Scenario 8 - Medial Collateral Ligament Sprain

Question 1

Demographics and Diagnosis,
45 Year old male
Salesman – Involves driving

Ligament injury, Medial aspect of the right knee on pain chart.
Valgus stress to right knee in collision with cycle.
2/52 ago, sub-acute stage of healing.

Answer 1

just the history, pick our the relevant facts

Question 2

MCL Anatomy and function?

Answer 2

Attaches proximally to Medial femoral epicondyle and distally to the medial tibial surface. Also has meniscal attachment.
Primarily stabilises the knee in valgus and external rotation.
Blow exceeding MCL strength to the lateral aspect of knee will cause a sprain.
Sprain is 2/52 old - sub-acute stage of healing

Question 3

Stage of healing and patho?

Answer 3

Decrease in inflammation
Growth of scar tissue
Formation of collagen fibres in a random order
Formation of new local blood vessels

Question 4

Subjective and Objective Markers

Answer 4

Subjective
VAS score 5/10 on movement
Pain whilst driving

Objective
Active and Passive Range of Movement
Accessory Movements

Question 5

Ax choice?

Answer 5

Valgus Stress Test
Patient laying supine.
Test with knee in 20-30 degrees flexion only as can not get full extension.
Apply an abduction force to the lower leg.
Compare right knee with left.
Positive test will be excessive laxity/movement in the joint.
Check other structures such as Anterior and Posterior Cruciate Ligaments and Menisci. Using Anterior/Posterior draw tests and Apley’s Compression/distraction test respectively.

Question 6

Treatment?

Answer 6

Joint Mobilisations.
Valgus stress
Decreases pain (stimulates mechanoreceptors and decreases nociceptor firing.
Increases circulation
Grade determined by P<P
30 seconds x 3 reps
Specific Soft Tissue Mobilisation
Re-orientates and increases number collagen fibres.
Early restoration of tensile strength.
Vaso-elastic effects, plastic deformation.
30/60 Seconds
DTF
2-10 minutes (decided by patient’s comfort and tolerance levels)