Fig. 1.1 Areas of auscultation and palpation of the peripheral arterial pulses. (a) Auscultation areas. (b) Palpation points. (c) Palpation techniques. (Source: Vascular diagnosis. In: Steffers G, Credner S, eds. General Pathology and Internal Medicine for Physical Therapists. 1st ed. Thieme; 2012.)
1. The patient is a 16-year-old male who underwent surgery after sustaining a traumatic left knee dislocation, involving tears of his ACL, PCL, and MCL (KD III—MC). Upon his in-hospital postoperative physical therapy evaluation, pulses and capillary refill were intact in his left lower extremity. He demonstrates the physical ability to ambulate with axillary crutches independently and understands importance of utilizing a locked knee brace or immobilizer with mobility activities. Poor quadriceps muscle activation was observed by having the patient attempt an isometric quadriceps contraction. His home exercise program should focus on frequent application of ice, compression, and elevation, in addition to beginning quadriceps isometrics, gluteal isometrics, ankle pumps, and knee range of motion (ROM) ahead of a consult with an orthopaedic surgeon.
4. Possible findings of catastrophic spine injury would include unconsciousness or altered level of consciousness, bilateral neurologic findings or complaints, significant midline spine pain with or without palpation, and obvious spinal column deformity.
8. A splint for a knee dislocation should be applied so that it adequately supports the joint at, above, and below the injury. In this case, splinting of the hip and ankle may be excessive, but a posterior knee splint or long leg immobilizer should be applied to prevent additional injuries.
9. Straight leg raises, side lying hip abduction, and prone hip extension can be initiated with the knee in an immobilizer or locked brace. Additionally, ankle and knee passive/active assist ROM should be included for this patient. The patient should avoid active hip adduction, to minimize stress to the healing MCL. Knee flexion beyond 90 degrees of flexion and 0 degrees of extension should be avoided at this stage to minimize tension on the vascular repair.
11. See Table 1.15.