Chondromalacia patella femoral joint (K1)
Inspection:
Tenderness: Tenderness patellofemoral joint. There is 1 prepatellar tenderness.
Swelling: None. Erythema: None. Deformity: None.
Palpation: Tenderness
Range of motion: Extension 0 degrees, flexion 140 degrees.
Effusion: Patella: None. Medial joint line: None. Lateral joint line: None. Patellar
tendon: None. Popliteal fossa: None.
Crepitus: 1+ crepitus in the patellofemoral joint with flexion and extension of the knee.
Muscle strength: Knee extension 5/5, knee flexion 5/5.
Neurovascular exam: Sensation to touch normal. Pulses: Dorsalis pedis posterior:
Normal. Posterior tibialis: Normal. Capillary refill time normal.
Special testing: McMurray’s: Negative. McMurray’s medial joint line: Negative.
McMurray’s lateral joint line: Negative. Black feet testing: Varus stress 0 degrees:
None. Varus stress 30 degrees: None. Valgus stress 0 degrees: None. Valgus stress 30
degrees: None. Lachman: None. Anterior drawer: None. Posterior drawer: None.
Pivot shift: None. Reverse pivot shift: None. Posterior lateral laxity: None. Patellar
compression test: Positive. Baker’s cyst: None palpable.
Gait: Normal.
Torn medial meniscus (K2)
Inspection:
Tenderness: 2+ tenderness medial joint line. Swelling: None. Erythema: None.
Deformity: None.
Palpation: Tenderness.
Range of motion: Extension 0 degrees, flexion 140 degrees.
Effusion: Patella: None. Medial joint line: None. Lateral joint line: None. Patellar
tendon: None. Popliteal fossa: None.
Crepitus: Patellofemoral joint: None. Medial compartment: None. Lateral
compartment: None.
Muscle strength: Knee extension 5/5, knee flexion 5/5.
Neurovascular exam: Sensation to touch normal. Pulses: Dorsalis pedis posterior:
Normal. Posterior tibialis: Normal. Capillary refill time normal.
Special testing: McMurray’s: Negative. McMurray’s medial joint line: Positive.
McMurray’s lateral joint line: Negative. Black feet testing: Varus stress 0 degrees:
None. Varus stress 30 degrees: None. Valgus stress 0 degrees: None. Valgus stress 30
degrees: None. Lachman: None. Anterior drawer: None. Posterior drawer: None.
Pivot shift: None. Reverse pivot shift: None. Posterior lateral laxity: None. Patellar
compression test: Normal. Baker’s cyst: None palpable.
Gait: Normal.
Impingement syndrome (S1)
Inspection: Deformity: None. Swelling: None. Erythema: None. Atrophy: None.
Asymmetry: None.
Palpation:
Tenderness: Neck: None. Trapezius: None. Clavicle: None. Acromioclavicular joint:
None. Periacromion: There is 2.1 to 2+ tenderness in the periacromion region. Lateral
deltoid: None. Anterior deltoid: None. Posterior deltoid: None. Anterior joint:
Anterior glenohumeral joint: None. Posterior glenohumeral joint: None. Biceps
tendon: None. Biceps muscle: None. Triceps muscle: None.
Range of motion neck: Flexion 100%, extension 100%, lateral bending left side 100%,
right side lateral bending 100%, rotation left side 100%, rotation right side 100%. Lateral
rotation with extension right side: 100%, lateral rotation with extension left side 100%.
Range of motion shoulder: Flexion, abduction 170 degrees. External rotation at 0
degrees. Abduction 60 degrees. External rotation at 90 degrees abduction, 100 degrees.
Internal rotation spinous thumbs reaches spinous process at T9. Extension 70 degrees.
Muscle strength
Muscle strength, neck: Flexion 5/5, extension 5/5, lateral bending left side 5/5, lateral
bending right side 5/5.
Muscle strength, shoulder: Supraspinatus isolation there is weakness to supraspinatus
isolation graded as 4/5 with pain. External rotation there 4/5 strength to external rotation
with pain.
Rotator cuff external rotation 5/5, internal rotation 5/5, biceps 5/5, triceps 5/5, deltoid 5/5.
Special tests:
Neck: Spurling’s maneuver: Negative. Cervical compression: Negative.
Shoulder: Cross-body adduction test. Near test: 1+ positive. Hawkins test 1+ positive.
Speeds test: Negative. O’Brien test: Negative. Jobes relocation test: Negative.
Anterior apprehension test (crank test) negative. Posterior apprehension test: Negative.
Inferior apprehension test: Negative. Sulcus sign: Negative. Lift-off test negative.
Crepitus with circumduction negative.
Neurovascular tests: Sensation: Neck normal. Shoulder normal. Brachium normal.
Forearm normal. Hands and fingers normal. Pulses: Radial 2+. Capillary refill digits:
Normal.
Elbow lateral epicondylitis (E1)
Inspection: Deformity: None. Carrying angle: Normal. Swelling: None. Erythema:
None.
Palpation: Increased warmth.
Tenderness:
Lateral epicondyle: 1+ tenderness.
Medial epicondyle: None.
Olecranon:
Bursa:
Posterior olecranon tip: None.
Volar forearm and dorsal forearm: None.
Range of motion ankle: Extension 0 degrees. Flexion: 140 degrees. Supination 80
degrees. Pronation 80 degrees.
Muscle strength examination: Wrist extension 4/5 with pain reported in the lateral
epicondylar region. Elbow flexion 5/5, elbow extension 5/5, forearm supination 5/5,
forearm pronation 5/5, wrist extension 5/5, wrist flexion 5/5. Forearm supination 4/5
with pain reported in the lateral epicondylar region.
Special tests: Valgus laxity: None. Posterior impingement test: (the balance test)
Negative.
Neurovascular: Brachium: Normal. Forearm: Normal. Hand and fingers: Normal.
Pulses: Radial 2+. Capillary refill normal.
Elbow medial epicondylitis (E2)
Inspection: Deformity: None. Carrying angle: Normal. Swelling: None. Erythema:
None.
Palpation: Increased warmth.
Tenderness:
Lateral epicondyle: None.
Medial epicondyle: 1+.
Olecranon:
Bursa:
Posterior olecranon tip: None.
Radiocapitellar joint: None.
Volar forearm and dorsal forearm: None.
Range of motion ankle: Extension 0 degrees. Flexion: 140 degrees. Supination: 80
degrees. Pronation: 80 degrees.
Muscle strength examination: Wrist flexion 4/5 with pain in the medial epicondylar
region and forearm pronation 4/5 with pain in the medial epicondylar region. Elbow
flexion 5/5, elbow extension 5/5, forearm supination 5/5, forearm pronation 5/5, wrist
extension 5/5, wrist flexion 5/5.
Special tests: Valgus laxity: None. Posterior impingement test: (the balance test)
Negative.
Neurovascular: Brachium: Normal. Forearm: Normal. Hand and fingers: Normal.
Pulses: Radial 2+. Capillary refill normal.
Risks and complications paragraph - LG1
A long discussion was carried out with the patient regarding the nature of the condition.
It was carried out with Dr. King. The patient was again given the choice of various
treatment alternatives, and surgical and nonsurgical options that were available. The
patient’s questions were answered, and with an expressed understanding of the risks and
benefits associated with both the surgical and nonsurgical treatment alternatives that were
available.
Knee joint aspiration (KING-KJA)
Following an explanation of the details and risks of the procedure the peripatellar region
was sterilely prepped with alcohol and Betadine. The skin and subcutaneous tissue were
then infiltrated with 2% lidocaine solution utilizing a 27-gauge needle. A 16-gauge
needle was then introduced into the joint itself. The knee joint fluid was aspirated.
Approximately ?? cc of fluid was obtained. The fluid was ?? in appearance. The needles
were withdrawn and a Band-Aid was placed over the injection site. The patient tolerated
this with minimal difficulty.
Synvisc injection knee (KING-SIK)
Following an explanation of the details and risks of the procedure the knee was sterilely
prepped with alcohol and Betadine. The skin and subcutaneous tissue were then
infiltrated 1-2 cc of 2% lidocaine plain solution utilizing a 30-gauge needle. A 22-gauge
needle was then introduced into the joint itself, and the joint was injected with 20 mg of
Synvisc. A Band-Aid was placed over the injection site. The patient tolerated this
procedure without difficulty.