ACL Reconstruction Surgery Discussion

This is a very important project about Anterior crucial ligamentreconstruction. I need help with my introduction paper, thesisstatement, and conclusion if possible. This is an evaluation of Physicaltherapy and we as a PTA need to treat the patient in the three phasesof recovery which are Maximum protection/ Acute Stage, MOderateProtection/Subacute stage and Minumun protection/ return to a functionalstage. These three phases should be included in the thesis part becauseI will do the treatment part. Please read the information that Iprovided and let me know if you think you can do it.

1-Instruction will be researching the diagnosis of” Right ACL tear”. Not too long but strong knowledge.

2-Summarizethe injury or surgical procedure – Injury Right ACL tear or you canpick to talk about surgery Right ACL reconstruction. One or the other.Epidemiology, incidence/ prevalence, etc. The focus of the body (thesisstatement) are Acute/ MAximun Protection phase, Moderate protectionphase, and Minimum protection phase. 3- Conclusion: Focus ofrehabilitation, Expectations of outcomes. We are going to pretend thatthis patient’s response was satisfactory to the treatment that I willprovide. Please see attachments if you need my book pages or otherinformation let me know. Date of Eval / Start of Care: 6/18/2020
Occupation: College Athlete
Medical Diagnosis: Right ACL Tear
Treatment Diagnosis: Impaired LE ROM & Strength, Gait Impairment
Date of Onset: 5/15/2020
Referring Physician: Dr. Colby
Precautions: Universal, WBAT, Protocol
Surgery Type / Date: ACL Reconstruction (6/02/12020)
History/Mechanism of Injury: Pt is a 20 year old female college soccer player, arrives accompanied by mother and father,
who is s/p 16 days from an ACL reconstruction using PTB autograft after sustaining tear from a hit to (R) knee during
recreational game. Pt recalls falling to ground, immediate pain & swelling, & inability to place weight on foot after accident.
She was immediately taken to local hospital, where she was diagnosed with a complete ACL tear. She underwent surgery
~2 wks later, and currently reports primary c/o Right knee pain & expected weakness w/ limited mobility affecting functional
activties/ADLs. Pt arrives with range-limiting brace locked in extension, and
. Trainer reports
expectation for pt to recover “quickly” in order to join team for off-season training ASAP.
PMH/PSH: Appendectomy, (R) MCL sprain 2016__________________________________________________
Social hx: Lives with 2 room-mates in condo apartment- 4th floor, elevator accessible
Medications: Naproxen, Tramadol________________________________________________________
Diagnostics: None available (Follow-up MD visit w/o complications)_________________________________________
Pain Site & Pattern: Right knee, peri-articular region_____________________________________________
Pain Level (0-10): Current: 4/10 At Best: 2/10 At Worst: 7/10
Prior PT: Y / N
With Improvement: Y / N
Objective Assessment:
Observation/Inspection & Posture:
Generalized joint swelling (girth difference of 2.4 cm Left knee as compared to Right)
Incision dried, steri-strips in place; Mild warmth & tenderness noted
Pt with hinged knee brace locked in ext & ambulating w/ Bilateral axillary crutches
R
L
Myotomes
Myotomes
Sensation:
L2: Hip flex
3/5
4/5
L4: Great toe ext
In-tact to LE dermatomes
Reflexes:
L3/4
S1/2
R
L
5/5
5/5
R
L
L3: Knee ext
2/5
5/5
L5: Ankle PF
5/5
5/5
2+
2+
NT
2+
L4: Ankle DF
5/5
5/5
L6: Knee flex
2/5
5/5
Motion
R PROM L
R Strength L
Special Tests
R
L
Hip Flexion
1000
1300
3+/5
5/5
Anterior Drawer
NT
Neg
Hip Abduction
400
450
3+/5
4/5
Posterior Drawer
NT
Neg
0
0
0
0
Hip ER/IR
30 /20 44 /24
NT
NT
Varus Stress test
NT
NT
Knee Flexion
640
1240
2/5
5/5
Valgus Stress test
NT
c/o pain
Knee Extension
-100
00
2/5
5/5
McMurray test
NT
NT
0
0
Ankle Dorsiflexion
4
12
3/5
5/5
Other: Ankle Eversion test
NT
NT
Flexibility / Joint Mobility / Palpation / Other:
Muscle guarding noted to Right Hip adductors, Hamstrings, Deep hip rotators (note ROM limits)
Left knee noted with mild instability (mild medial knee pain & laxity w/ testing)
Right knee pain-free ROM only for measurements (noted above)
Balance: Standing- Static= Good; Dynamic= Good Lower Extremity Functional Scale & Value:
Timed Up and Go: N/A
20/80
6 minute Walk: N/A
Other: N/A
Pain Catastrophizing Scale Score: N/A
Name: Miller, Stephanie
DOB: 8/15/99____ MD: Colby
MR# 0000784785
Page 1 of 2
[Type text]
Assessment & Reason for Referral: Pt is a 20 y.o. female, student athlete, who sustained a complete ACL tear during
recreational game (valgus force to planted LE while pivoting) is referred to physical therapy after ACL Reconstructive
surgery. Pt presents with generalized joint swelling, decreased LE strength & mobility, and decreased functional activities
due to physical limitations. Pt was highly active individual without limitations participating in physically demanding sport,
with expectation to return to PLOF. Recommend continued skilled physical therapy services to address limitations &
impairments for safe return to sport specific activities._______________________________________________________
Patient states prior level of function
was
community ambulation, stair negotiation, and safety concerns.
Patient would benefit from Therapy to address:
reaching
lifting
sitting
standing
walking
squatting
kneeling
bending
other: Safe return to PLOF/Sport activities
Rehab Potential: Excellent Good Fair Poor
Patient Barriers to achieving goals: Yes
No
Explain / Due to: Other musculoskeletal deficits (L ankle)
STG
1.
2.
3.
LTG
1.
2.
3.
4.
carrying
stooping
overhead activities
stair climbing
Patient/Family oriented to Rehab Program and Goals: Yes No
Patient/Family oriented condition and precautions: Yes No
Level of family support: Family,Team support/ resources available
Pt will have decreased (R) jt swelling for improved ROM & muscle activity demonstrated by girth
measurement difference of less than 1 cm as compared to Left knee.
Pt will tolerate PROM of (R) knee flexion of at least 900 for improved transfers & sitting posture.
Pt will improve MMT of (R) knee musculature by at least ½ grade for stability w/ weightbearing/standing.
(functional, measurable and do not exceed PLOF or justify)
Pt will demo (R) knee ROM of 00 to 1100 in preparation for ease w/ squatting when approved by
MD/protocol.
Pt will demo (R) knee strength of more than 3/5 for joint stability with prolonged standing/walking
with brace and WBAT.
Pt will demo near normal gait pattern w/o AD (use of knee brace PRN) over even & uneven
surfaces- i.e., steps/stairs, grass, etc.
Pt will comply w/ surgical protocol, precautions, & HEP 100% of the time for safe recovery.
BY:
3 weeks
3 weeks
3 weeks
BY:
6 weeks
6 weeks
6 weeks
6 weeks
PLAN OF CARE:
Hot pack for muscle relaxation, increased circulation
Cold Pack to reduce inflammation, spasm, pain
Ultrasound to promote tissue mobility, decrease scar formation
Iontophoresis to reduce inflammation
Traction to relieve compression-related symptoms
Other (ie, splinting, bracing, orthotics)
Electrical stimulation for strengthening, pain and spasm reduction, muscle re-education
Therapeutic exercise for strengthening, endurance, stabilization, and flexibility
Neuromuscular re-education to improve balance, posture, coordination, proprioception, kinesthetic awareness
Manual therapy to promote tissue, joint mobility, ROM, and joint nutrition via mobilization/myofascial release (to unaffected structures)
Gait Training for safe ambulation and stair negotiation
Home Management training: home exercise program, body mechanics, energy conservation, safety, dressing, transfers
Patient will be seen _2-3__ times per week for _6__ weeks.
Date:
Clinician Signature: (legible)
6/18/2020
Yessenia Roa, MSPT Lic#12345
I certify the need for these services furnished under this plan of treatment while under my care.
Date:
Physician Signature: (legible)
6/18/2020
Dr. Harvey Colby
Name: Miller, Stephen
DOB: 8/15/99____ MD: Colby
MR# 0000784785
Page 2 of 2
General Evaluation and Plan of Care
[Type text]
PTA 201: Therapeutic Exercises II and Lab
TE II Project Outline
I.
Introduction
a. Introducing topic: ACL TEAR page 805
i. Summarize the patient case
1. Pertinent info from eval & possible extrinsic/pychosocial
factor(s) that applies to the patient
ii. Summarize the injury or surgical procedure – Injury Right ACL tear,
surgery Right ACL reconstruction page 812
1. Epidemiology, incidence/prevalence, etc
b. The focus of the body (thesis statement)
II.
Body
See the
Rubric
for
guidance
a.
Work with
course
instructor
Does it apply
to your
patient?
Does it apply
to your
patient?
Acute/ Maximum Protection Phase page 818 book
i. First management guideline page 818 819
1. Treatment intervention
Prevent DVT
Ankle pumping ex, Page 818-819
a. Explain instructions, equipment (if applicable),
parameters (if applicable), dosage
b. Explain the clinical rationale for the choice of treatment
(Guiding question: what goal will the treatment help the
patient progress towards?)
*Evidence supporting information* book page 816-817
2. Treatment intervention
SLR with assistance
a. Explain instructions, equipment (if applicable),
parameters (if applicable), dosage
b. Explain clinical rationale for choice of treatment
(Guiding question: what goal will the treatment help
patient progress towards?)
ii. Second management guideline: Voluntary isometric and dynamic
activation of knee musculature
1. Treatment intervention quads muscle settings,
2. Treatment intervention SLR four positions ex
*Evidence supporting information
iii. Third management guideline: ROM and Patella mobility
1. Treatment intervention patella mobilization
PTA 201: Therapeutic Exercises II and Lab
2. Treatment intervention patient supine, towel on the heel, knee
unsupported
*Evidence supporting information
[Follow the same format for the other TWO phases of rehabilitation]
Moderate Protection phase
i.
Work with
course
instructor
First management guideline ROM and joint mobility
3. Treatment intervention: Flexibility ex to the hamstrings
a. Explain instructions, equipment (if applicable),
parameters (if applicable), dosage
b. Explain clinical rationale for choice of treatment
(Guiding question: what goal will the treatment help
patient progress towards?)
*Evidence supporting information*
4. Treatment intervention: End -range self stretching
a. Explain instructions, equipment (if applicable),
parameters (if applicable), dosage
b. Explain clinical rationale for choice of treatment
(Guiding question: what goal will the treatment help
patient progress towards?)
ii.
Does it apply
to your
patient?
Does it apply
to your
patient?
Second management guideline: Strength and muscle endurance
5. Treatment intervention: bridging ex close-chain
6. Treatment intervention: straight-line lounges
*Evidence supporting information
iii. Third management guideline: Neuromuscular control/ responses,
proprioception and balance
7. Treatment intervention: static balance
8. Treatment intervention: dynamic balance
*Evidence supporting information
[Follow the same format for the other TWO phases of rehabilitation]
Minimum Protection Phase
i. First management guideline: Increase strength
9. Treatment intervention: Step up and down w/ elastic resistance
a. Explain instructions, equipment (if applicable),
parameters (if applicable), dosage
PTA 201: Therapeutic Exercises II and Lab
Work with
course
instructor
Does it apply
to your
patient?
Does it apply
to your
patient?
III.
See the
Rubric
for
guidance
b. Explain clinical rationale for choice of treatment
(Guiding question: what goal will the treatment help
patient progress towards?)
*Evidence supporting information*
10. Treatment intervention”: Lounges
a. Explain instructions, equipment (if applicable),
parameters (if applicable), dosage
b. Explain clinical rationale for choice of treatment
(Guiding question: what goal will the treatment help
patient progress towards?)
ii. Second management guideline: Balance ex
11. Treatment intervention: sitting and reaching page 907
12. Treatment intervention: kneeling on unstable surface pg 908
*Evidence supporting information
iii. Third management guideline: neuromuscular control
13. Treatment intervention:
14. Treatment intervention:
*Evidence supporting information
[Follow the same format for the other TWO phases of rehabilitation]
Conclusion
a. Summary of body
i. Focus of rehabilitation
ii. Expectations of outcomes