Date of Award

2016

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Mark Romanick

Keywords

Arthroplasty, Replacement, Knee -- rehabilitation; Iliotibial Band Syndrome -- rehabilitation; Case Reports

Abstract

Background and Purpose: Total Knee Arthroplasty (TKA) is one of the most common joint replacements performed in orthopedic medicine. The decision to replace a knee is made through evaluation by an orthopedic surgeon, imaging of the joint, clinical presentation, and the patient's individual needs and desires. Iliotibial band syndrome (ITBS) is a soft tissue dysfunction that can present as pain and tenderness in the hip, thigh, or knee. It primarily stems from rubbing or friction of the IT Band at the lateral femoral condyle. Pain caused by knee degeneration and pain from ITBS can have similar presentations and deserves research recognition.

Case Description: The patient was a 67-year-old female attending physical therapy for a standard TKA protocol rehabilitation. She had been experiencing knee pain for 9 months prior to knee replacement. Steroid injections, joint aspiration, and meniscal debridement had been performed prior, with no reduction in pain symptoms. A TKA was performed and she was referred to physical therapy. Following concern that pain remained unchanged following the arthroplasty, re-evaluation revealed symptoms consistent with ITBS.

Outcome: The patient was seen for 14 TKA visits, and 4 treatment visits that targeted the IT Band. Following the shift in intervention strategy, pain symptoms were reduced to nearly nonsymptomatic, a level which had not been achieved with prior treatments.

Discussion: Research into pain presentation comparing knee degeneration and ITBS is very limited. Correct medical diagnosis is important in functional outcomes and patient satisfaction, and the relationship between these two diagnoses deserves further attention.

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