TKR

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TKR - February 28, 2007 12:23:00 PM

jsalva

Posts: 46
Joined: December 22, 2005
Status: offline

I have a pt with (R) TKR s/p 8 weeks. He has fair PROM (0-110), and good patellar mobility, but is having difficulty progressing with strength and function.

He gets a lot of stabbing pain to the posterolateral aspect of the knee, and shooting pain to his HS and achilles. The biceps femoris and lateral gastroc are very tender to palpation, and cause pain with stretching, or contraction. He also reports increased pain when wearing dress shoes (slight heel)

I have tried STM, ASTYM, stretching, knee and fibular mobilizations without any success. Can anyone offer insight/suggestions?

Thanks in advance.

John

Post #: 1

Re: TKR - March 1, 2007 2:26:00 AM

Shill

Posts: 1098
Joined: February 13, 2003
From: Madison WI USA
Status: offline

Hi John,
Was there a flexion contracture prior to the TKA ? If so, the neural, tendinous, and capsular structures are still trying to adjust to their new lengths, and 8 weeks is not necessarily a long time. Patience, gentle extension and strengthening within the comfort zone is still the way to go. Make sure of course that he is still achieving full extension, in positions that dont yank on the sciatic or tibial, or peroneal nerves much, might help. (Prone lying, perhaps with some hip extension if tolerated, or Prone on elbows) The slight heel pain may be due to a relative state of hyperextension (neutral can be this relative state, with the soft tissues being so used to prior shortened state).

I think you are doing the right stuff, although I would add ice to this region as well. Its a great pain reliever.

Steve

_____________________________

Steve Hill PT

(in reply to jsalva)

Post #: 2