side of the knee? In your previous videos, you did that test to check lateral capsule instability and LCL sprain. So my question is”Varus stress test is for to identify medial side abnormalities or lateral?”

[@OrthoEvalPal]

While it stresses the outer side of the joint it compresses structures on the inside of the joint

[@UrviShah-hp7hq]

@@OrthoEvalPal got you, thank you 🙏

[@khalidkhalid9335]

why not check the meniscus?

[@OrthoEvalPal]

I did in the full eval. When I do it all over for the video I cut it down a bit for the patient's sake.

[@sarabjeetkaur2099]

How to reduce that effusion?

[@OrthoEvalPal]

Compression and elevation are the best ways. NSAID's can help also.