Physio needs help - knee stuck in extension

[reem101]

Hi all physio's,

I am recently graduated and i need help with my case, she is 2yrs post road traffic accident (RTA) and has a stiff left knee in extension. She can`t flex it at all. I tried with her to flex it actively then passive with no results. We've taken x-ray for lumbar spine, hip and knee and there is nothing limit the movement. I start stretching the hip so she can stand up straight but regarding the knee I am confused??? Any help

[Northwest Physio]

• how long has the knee been restricted like this ? since the accident or only recently?
• how old is the patient?
• how are her quads ?
• does she resist attempts to flex the knee ?
• meniscal tests?

I had a patient once (~12-14yr girl) who was involved in a severe boating accident (fatalities involved) and was told at some time by a doctor if she didnt rest her leg and keep it straight it would need to be amputated like one of her friends had to.(she had some minor injuries but nothing significant from memory).

She was a year or so later diagnosed by the rehab team as conversion disorder and the neuro psychologist suggested treating it as a musculoskeletal problem. She couldnt flex her leg, and we couldnt flex her leg. She would sit and walked with a straight leg all the time.
Sleep studies however showed that it would bend when asleep.

I tried to fatigue her into flexion once with about 30kg of ankle weights on her leg. 20minutes, nothing changed ! We discharged her after a long time with no result. The neuro-psychologist would rather we continued, but it was pointless. About 2 years later she just started to bend her leg as if nothing was wrong...


Some things arent always simple, and not always musculoskeletal in origin...
good luck

[reem101]

first of all iam appreciating your thought
her leg is like this since the acciedent,she is 30yr,with grade 4 of the Rt and the Lt with grade 1.she is not resisting the movment and all investgation came -ve.we take her to x-ray and show narrowing of the joint nothing else.now we refer her to orthopedic surgen.

iam thinking now about your idea,it can be right because she is severly depressed following her lost of her husband in that accident

[neurospast]

All well to put it on the psycho side but do you feel your examination or examination in general is sufficient to conclude that it is likely a psychological problem?
Physical examination by X-ray cannot conclude anything about soft tissue damage (although it might indicate) and further investigation by p.e. MRI is necessary. How about pain, muscle waiste (should be remarkable after 2 years, no vastus medialis left by now) Injuries like meniscus cannot be excluded at this point.
Depression is an indication that the mind might play tricks and contribute to the problem. Have you tried with resistance to flexion?

[reem101]

HI again,
in terms of determine the patient as psychological patient it`s not up to me.i ask my supervisior work as a physical medicine to help me in this case because the patient you is suffer enough that way iam asking every body to help me.regarding the examination i think it`s full.there is some degree of neglection from the patient side,she is no more have the hope in regaining her independence,,,