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Increased tone with no real reason?

 
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Increased tone with no real reason? - February 18, 2016 10:36:13 AM   
NDomino

 

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Hello, I have a patient that has a very strange presentation. She came in for eval with a generic R knee pain script. She came in and she was walking with R LE circumduction, and an inability to actively flex the knee or DF the ankle. There is definitely increased tone in the Quadriceps and Gastroc on the R side. Pt is able to bend the knee with assistance but remove that assistance and the knee locks right back out. There is no spasms with motion. With MET i can get her to up to 110 deg of knee flexion though she demonstrates co-contraction of hamstrings and quads with any stretching. I sent her back to her doctor twice because of this and all they did was a doppler (which found a bakers cyst, as if that explains it) and they keep sending her back. There is no other symptoms and she has no real red flags in her medical history and is not limited in any other way beyond this.

Anyone have any ideas what it could be? Any help would be appreciated, it is baffling myself and the other PT here at the clinic.
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RE: Increased tone with no real reason? - February 22, 2016 12:06:01 PM   
Tom Reeves DPT ATC

 

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probably just in subconscious max protect mode. Baker's cyst suggests some intra-articular effusion. the lizard brain is protecting the knee by doing co-contractions of mm that surround the joint. reassure them that its not serious, then give them exercise to do that is non-provocative. that will most likely reduce the threat level and the tone will go away.

(in reply to NDomino)
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