Marjon Clinic – 21st April 2021 for 2 hours

Within these two hours, I planned and conducted an online consultation with a client who had been experiencing locking and a deep ache in the right knee.

Reflective Summary 

The clinical impression for this client is a medial meniscal tear within the right knee. Meniscal tears are normally traumatic where the mechanism of injury is characterised by twisting on a loaded flexed knee (McDermott, 2011). The client did experience trauma when they were 14, when they ran down a hill and slipped which is when the knee first jarred. More recently, since passing their driving test they experience a deep ache in the knee which has moved medial. Moreover patients with a meniscal tear tend to report mechanical symptoms such as popping, catching and locking (Doral, Bilge, Huri, Turhan & Verdonk, 2018), all of which the client has. An objective assessment should include examinations such as palpating for joint line tenderness as well as conducting McMurray’s, Apley’s and Thessaly’s special tests. I will also perform tests for ligamentous injuries as symptoms and physical findings for a meniscal injury are similar (Doral et al., 2018). Another thing to recognise is that the client has hyper-mobile knees; a study by Pacey, Nicholson, Adams, Munn and Munns (2010) identified that those with generalised hyper-mobility are at an increased risk of knee joint injury (Konopinski, Jones & Johnson, 2012). This is because most knee injuries occur at the end of extension range. With regards to treatment, strengthening the hamstring muscles may be of use as they provide some active restraint to the end range of knee extension, however their moment arms are small so they are unlikely to provide sufficient torque to restrain extension (Pacey et al., 2010). Expert opinions also recommend that dynamic stability of hypermobile joints should be improved (Pacey, Tofts, Adams, Munns & Nicholson, 2013).

What Went Well

I believe I asked all the correct questions required within the subjective assessment section which allowed the notes to be very detailed. I was also able to select the appropriate exercises based off of clinical findings.

Areas for Improvement Action Plan
Always ask the client if there was any previous trauma when presenting with any injury (even if appears a gradual onset). With the next client I see, check for any trauma to the injured site.
Ensure internet connection is optimal. Next time I have an online consultation, ensure my internet is working sufficiently to get the most out of the online consultation.

Closing the Loop

Since writing this reflection, I ensure that I check if the client has had any trauma, even if it was not necessarily considered to be  ‘recent’.

References

Doral, M. N., Bilge, O., Huri, G., Turhan, E., & Verdonk, R. (2018). Modern treatment of meniscal tears. EFORT open reviews, 3(5), 260-268.

Konopinski, M. D., Jones, G. J., & Johnson, M. I. (2012). The effect of hypermobility on the incidence of injuries in elite-level professional soccer players: a cohort study. The American journal of sports medicine, 40(4), 763-769.

McDermott, I. (2011). Meniscal tears, repairs and replacement: their relevance to osteoarthritis of the knee. British journal of sports medicine, 45(4), 292-297.

Pacey, V., Nicholson, L. L., Adams, R. D., Munn, J., & Munns, C. F. (2010). Generalized joint hypermobility and risk of lower limb joint injury during sport: a systematic review with meta-analysis. The American journal of sports medicine, 38(7), 1487-1497.

Pacey, V., Tofts, L., Adams, R. D., Munns, C. F., & Nicholson, L. L. (2013). Exercise in children with joint hypermobility syndrome and knee pain: a randomised controlled trial comparing exercise into hypermobile versus neutral knee extension. Pediatric Rheumatology, 11(1), 1-12.

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