Total knee Replacement & Total Hip Replacement

Data patient:

Name : Mrs. N.H

Age : 74 years old

Live : Melbourn, Australia.

Identity and X factor

- kind person

- if talk with her little louder

- quickly talk and little difficult to understanding

- 1 years ago her husband died so she still sad

- she have hobby reading book

History patient:

Patient came to clinic at june 24 2014. Early about 14 month ago operation in the knee left (TKR) side after that took operation in the right side of hip(THR)

Goal :

Patient back to Australia with good feel, there was no pain and absolutely happy.

Complaint

-       She feel there was something bounce in her knee and there was stiffness.

-       Antalgic gait or lyimping gait

-       Baker cycst

-       Leg Lenght Discrepancy so appears left longer than other.

Diagnosis

THR( Total Hip Replacement) on theright side and TKR(Total Knee Replacement) on the left side.

Treatmen:

1.       Massages. We can give in the left foot on knee and right side on the hip and on the knee

2.       LOS(Leg On Shoulder). In this position make massages on the posterior side more easier beside can give US. With LOS make knee Open Chain Position so Wave of the US can directly touch in to articulation.

3.       Traction. Traction to latero caudal way on the right hip, traction from the knee with flexion position also can give traction from the ankle combine with inrotasion or eksrotasion.

4.       US if there was scar tissue.

5.       Exercise focus on body and brain awareness it always be maintanance, propioseptif and balance.

Read More

PES Anserinus Bursitis

1.       Data patient

Miss G and have age about 18 years old. She live in jakarta, indonesia. Her hobby is play rugby. She have target in this september she must go jerman to contiune her study. She is kind girls, easygoing, and cheerfull.

2.       History patient

One years ago when she was playing rugby her friend fall and directly touch her knee on semi fleksion position. After that she check her condition in RS.O with diagnose menicus, MCL and LCL on the left side. Then doctor suppose her to take physical therapy. It took about 3 month, she was given US, Diatermy and SWT. She feel uncomfortable with her knee even she can’t to stand or walking around. Her family brought her to sensei and she can walk, to make sure about her condition. Her family took therapy in singapore which have specifical in knee joint. From the MRI have conclusion that Meniscus and ligamen better. Dokter in singapore give advice to take therapy which location near with home and have good effect for her condition. Now she feel knee pain, when bending knee pain, unstabil when lounges, baker cycst and little swollen.

3.       Diagnosis and basic concept.

PES Anserinus Bursitis

Basic Concept  :

Knee intracapsular there were sinovial fluid, meniscus, ligament and cartilages. Ekstracapsular there were muscle tendon, in the medial side is PES anserinus( semitendinosus, gracilis, and sartorius) have function as stabilitaion in medial knee beside of the MCL and which have function mover join call VMO (Vastus medial oblique). In the lateral side call ITB( illio tibial band) beside of the LCL have same function with it. PES anserinus Bursitis is condition which show there pain in medial proximal tibia, if we palpate location feel soft.

4.       Goal Patient :

She wanna be condition before injury, she want to run quickly as before.

5.       Treatmen

For the fist time treatmen PT still confuse this condition have stiffness around the knee and the symtomp was like PES anserinus Bursitis and sometimes she feel pain on medial below of pattelar(medial tibia proximal). So for the treatmen depend of her condition but the PT have plan treatmen (protocol) such as :

a.       Fisrt week for healing proses and rest, this week have priority for relief symtomatic problem.

b.      Second week until third week for strenghtening static, balance, and propioseptif.

c.       Fourth week until sixth week for strenghtening program but more increase load like gym program.

d.      Seventh week until nineth week for sport specific

Combine treatmen there were massages can use flush efflurage, US, LOS (Leg On Shoulder) add with US, after massages use ice to control inflame. When we use US for acute condition intensity about 0,4 – 0,8 and 1 – 1,5 used for cronic condition, suppose to use continous wave. Time when use US about 1 minutes or depend on area and era US it self.

Exercise for the treatmen there are squat( double leg squat/ single leg squat), lounges on stepper, lounges on magic box, crab squat with terabend, use wobble board closed eyes or opened eyes. The most important thing is alignment when exercise going on.

Read More