I have a patient coming to me at the moment - female 20 years, hockey player. She was referred to me by sports GP with MCL sprain. After doing quick knee ligamentous assesment, she did appear to be MCL sprain, so I didn't continue to examine too much more - note to self dont ever rush assessment, or take referral as true! - however she was complaining of pain in posterior / popliteal fossa especially on full squat. Because she had some minor swelling I was presuming she was restricted by this at full squat and didnt investigate much more.
However after coming 2 more times since then I'm beginning to think she has a popliteal tendonitis. Her pain is mostly posterior. Symptoms are:
Pain into full extension, very end of range, posteriorly
Weak Hams through all ranges.
Tender on palpation popliteal muscle, however there are so many bursa around here I'm wondering what exactly I'm on.
Biomechanically she has femoral internal rotation, overpronates slightly on squatting, more so on her affected side.
Tender all through her medial quad / adductors
Treatment so far has been rest for aggravating acctivities all the usual precautions etc. I'm getting her to strengthen IRQ / hams / increase flexibility in tissues - hams adductors -
SHould I be going down the orthotic for anti - pronation road?
How do I diffentiate between this and bursitis?
How can I be sure its popliteal? I find the flex knee resisted external rotation very tricky to be sure I have it right?