Medial Menisci Tear

Short Case
Wahyu Sita Wardani

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 Patient Identity
Name Mr. Reynaldi
Age 27 years old
Sex Male
Address Cipta Menanggal I/16 Surabaya

Religion Christian
Ethnic Javanese
Occupation Operator for Telkom Call Center

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 History Taking
Referred from Orthopedic Department
Outpatient Clinic with Left Knee Medial Menisci
Injury. Mohon dilakukan Fisioterapi.

Chief Complaint: Nyeri lutut kiri ketika lari

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 History of Present Illness

He felt pain at left knee since 7 months ago, the pain felt
when hes doing running in sport activity. (VAS 3). The pain
didn`t radiate. The pain decreased when he walked or take
a rest.
Hes got a traditional massage twice as a treatment for his
pain but there was no improvement at that time.
About 3 months ago, hes got an injury in a futsal game.
When he tried to turn his body, suddenly his knee felt
extracted and making klek sound. He felt pain at that
time (VAS = 7) but there was no swollen.
He take himself to get examined at an Orthopedist in Royal
Hospital, then suggested to take an MRI examination. And
from the result hes suggested to take a surgery.
No radiating pain, no stiffness, no tingling sensation, no
numbness, no fever.
 History of Past Illness
History of DM (-)
History of HT (-)
Theres no history of previous trauma
 Vocational History
He work as an operator for Telkom Call center
Mostly hes working by sitting to receive calls.
He work from 08.00 17.00
He work at the second floor in hes office building and always taking the
stairs when hes going to the 2nd floor.

Hes playing futsal twice a week , for about 1-2 hours, his position is a
striker
His hobby beside futsal is hiking, hes been going hiking twice (to
Semeru and Ijen Mountain) after he started to feel pain for the first
time. He did it with using a knee decker for his left knee.
He is also regularly doing static cycling for 15 minutes and walking in
treadmill for 10 minutes , once a week

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 Physical Examination
General State
Consciousness: CM Ambulation: Independent Gait: Normal

Right Handed W: 61,5 kg H: 171 cm BMI: 21

Vital Signs: BP: 120/80 mmHg RR: 20x/min
HR: 74 x/min
Head and Neck Anemic/Jaundice/Cyanosis/ -
Dyspneu
Thorax Heart/Lung N
Abdomen N
Extremities Warm at all extremities
Barthel Index 100 7
 Neurological State

Cranial Nerves I-XII N

Muscle Tone N
Deep Tendon BPR +2 | +2 KPR +2 | +2
Reflexes
TPR +2 | +2 APR +2 | +2
Pathological Hofmann - | - Babinski - | -
Reflexes
Tromner - | -
Sensory Deficits No sensory deficits

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 Musculoskeletal State
Region Movement ROM MMT
Neck Flex. Full (0-45) 5
Ext. Full (0-45) 5
Lat. Flex. Full (0-45)/Full (0-45) 5/5
Rot. Full (0-60)/Full (0-60) 5/5
Trunk Flex. Full 5
Ext. Full (0-30) 5
Lat. Flex. Full (0-35)/Full (0-35) 5/5
Rot. Full (0-45)/Full (0-45) 5/5 9
Region Movement ROM MMT
Shoulder Flex. Full (0-180) Full (0-180) 5 5
Ext. Full (0-80) Full (0-80) 5 5
Abd. Full (0-180) Full (0-180) 5 5
Add. Full (0-45) Full (0-45) 5 5
Int. Rot. Full (0-55) Full (0-55) 5 5
Ext. Rot Full (0-45) Full (0-45) 5 5
Elbow Flex. Full (0-150) Full (0-150) 5 5
Ext. Full (150-0) Full (150-0) 5 5
Pro. Full (0-80) Full (0-80) 5 5
Sup. Full (0-80) Full (0-80) 5 5
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Region Movement ROM MMT
Wrist Flex. Full (0-80) Full (0-80) 5 5
Ext. Full (0-70) Full (0-70) 5 5
Rad. Dev. Full (0-20) Full (0-20) 5 5
Ulnar Dev. Full (0-30) Full (0-30) 5 5
Finger Flex. Full (0-90) Full (0-90) 5 5
MCP Ext. Full (0-15) Full (0-15) 5 5
Abd. Full (0-20) Full (0-20) 5 5
Add. Full (20-0) Full (20-0) 5 5
PIP Flex. Full (0-100) Full (0-100) 5 5
Ext. Full (100-0) Full (100-0) 5 5
DIP Flex. Full (0-90) Full (0-90) 5 5
Ext. Full (90-0) Full (0-180) 5 5 11
Region Movement ROM MMT
Thumb Flex/Ext Full (0-50) Full (0-50) 5 5
MCP Abd/Add Full (0-50) Full (0-50) 5 5
Opposition 5 5
IP Flex/Ext Full (0-90) Full (0-90) 5 5
Hip Flex. Full (0-125) Full (0-125) 5 5
Ext. Full (0-30) Full (0-30) 5 5
Abd. Full (0-45) Full (0-45) 5 5
Add. Full (0-20) Full (0-20) 5 5
Int. Rot Full (0-80) Full (0-80) 5 5
Ext. Rot Full (0-80) Full (0-80) 5 5
Knee Flex. Full (0-135) Full (0-90) 5 5
Ext. Full (135-0) Full (135-0) 5 5 12
Region Movement ROM MMT
Ankle Inver. Full (0-35) Full (0-35) 5 5
Ever. Full (0-25) Full (0-25) 5 5
Dorsal Flex. Full (0-30) Full (0-30) 5 5
Plantar Flex. Full (0-45) Full (0-45) 5 5
Toes Flex. Full (0-30) Full (0-30) 5 5
MTP Ext. Full (0-80) Full (0-80) 5 5
IP Flex. Full (0-50) Full (0-50) 5 5
Ext. Full (0-80) Full (0-80) 5 5
Big Toe Flex. Full (0-25) Full (0-25) 5 5
MTP Ext. Full (0-80) Full (0-80) 5 5
IP Flex Full (0-25) Full (0-25) 5 513
Inspection Deformities N/N
Inflammation Signs -/+
Redness, Rash -/-
Palpation Tenderness -/-
Crepitus +/+
Warmth -/+

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 Special Tests
Right Left
Patellar Grinding - -
Anterior Drawer Test - -
Posterior Drawer Test - -
Valgus Stress Test - -
Varus Stress Test - -
Compression Test - -
Distraction Test - -
Mc Murray Test - -
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 Right Left
Quadriceps Circumference (10 37,5 cm 36,5 cm
cm Above MTP)
Cruris Circumference (10 cm 32,5 cm 31,5 cm
below MTP)
Q Angle
- Non WB 15 15
- WB 15 15
Leg Length
- Apparent 98 cm 98 cm
- True 94 cm 94 cm

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Supporting Examination

X-Ray 17
Supporting Examination

MRI 18
Supporting Examination

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 Assessment
Clinical Diagnosis Left Knee Pain + Muscle Atrophy of
Left Lower Extremity + Medial
Menisci Tear of Left Knee

Functional Impairment -Left Knee Pain

Diagnosis -Left Lower Musle Leg atrophy
-Left Knee Medial Menisci Tear

Disability Felt pain when hes running in

playing futsal
Handicap

Problem List
Surgical: Planninng for surgery from Orthopedic Department
Medical: Left Knee Pain + Muscle Atrophy of Left Lower Extremity +
Left Knee Medial Menisci Tear 20
 Rehabilitation
R1 (Mobilization) Pain in running activity
R2 (ADL) No problem
R3 (Communication) No problem
R4 (Psychology) No problem

R5 (Social Economy) No problem

R6 (Vocational) Pain when doing sport activity (running)
R7 (Other) Pain on left knee
- when hes running (since 7 months ago) : VAS
3
-when hes got injury : VAS 7
Atrophy on left leg
Warmth in medial part on left knee
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 PLANNING
Diagnostic Muscle Contraction Examination Left Vastus Medial Oblique and
Left Vastus Medial Lateral Using Biofeedback (in next 2 weeks)
Therapeutic Modality: Therapeutic Exercise:
-Laser 0,5-1 Joule/cm -Isometric strengthening exercise :
at medial part of the Quadriceps Sinistra
knee
-Icing at the medial
part of the knee using
Cool Pack for 15
Minutes
-ES at Vastus Medial
Oblique Muscle for 15
minutes
Monitoring Clinical (Pain at knee), VAS, Circumference, MMT, ROM,
Inflamations signs
Education Health Education/Home Exercise Programs
-Explain about patient condition
-Explain about knee joint conservation
-Isometric strengthening exercise at home
-Icing at the tender area 4-6x/day
-Not playing futsal, hiking, jogging until post rehabilitation after 22
sutrgery (6 months)
Summary
Reported Male Patient, 27 years old, referred from
Orthopedic Outpatient Clinic with Left Knee Medial
Menisci Injury.
The Chief complaint : nyeri pada lutut kiri ketika lari. He
first noticed the pain since 7 months ago only when hes
doing running activity (VAS=3). About 3 months ago, hes
got an injury in a futsal game when he tried to turn his
body, suddenly his knee felt extracted and making
cekluk sound (VAS=7). No radiating pain.
Hes examined by an Orthopedist in Royal Hospital, then
suggested to take an MRI examination. From the result
hes suggested to take a surgery.
From Physical examination,there was krepitation at both
knee, and there was difference in Quadriceps
circumference. There is warmth in palpation at the
medial part of the left knee.
Planning therapy are Laser at the medial part of the left
knee, icing at the medial part of the knee, ES at Vastus
Medial Oblique Muscle and isometric Left Quadriceps
Muscles strengthening exercise. Planning monitoring are
Clinical (Pain at knee), VAS, Circumference, MMT, ROM,
Inflamation signs
Planning education are knee joint conservation ,
isometric exercise and icing at the left knee and prevent
futsal, hiking, jogging until post rehabilitation after
surgery (6 months)
Thank You

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