Case Study – Knee Fixed Flexion Deformity

January 16, 2019 | By | Reply READ MORE...

– Drashti Jogani

Sara 18 year old girl came to PHYSIOREHAB with inability to straighten the left knee and attempting to straighten would give her pain around the knee cap. Being a medical student she has to stand and walk around extensively.

MECHANISM OF INJURY:

During a college event, had to climb stairs and run around frequently every day for 2 weeks. Though, doesn’t remember twisting the knee.

AGGRAVATING FACTORS:

  • Standing > 15-20 minutes
  • Walking >10 minutes
  • Sit to stand for more than 1 hour of sitting.

RELIEVING FACTORS:

Icepack.

ORTHO VISIT:

Sara visited the local doctor and he advised physiotherapy.

ON PALPATION:

Tenderness at left inner side of the knee joint and lower part of the knee cap.

ON EVALUATION:

  • Stands with left knee bent at 20 degree
  • Limps on walking
  • High arched feet left> right
  • Functional assessment: In all the standing tests the left knee remained bent with poor control of core and buttock muscles.
  • Left hamstring muscle tighter than right (not allowing the left knee to straighten completely)
  • Girth of left quadriceps(front thigh) muscle showed a difference of 1.5 cms.
  • She rotated her hip inside much more than outwards while walking. L>R
    cs_knee-fixed-flexion-deformity-01

WHAT IS KNEE FIXED FLEXION DEFORMITY?

Inability to straighten the knee and the knee looks bent in all the positions is called a fixed flexion deformity or fixed flexion contracture.

Normal range of the knee 0-140.

CAUSES OF FIXED FLEXION DEFORMITY:

  • It can be associated with joint erosion like osteoarthritis, Changes in the normal anatomy like osteophytic lesion, cystic lesion, scar tissues, tightness of hamstrings muscle, few others like inflammatory conditions like burn-scars, intra-articular fractures, septic arthritis, juvenile RA neurological conditions like cerebral palsy.
  • Bio-mechanical dysfunctions (altered movement pattern).

cs_knee-fixed-flexion-deformity-02 cs_knee-fixed-flexion-deformity-03

DIAGNOSIS:

Reflex muscle spasm caused due to loading of the knee and capsular tightness.

TREATMENT:

We at PHYSIOREHAB designed a specific exercise regime of 10 weeks for Sara.

  • First 2-4 weeks we focused on managing her pain and improving her knee range by trigger point release of distal hamstrings muscle, electrotherapy like Ultrasound and kinesiotaping to support her knee .
  • At home she was asked to maintain her knee range by gentle capsule stretch and specific quadriceps muscle strengthening exercises earlier with brace on and later progressing to without it.
  • We emphasized on specific gluteus and core strengthening functional exercises and constant reinforcement was given to make her gait pattern better.
  • After she was pain free started with her functional exercises with therabands for strengthening, started with her balance and proprioception exercises.

cs_knee-fixed-flexion-deformity-04 cs_knee-fixed-flexion-deformity-05Straight leg raise

cs_knee-fixed-flexion-deformity-06Squats

After the completion of tailor made rehab program of 2 months, which included treating not only her main problem of inability to bend and straighten her knee but also worked on the other bio-mechanical dysfunctional aspects like in toeing gait, high arched foot , she was pain free in performing her activities of daily living and was able to weight bear on her left leg and regained her confidence in walking, running.

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Category: Case Studies

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