Knee Contractures
I am a physical therapist who recently evaluated a patient for inpatient short-term rehab S/P acute anteroseptal MI. Upon evaluation, I learned that this was only one of many problems. He presented with "Housemaid's Knees". This he aquired from crawling around his home for the past two years on his hands and knees. He states he had a gradual deterioration of ambulation and then just stopped walking. He eludes to an old hamstring injury that he feels started it all. Upon a ROM evaluation, I noted that he had near 90 degree flexion contractures in both knees, severe limitaions in both hips, and ankles that were locked in almost neutral. This gentleman's goal is to be able to stand with crutches and possibly ambulate around his home. Because of the severity of his contractures, I told him standing was not an option at this point until we could reduce the severity of his contractures. We currently are utilizing moist heat followed by ultrasound to the hamstring tendons. After the modalities we passively stretch him sideline with deep pressure applied to the tendons. I am exploring the possibility of dynamic splinting but want to wait and see if his doctor will order him a medication (ie. muscle relaxer) so that he could tolerate the splinting without cramping or spasms. My question is to know if we are on the right path: is a muscle relaxer going to be helpful? What other options does he have? What can we expect with the history and severity of the contractures? Should his "Housemaid's Knees" be seen by an orthopedic surgeon? This man is a young 72 and is really looking for some help. Any advice you could give us would be appreciated. Thank You. Sincerely, Kiersten Ryndak, P.T.
From:
ryndak@localnet.com
