Case study. 🧵 58yo gardener. 2 year Hx of increasing left knee pain. Difficult to work, unable to squat. Pain with stairs. Waking at night. 🚶 tolerance of 10-15 minutes. XR/MRI confirms OA, with bilat narrowing and Gd 3/4 changes. #physiotherapy #physicaltherapy #MSK 1/ - ThreadSky

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camtudor.bsky.social • 105 days ago

Case study. 🧵 58yo gardener. 2 year Hx of increasing left knee pain. Difficult to work, unable to squat. Pain with stairs. Waking at night. 🚶 tolerance of 10-15 minutes. XR/MRI confirms OA, with bilat narrowing and Gd 3/4 changes.
#physiotherapy #physicaltherapy
#MSK 1/

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camtudor.bsky.social•105 days ago

Wait listed for arthroplasty and referred for physio in the interim. Physio included; one in person consult, a sheet of exercises, advice to 🚶more, and 6 group exercise classes. 3/12 later, no better and resigned to a TKR. 2/

camtudor.bsky.social•105 days ago

Came for 2nd opinion. Examination: 120 degrees flexion. Fixed flexion deformity of 5-10 degrees. Quads atrophy++ Tender joint lines. Small effusion. Poor single leg balance. Unable to sit to stand without support..3/

camtudor.bsky.social•105 days ago

Impression: His arthritic knee was impacting quality of life and ability to work. Arthroplasty was a reasonable option, but to proceed before more comprehensive physio/rehab is questionable. Failure to improve from an OA class is not a failure of physio. 4/

camtudor.bsky.social•105 days ago

But...with established flexion contracture, night pain, substantial loss of range and function, and > 12/12 Hx of pain it can be challenging to get good conservative outcomes without complete patient commitment to a difficult rehab program. 5/

camtudor.bsky.social•105 days ago

What did we do? Five key pillars.

1. Educate. In detail. To succeed, patients with moderate/advanced knee OA need to embark on a fairly demanding rehab program. So they need to understand their condition and the reasoning behind everything they'll be doing. 6/

camtudor.bsky.social•105 days ago

2. Medication: 1/12 course of Naproxen. Oddly, had not tried NSAID’s previously. Immediately helped his night pain. Sleep is important for many reasons, but it’s particularly important during intensive rehab, and can help break a pain cycle. 7/

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