Case Study: Knee Injury Treatment

Case Study Knee Injury Treatment terse case synopsis 25 years old, female injured her right knee during basketball game. primary care provider evaluated her, gave her non-steroidal anti-inflammatory with P.T referral. Patient came 2 days after injury, with knee swelling and locking. . Patient b other and implement of injury are consistent with a medial semilunar cartilage injury.Diagnostic streamlet McMurrays running game, was Positive with evident click.reliableness of McMurrays test Evans ET. al1 demonstrated a low level of agreement between the two examiners with inter-tester agreements ranging from low for reproduction of a medial sensation (Kappa = 0.10) to fair (K = +0.38) for lateral pain.Validity of McMurrays test shortage of statistics in the literature increased the risk that the positive test criteria can variety the test g everyplacenment issue, irrespective of whether the test was performed in the same manner on the same patient.1I will change my first choice . McMurrays test al wizard is weak diagnostic tool for medial meniscus injury, the review2 has demonstrated that the inter-tester reliability and sensitivity (sensitivity ranged from 27% to 70%, specificity figures (29-96%) of the McMurrays test is relatively low.Another reading meta-analysis3, documentationed to physical exertion joint line tenderness test, McMurrays test, and Apleys test. I will add the other two tests to get strong diagnostic evidence for medial meniscus injury. Three special tests-McMurrays, joint line tenderness (JLT), and Apleys were included in the meta-analysis. Sensitivity of McMurrays test is 70.5 (95% CI 67.4 to 73.4) and its specificity of 71.1 (95% CI 69.3 to 72.9). Joint line tenderness sensitivity of 63.3 (95% CI 60.9 to 65.7) and its specificity of 77.4 (95% CI 75.6 to 79.1). Sensitivity of Apleys test is 60.7 (95% CI 55.7 to 65.5) and its specificity of 70.2 (95% CI 68.0 to 72.4).Another reading4 supported Thessaly Test at 5 and 20 degrees (Eviden ce obtained from high quality randomize controlled trials, prospective studies, or diagnostic studies).Intervention therapeutic exercises to restore muscular strength and aerobic fitness. I found two evidences for therapeutic exercise intervention. I think both are strong evidences. commencement exercise one4The supervised exercise group was significantly better than the home-based group regarding Sports Activity Rating shield and vamoose tests (Evidence level B).the same guidelines recommended that, Clinicians should consider a clinic-based exercise program in patients pursuance arthroscopic meniscectomy to increase musculus quadriceps femoris strength and functional performance(Evidence level B).The second evidence5was meta-analysis and systematic review reported that No studies described the forcefulness of exercise therapy compared to no exercise therapy in non-surgical patients with a meniscal lesion.I will not change my old decision about therapeutic exercise as the ma in choice intervention for two reasons First, the clinical guidelines support that choice with level B evidence.Second reason although the second correction is systematic review, meta-analysis studyIt didnt introduce a strong alternative to my choice.Out stupefy measure lower extremity function scale (LEFS SCALE) The test evaluate the impairment of a patient with lower extremity musculoskeletal condition or disturbs. Test measures initial function, progress of function, and outcome to design functional goals. In my case I using up the LEFS for medial meniscus injury outcomes. Questionnaire is asked about 4 level of performance in 20 proletariat questions that patient perform in daily life. minimum score is 0(complete disability) and maximum score is 80(complete functional level)Minimal Detectable Change (MDC)6 discordant visit Extremity Injuries (medial meniscus injury) MDC= 9 points. Minimally Clinically weighty Difference (MCID)6 Various Lower Extremity Injuries MCID = 9 po ints.harmonize to, Binkley ET al6. The LEFS isvalid compared to the SF-36 in target population, and reliable. The LEFS Sensitivity to outcome change was higher than the SF-36 in this population. The LEFS is applicable for clinical situations for individual patients and research.LEFS SCALE reliability Test-retest Reliability, Various Lower Extremity Injuries Excellent test-retest reliability for the entire sample (r = 0.86 95% lower terminus ad quem CI = 0.80) 6.Interrater/Intra-rater Reliability Various Injuries of Lower Extremity Excellent interrater reliability (r = 0.84)6LEFS SCALE validity Construct Validity Various Lower Extremity Injuries Excellent correlations between the LEFS scores and the SF-36 physical function subscale and physical component summary scores (r = 0.80 95% lower limit CI=.73) and (r = 0.64 95% lower limit CI = 0.54), miserable correlation between the LEFS scores and the SF-36 mental component summary scores (r = 0.30 95% lower limit CI = 0.14)6Another refe rence reported that, Lower Extremity Functional Scale may be an alternative to the horse opera Ontario and McMaster Universities Osteoarthritis Index physical function scale.I will not change the outcomes measurement (LEFS) for knee injuries, I personally, prefer LEFS scale for its ease way and quick appliance to the patient. to a greater extent than one strong study support high evidence, validity and reliability of LEFS. The LEFS has good measurement properties test- retest reliability and cross-sectional construct validity and it could be an alternative to WOMAC-PFIf I change the outcomes measure Ill use Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Comparison between WOMAC scale and LEFS scale showed approximate results of strong evidence check to validity and reliability to the both scales.ReferencesEvans PJ, Bell GD, Frank CY. Prospective evaluation of the McMurray test. Am J Sports Med. 1993 21604-608Hing, W.,white, S.,Reid,D.,et al. Validity of th e McMurrays Test and Modified Versions of the Test A Systematic Literature Review,. J Man Manip. Ther. 2009 17(1) 22-35.doi 10.1179/106698109790818250Meserve BB, Cleland JA, Boucher TR A meta-analysis examining clinical test utilities for assessing meniscal injury, Clinical Rehabilitation 2008 Feb22(2)143-61. doi10.1177/0269215507080130.Logerstedt D, Mackler L., Ritter R, et al., Clinical Practice Guidelines Linked to the International smorgasbord of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association J Orthop Sports Phys Ther. 200939Swart N.M. , Oudenaarde K., Reijnierse M., et al., intensity of exercise therapy for meniscal lesions in adults A systematic review and meta-analysis, Journal of Science and Medicine in Sport, 2016-12-01, hatful 19, Issue 12, Pages 990-998.Binkley JM, Stratford PW, Lott SA, et al., The Lower Extremity Functional Scale (LEFS) scale development, measurement properties, and clinical application. No rth American Orthopedic Rehabilitation Research Network. Phys Ther. 1999 Apr 79(4)371-83).Pua YH, Cowan SM, Wrigley TV, et al., The Lower Extremity Functional Scale could be an alternative to the Western Ontario and McMaster Universities Osteoarthritis Index physical function scale, Journal of Clinical Epidemiology 62 (2009) 1103e1111).Attending residential civilises among ancient People posttraumatic stress disorderAttending Residential Schools among Aboriginal People posttraumatic stress disorderSon Ian Lampsychological Traumas of attending residential teachings among pristine pluralityOutlineIntroduction Percentage of Indian Residential drill students bonkd tread and maltreatmentPsychological disorder IRS survivors frequently diagnosed with Post traumatic stress disorder, residential syndrome, and historic trauma.BodyPost-traumatic stress disorder (PTSD)PTSD affect patients by some(prenominal) faces physical, physiological, mental, and spiritual.Defense mechanism of PTS D patientsHow the defense mechanism affect their family relationship with family and daily life (inability to advance decisions)Residential inform syndrome (RSS)Definition of RSSSymptoms of RSSRSS affect intergeneration diachronic traumaDefinition of HTSymptoms of HTDifference between HT and RSSIRS survivors suffer more pain than other aboriginal batch?Some IRS survivors did not be abuse firearm native people in unobtrusiveness suffer from no freedom and abuseOnly little part of IRS survivors did not experience maltreatment, most of them suffer from no freedom, maltreatment and depressed.Conclusion Experiences of IRS survivors lead to various mental worry which come with them the lifetimeThose mental problem would affect intergeneration which would contribute to a vicious cycleTo furbish up IRS survivors, first of all, we need to provide an environment with respect and no discriminationIntroductionIndian Residential schools (IRS) are notoriously known as isolating and assimi lating native people in Canada during 1800s to 1996. According to Robertson, a study of IRS attendee in British Columbia in 1991 indicated that 48% of former students had come across sexual abuse, 32% of them ref employ to answer, only a few of them claimed that they did not experience any abuse (2006). A big with the last residential school closed at 1996, the last cluster of students left the school and the government undertook the responsibilities of IRS, however, what had happened in IRS were irreversible. The experiences undergone in IRS were detrimental to those school attendee. The majority of IRS students were enduring psychological problems post-traumatic stress disorder (PTSD), residential school syndrome (RSS), and historic trauma (Robertson, 2006).Post-traumatic stress disorder Post-traumatic stress disorder (PTSD) was the most putting surface diagnosis in former IRS students, stood for approximately 64%. Symptoms of PTSD is partially quasi(prenominal) to RSS but PTSD would influence not only psychological aspect, but withal physically, emotionally, physiologically, and spiritually torture a PTSD patient. According to Sochting, Corrado, et al, the majority of IRS students conformed to the symptoms of complex PTSD impairment in regulating affective impulses, in particular, raise directed at both self and others, chronic self-destructive behaviors, such as self-mutilation, eating disorder, or substance abuse. Some of IRS survivors also indicated that they had a chronic headache, heart problem, and arthritis (2007). Additionally, they would develop defense mechanisms to protect themselves not to experience the disaster again, such as suppression, inability to express or acknowledge their feelings, and stopping mechanism. crushing is a mechanism that would contribute to gap memories and patients would become apartness and inferior and stopping mechanism is shutting take their feeling or bodily functions related to the experiences in IRS (Chansonn euve, 2005). These mechanisms affect PTSD patients in various ways, for example, their relationship with other a female IRS survivor elaborated how she hurt her children because of lacking empathy after traumatized, she anticipated her children to be perfect, all the things had to be done in a particular way and time, which was the same way she was used to be taught. One of her children suffered from anorexia later which is a disorder that people is losing appetency to eat and drink (Grant, 1996). On the other hand, their apartness contributes to their inability to decide as they also did not have a chance to make decisions. Approximately all the IRS students cannot make alternatives except as one of the alternative is good for them straightly.Residential School Syndrome (RSS)The Residential School Syndrome (RSS) is the one of the consequence after the feeling of indigenous children had been tried to close absent and maltreated. (Grant, 1996). According to Robertson, some expert cl aimed that RRS was one type of PTSD, but Charles Brasfield defined RSSs standard and recognized several differences between these two disorders. On the other hand, there were not many RRS patients were diagnosed RSS, 6.3% of former students were diagnosed in a sampling survey in British Columbia. However, the symptoms of RRS is severe.The symptoms of RSS are as followAddiction of drugs or alcohols at an early age and constantly with angerdepreciation on plethoric cultural activitiesundergone a consternation IRS school experience or related to a person who used to be an IRS studentthe billet to IRS is passive, anxious, angry, and unassistedKeep dreaming the lives in IRS and vogue to feel the scenario in IRS reappear again odour extremely dismayed when stimulate by something or someone can remind them of their memories in IRS (2006).Besides, the patients tendency to get angry easily causes much physical abuse, their arousal sometimes lead to family hysteria. After long-time basi s, the violence would affect generation by generation. Their next generation may also suffer from RSS (Robertson, 2006).Historic TraumasHistoric trauma (HT), is defined as spiritual imbalance and cumulative emotional psychological wounding over the lifespan and across generation. Besides, HT is suggested for indigenous people as they had experienced genocide through IRS (Robertson, 2006). According to Robertson, IRS students diagnosed with HT always with those symptoms depression, self-destructive behavior, the tendency to suicide, anxiety, inferiority, wage, and lacking emotional intelligence. The historical trauma would deliver to the next generation which is a mechanism of HT as the trauma had been ingrained in the culture and peoples memories. And people in the next generation would also underlie the thought of being lessness. On the other hand, some might say that RRS is similar with HT. However, these two are focused on two different aspects RRS is focused on the individuals p sychological aspect while HT is focused on the how the cultures affect by the trauma and how people in the communities be abnormal (2006).IRS students suffering more pain than other aboriginal people?Some may say other aboriginal people also experienced a tough time in reserve, IRS survivors did not experience more pain than other aboriginal people (Robertson, 2006). Virtually, some of former IRS students were living well without problems and aboriginal people in reserves were also undergone abuse and had the tendency to suicide. However, those were a rare part of people that did not experience maltreat or abuse in IRS and aboriginal people in the reserve did not suffer from the chronic stress (Elias et al, 2012). IRS survivors also lost their ability to learn and express feeling, while native people in reserve were not (Grant, 1996).ConclusionIndigenous people undergone a tragedy in IRS and these memories contributed to various problems on them, especially mental problems which ca nnot be erased and like a shadow following with their whole life. Although the IRS era had gone, we still can see the effect of IRS on generations. The majority of IRS survivors had diagnosed more than one psychological disorder, and most of them were alcoholic. Alcoholic parents may make their children feel shame while their children may also suffer from maltreatment. When the children grow up, they would know their culture was not being accepted in nowadays dominant culture and they would start drinking and suffer from historical traumas (Grant, 1996). Obviously, this is a vicious cycle but it is scarcely what happening right now in the society. Fortunately, there is various way to heal with IRS survivors, such as their culture, language loss, and their mental health can be fixed but it does take a long time. But in the first place, we need to provide a safe, confidential environment with respect and no discrimination (Chansonneuve, 2005).ReferencesChansonneuve, D. (2005). Reclai ming Connections understanding residential school traumaamong aboriginal people.Elias, B., Mignone, J., Hall, M., Hong, S. P., Hart, L., Sareen, J. (2012). Trauma and suicidebehaviour histories among a Canadian indigenous population an empirical exploration of the potential role of Canadas residential school system. societal science medicine, 74(10), 1560-1569.Grant, A. (1996). No End of Grief Indian Residential Schools in Canada. Pemmican Publications, Inc., 1635 Burrows Ave., Winnipeg, Manitoba, Canada R2X 0T1.Robertson, Lloyd Hawkeye. The residential school experience Syndrome or historic trauma. Pimatisiwin 4.1 (2006) 1-28.Sochting, I., Corrado, R., Cohen, I. M., Ley, R. G., Brasfield, C. (2007). Traumatic pasts in Canadian Aboriginal people Further support for a complex trauma conceptualization?. British Columbia Medical Journal, 49(6), 320.