Rheumatoid Arthritis / Knee Surgery

Case Description: Patient is 21 y/o female who was diagnosed with juvenile RA at the age of 5.  In recent years she has struggled with chronic knee pain and swelling, to the point where she was largely wheelchair bound and struggling with basic tasks like dressing, walking household distances and had stiffened to the point where she had only about 15 degrees of total knee mobility bilaterally.  After multiple attempts at physical therapy without improvement, she underwent a total synovectomy on both knees.  She initiated physical therapy ~3 weeks later.     

Objective Measures: Patient was seen for 14 physical therapy visits over 12 wks

Tests and Measures	Initial Evaluation	Day of Discharge from Physical Therapy
VAS for Pain	3-8/10, described as sharp/catching	1/10
LEFS impairment	59% disability	16% disability
Knee Mobility	R FLEX:  85 deg   L FLEX: 90 degR EXT:   -15 deg   L EXT    -15 deg	R FLEX: 119 deg   L FLEX: 118 degR EXT:   0 deg        L EXT    0 deg
Gait Pattern	Highly compensated with circumductory pattern	Ambulatory without compensation, even at relatively fast speeds
Daily function	Highly compensated with transfers, gait, avoiding fitness activities, avoiding stairs, unable to don/doff socks or shoes	Sit to stand without compensation, gait with ease, returned to a swimming routine, stairs without compensation, able to don/doff shoes and socks with ease

Patient Comments at Discharge: “Much improvement.  Able to walk without looking like a clown. Physical therapy allowed me to live a more meaningful life as my mobility has improved a lot! (Physical therapy was) …personable, adaptable to my interests and goals. Very kind. Also, very timely and considerate.”

Sincerely,

Luke Vander Zouwen, DPT
Full Potential Physical Therapy