case presentation acl 1
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7/23/2019 Case Presentation Acl 1
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Case presentation
Post Reconsrtruction
ACL InjuryBy: Nurdina afni izamudin
(031390) diploma fsioterapi
unisza
7/23/2019 Case Presentation Acl 1
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PHYSIOTHERAPY AX.
• Name:r. A
• A!e: "# years o$%
• Se&: a$e
• 'ate o( re(erre%:"). *une +,"-• 'ate o( A&.: ).Au!ust.+,"-
• 'r. : Lt. ACL tear an% meniscus injury
• 'r. &.:operatie/ post recon.01 2ee3s a!o4
conseratie/ re(er p5ysio
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S67*ECTI8E A&.
• Pro9$em: pt. co 2ea3ness Lt.LL.
• Pain sca$e: NIL
2ea3ness
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• Current H&.: 5o su%%en stop an%c5an!e %irection %urin! p$ayin!
(oot9a$$ since + years a!o. ;ra%ua$$yincrease pain a9out " 2ee3s an%2ent to H' t5en trans(er to HSN< on
t5e same %ay (or (urt5er m&. 'oneRI. 'r. %ia!nosis Lt. ACL tear an%meniscus injury. Pt. re(er (or ACLreconstruction. 'one reconstructionon *une +,"-. On 9races (or +2ee3s.'r. re(er 5im to p5ysio (or(urt5er m&.
• Past H&.: NIL
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• Specia$ =uestion:
Occupation:Stu%ent
House: Sin!$e storey 5ouse current$y stay at 5oste$.
Toi$et: S=uattin!
• I&.:
X>rayme%icationRI
'one + years a!o 9e(ore recon.Resu$t: Lt ACL tear an% meniscus
injury.
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• ?&. Actiity
pt. %i@cu$t to c$im9 up an% 2a$3in!
%o2n stairs.pt. (ee$ 2ee3 25en pro$on! 2a$3in!
an% stan%in!
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O7*ECTI8ES A&.
• ;enera$ o9seration: A me%ium siea$ay a$e come to %epartmentin%epen%ant$y. Norma$ !ait. Norma$
posture.
• Loca$ o9seration:
re%ness
%ry s3in Lt. 3nee
s2e$$in!
ms. 2astin! at Lt. t5i!5
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scar at ant. Part o( Lt. 3nee 0) cm4
%e(ormity at Lt.LL
open 2oun% at Lt. LL
9ruisin! at Lt. LL
• Pa$pation:
increase in 2armt5 at Lt. (oot
ten%erness Lt. LL
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O7*ECTI8ES A&.
• ;enera$ o9seration: A me%ium siea$ay a$e come to %epartmentin%epen%ant$y. Norma$ !ait. Norma$
posture.
• Loca$ o9seration:
re%ness
%ry s3in Lt. 3nee
s2e$$in!
ms. 2astin! at Lt. t5i!5
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• RO: *t. ot. ARO 0 4 PRO 0 4
Rt. Lt. Rt. Lt.
Hip ?$e&.E&t.A9%.A%%.Int. rot.
E&t. rot.
A?RO
A?RO
Bn. ?$e&.E&t.
A?RO
A?RO
An3. 'orsie&.P$antare&.
InersionEersion
A ?
R O
A?
RO
A?
RO
A?
RO
A?RO o( 9i$atera$ LL.
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• s. po2er
*t. ot. Lt. Rt.
Hip ?$e&orE&tensorA9%uctorA%%uctorInt. rotatorE&t. rotator
D-
D)
Bn. ?$e&orE&tensor D- D)
An3. 'orsie&orP$antare&orInersionEersion
D-
D)
ms. Po2er o( Rt. LL %t pro$on! immo9i$ise%
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• s. !irt5
?romsuprapatte
$a
Rt.0cm4 Lt.0cm4 0cm4
8astusme%
ia$is 0)cm4
-+ F -
Gua%riceps 0", cm4
-) -+
Harmstrin! 0") cm4 - - -
ms. 2astin! o( Rt. t5i!5 %t $ac3 o( actiity
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ANALYSIS
• Pro9$em i%entication:
". ms. Po2er o( Lt. LL %t pro$on!immo9i$ise%
+. ms. 2astin! o( Lt. t5i!5 %t $ac3 o(actiity
. ?unctiona$ actiity %t ms.2ea3ness.
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• S5ort term !oa$
". ms. po2er o( Lt.LL 2it5in )+
+. ms. 2astin! o( Lt. t5i!5 2it5in )+
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• Lon! term !oa$
". To re!ain (unctiona$ actiity
+. To maintain en%urance
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PLAN O? TX.
". Stren!t5enin! e&s.+. *t. sense
. HEP
-. Pt. e%ucation
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Interention
• Stren!t5enin! e&s.
• pt. sitt./ =ua% 9enc5 e&s. 0" 3!4 atLt. =ua%/ 3n.e&t./ 5o$% ", sec/ ")rept. J set.
• pt. 5i!5. sitt./ t5era9an% 0ye$$o24atLt.(oot/ %orsie&./ 5o$% ", sec/ ")rept.
•
pt.5i!5. sitt./ t5era9an% 0ye$$o24 atLt.(oot/p$antare&./ 5o$% ", sec/ ")rept.
• Cyc$in! e&s./ +,K.
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• *t. Sense e&s.
• pt. stan%.on 2o99$e9oar%/ ")K.
• HEP
• ;ie e&s. pamp$et to pt.
•
As3 pt. to %o a$$ prescri9e e&s. at5ome
• Pt. e%ucation
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E8AL6ATION
• pt. !ie cooperation to %o a$$ e&s.
• pt. (ee$ increase stren!t5 o( Lt. LL.
•
Pt. (ee$ $i!5t o( Lt. LL compare to9e(ore e&s.
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RE8IE
• Reie2 ms. !irt5 o( Lt. t5i!5 on ne&tt&.
• Repeat interention on ne&t t&.
reie2
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?o$$o2 up
• Name: r. A
• 'ate o( A&.: "#. Au!ust. +,"-
S: Pro9$em: pt. co 2ea3ness Lt.LL.
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O7*ECTI8ES A&.
• ;enera$ o9seration: A me%ium siea$ay a$e come to %epartmentin%epen%ant$y. Norma$ !ait. Norma$
posture.
• Loca$ o9seration:
re%ness
%ry s3in Lt. 3nee
s2e$$in!
ms. 2astin! at Lt. t5i!5
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scar at ant. Part o( Lt. 3nee 0) cm4
%e(ormity at Lt.LL
open 2oun% at Lt. LL 9ruisin! at Lt. LL
• Pa$pation:
increase in 2armt5 at Lt. (oot
ten%erness Lt. LL
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• RO: *t. ot. ARO 0 4 PRO 0 4
Rt. Lt. Rt. Lt.
Hip ?$e&.E&t.A9%.A%%.Int. rot.E&t. rot.
A?RO
A?RO
Bn. ?$e&.E&t.
A?RO
A?RO
An3. 'orsie&.P$antare&.InersionEersion
A ? R O
A?RO
A?RO
A?RO
A?RO o( 9i$atera$ LL.
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• s. po2er
*t. ot. Lt. Rt.
Hip ?$e&orE&tensorA9%uctorA%%uctorInt. rotatorE&t. rotator
D-
D)
Bn. ?$e&orE&tensor D- D)
An3. 'orsie&orP$antare&orInersionEersion
D-
D)
ms. Po2er o( Rt. LL %t $ac3 o( e&ercise.
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• s. !irt5
?romsuprapatte
$a
Rt.0cm4 Lt.0cm4 0cm4
8astusme%
ia$is 0)cm4
-+ #
Gua%riceps 0", cm4
-) - +
Harmstrin! 0") cm4 - --
ms. astin! o( Lt. t5i!5 %t $ac3 o( actiity
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ANALYSIS
• Pro9$em i%entication:
". ms. Po2er o( Lt. LL %t $ac3 o(e&ercise
+. ms. 2astin! o( Lt. t5i!5 %t $ac3 o(actiity
. ?unctiona$ actiity %t ms.2ea3ness.
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• S5ort term !oa$
". ms. po2er o( Lt.LL 2it5in )+
+. ms. 2astin! o( Lt. t5i!5 2it5in )+
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• Lon! term !oa$
". To re!ain (unctiona$ actiity
+. To maintain en%urance
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PLAN O? TX.
". Stren!t5enin! e&s.+. *t. sense
. HEP
-. Pt. e%ucation
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Interention• Stren!t5enin! e&s.
•
pt. sitt./ =ua% 9enc5 e&s. 0".) 3!4 at Lt.=ua%/ 3n.e&t./ 5o$% ", sec/ ") rept. J set.
• pt. 5i!5. sitt./ t5era9an% 0ye$$o24at
Lt.(oot/ %orsie&./ 5o$% ", sec/ ") rept.• pt.5i!5. sitt./ t5era9an% 0ye$$o24 at
Lt.(oot/p$antare&./ 5o$% ", sec/ ")rept.
• S=uattin! e&s./ 5o$% ", sec/ ", rept. J set.
• Cyc$in! e&s./ +,K.
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• *t. Sense e&s.
• pt. stan%.on 2o99$e9oar%/ ")K.
• HEP
• As3 pt. to %o a$$ prescri9e e&s. at5ome a!!rise$y.
• Pt. e%ucation
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E8AL6ATION
• pt. !ie cooperation to %o a$$ e&s.
• pt. (ee$ increase stren!t5 o( Lt. LL.
•
Pt. (ee$ $i!5t o( Lt. LL compare to9e(ore e&s.
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RE8IE
• Reie2 ms. po2er o( Lt. t5i!5 onne&t t&.
• Repeat interention on ne&t t& an%a%% more a!!ressie e&s.
reie2
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