pain first, with symptoms progressing to the groin or medial thigh pain over a span of months to years (Dorman, 2016). Thus, differential diagnosis is important in these cases. Patients may have been improperly diagnosed with a groin strain, or with mechanical knee pain, and sent to physical therapy. If knee pain becomes progressively worse in the absence of continued trauma, a reasonable suspicion of SCFE should be elicited and discussed with the child’s physician (OrthoInfo, n.d.c). Initial treatment begins with surgery, usually within 24 to 48 hours of diagnosis, and varies depending on the degree of slippage. Most procedures involve placing a screw through the femoral epiphysis, with highly displaced slips requiring additional screws (OrthoInfo, n.d.c). Physical therapy treatment may be prescribed following surgery and should consist of hip strengthening, aerobic conditioning, and gait and balance training. Juvenile rheumatoid arthritis Juvenile rheumatoid arthritis (JRA), also referred to as juvenile idiopathic arthritis, is the most common form of arthritis diagnosed in children under the age of 16. The disease causes pain, stiffness, and swelling in the joints (Mayo Clinic, 2017). Once diagnosed with JRA, the child or adolescent is often medically managed with aspirin or NSAIDs to relieve symptoms. Corticosteroid injections may be administered for temporary relief of synovitis, and disease-modifying antirheumatic drugs (DMARDs) may be used to reduce or prevent joint damage from JRA, prevent loss of function, and alleviate pain. These pharmaceuticals including methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide are considered standard of medical care for JRA (Mayo Clinic, 2017). Physical therapy treatment is often prescribed to address pain, range of motion restrictions, and to educate the child and family in joint protection. Splints and braces may be used for joint protection as well.
femur. This results in poor blood supply, possible avascular necrosis, and disturbance of the physeal plates, which may manifest as a shortened femoral neck and trochanteric overgrowth, among other femoral head deformities. It is most commonly diagnosed in boys aged 4 to 10, and the first sign is generally a limp. Some patients with Perthes disease experience bone remodeling typical of natural development and, therefore, experience reduced symptoms without additional treatment. Those without natural bone remodeling and subsequent femoral neck and head deformity are known to experience degenerative joint disease in long-term retrospective studies. The most important prognostic factor in outcome is residual deformity of the femoral head and resulting hip joint incongruity (Dorman, 2016). Recommended physical therapy treatment for youth aged 3 to 12 with identified Perthes disease includes balance activity, gait training, lower extremity strengthening exercises, and range of motion exercises (Karkenny, 2018). Slipped capital femoral epiphysis Slipped capital femoral epiphysis (SCFE) is a disorder in which the capital femoral epiphysis is displaced through the physeal plate. It occurs more often in children and adolescents age 10 and older, and more commonly in males than females. Endocrine abnormalities, such as hypothyroidism and treatment with growth hormones, have a tendency to weaken the physis thereby increasing the frequency of SCFE (Dorman, 2016). This impairment is classified into three categories based upon patient presentation and radiographic findings: mild, moderate, and severe (Dorman, 2016). The slip may also be classified as stable or non-stable. Acute slips are those that are found within 2 weeks of symptom onset. The pain experienced from the acute slip is usually enough to prevent weight bearing, and if the patient can walk, it is generally with a limp. Patients with chronic-slipped capital femoral epiphysis often present with a history of knee or lower thigh
OUTCOME MEASURES FOR THE KNEE
to the lower extremities. Additionally, it takes into consideration pain, symptoms, sports and recreation, and quality of life. ● Lower-extremity functional score (LEFS) : This outcome measure is applicable to all lower-extremity impairments and has a minimum clinically significant difference of 9 points. ● Lysholm knee scale : This is a 10-point questionnaire covering pain and symptoms including swelling, locking, ambulatory device, stair climbing, and squatting. It is quick to score, but it is very specific regarding symptomology and does not include many functional measures.
As with the hip, there are several outcome measures for the knee that are used to establish baseline scores and track changes over time. Some of these tools are self-report and some are administered by a physical therapist or other qualified examiner. The following are some of the most widely used and validated tools: ● Knee injury and osteoarthritis outcome score (KOOS ): This is a scale measuring pain, functional ability, quality of life, and sport and recreation participation. A higher score indicates fewer problems. ● Rheumatoid and Arthritis Outcome score for the lower extremity (RAOS ): The RAOS, an adaptation to the KOOS, evaluates functional limitations of individuals with inflammatory joint diseases and impairments
KNEE PATHOLOGIES AND EVIDENCE FOR INTERVENTIONS
Knee pain and impairments require thorough and complete assessment in order to develop a plan of care. Mobility and motor control of the knee should be evaluated in Knee osteoarthritis The diagnosis of knee osteoarthritis is used to describe a prevalent form of DJD and is a complex disease involving varied structural processes occurring at the knee joint. As the population of Americans ages, the incidence rate is expected to increase significantly, with current statistics revealing that 30% of adults over age 60 demonstrate functional difficulties with tasks such as rising from a chair and ambulating on stairs due to knee OA (Currier et al., 2007). Even though the incidence rate increases
conjunction with the hip and the foot due to their roles in ambulation.
with age, OA is not thought to be simply a normal part of aging (Swagerty & Hellinger, 2001). Obesity and a history of traumatic knee injury (e.g., anterior cruciate ligament rupture and/or meniscal tear) are key risk factors for the accelerated development of knee OA. Hallmark signs include patient-reported pain and radiographic evidence of osteophyte formation on the joint surface. There has been significant discussion and research aimed at determining the link between the patient’s report of
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