I have the Grammarly extension for chrome and it keeps telling me I should be using "that" instead of "because." Here is an example of part of one of the sentences it wants me to correct:
"The reason the knee is flexed 30 degrees during varus or valgus stress testing is because the ACL and PCL are tight in the neutral position, and have more slack when the knee is slightly flexed, so in the flexed position only the MCL or LCL integrity is being tested when a medial or lateral force is applied."
submitted by Hello DubNation!
As Steph's injury seems to have caused all sorts of heartache, stress, nervous tension, anxiety, and the like, to this community, I wanted to address this diagnosis to help further our understanding and hopefully enlighten a few individuals into our beloved leader's current situation. I am not an MD. I am a doctor of physical therapy that enjoys all sports and loves the Dubs.
I will cover the anatomy, diagnosis, assessment, common symptoms, and recovery expectations
with a TL;DR at the bottom!.
Anatomy First let's define the
MCL (medial collateral ligament) - The MCL is the broad fan-like ligament that provides the stability to the medial (or inside part) of your knee joint . It prevents
"valgus" forces (forces pressing from the outside of the knee inward) from completely bending your knee inward.
Diagnosis What is the difference between the grades? Here's a nice picture explained in massive block of words below.
Grade 1: most mild injury, likely due to slight over-stretching of MCL such as with a rapid valgus movement. At WORST there are minor tears to the MCL, but again, very minimal. It is possible for this to be a contact OR non-contact injury (as with Steph). Note the valgus alignment of Steph's knee in
this picture (not terribly gruesome, but if you're squeamish... maybe just leave that link blue...).
Grade 2: wide range of moderate to severe injury that includes an over-stretched MCL as well as incomplete tearing of the MCL (or a "partial tear). This is the grade is by far the hardest to predict recovery time as this depends greatly on the extent of the tear.
Grade 3: severe injury due to large valgus force at the knee that leads to a complete rupture/tear of the MCL. In a professional athlete this would likely require surgery.
Assessment The obvious gold standard for this assessment is an MRI that would be able to show the extend of the damage to the MCL. Within an outpatient clinic or with the trainer prior to the MRI they would also conduct a series of "special tests" to check the stability of the knee ligaments and structures. Here are some of those tests that would be done:
Common Symptoms Steph would most likely experience pain. Duh. Other than this, he may have some slight instability and discomfort with any tasks that would put (here's that buzzword again) a valgus stress on his right knee. This would include pushing off from his right leg in a defensive slide, trying to maintain a right pivot foot with someone (looking at you Beverley) leaning into his leg/knee, or even happening to take the wrong jab-step with his right leg.
So why was he limping to the bus in that video o0blarson0o!?!? Well... when your knee hurts you limp. Also, when you have a ligamentous injury such as this, the knee wants to inherently be in its "loose-packed" position (the position that all the joint's surrounding ligaments are most lax) and avoid the "close-packed" position (ligaments are most taut). For the knee, loose-packed = ~25 degrees of bend (which is about where Steph was) and close-packed = full knee extension (which is what a limp avoids).
Recovery Expectation As stated millions of times from every Reddit doctor available, MCL injuries are difficult to judge. Grade 3 is easy: out for the season (likely at least 6-8 weeks or possible surgery with appropriate rehab). Grade 2 has slightly more gray area, but still most likely out for the season (probably around the 6-8 weeks guideline, but possibly sooner). Grade 1 is tough as a lot will depend on how painful it is, how long the tissues take to heal, but can range anywhere from as little as 1 week to as long as about 6 weeks (if instability and pain remain with sharp cuts). Important to also note is that this injury possesses a definite possibility of getting worse if Steph is rushed to return to play.
Complicating Factors A couple notes: the MCL is very closely tied into the medial meniscus and even has some connecting fibers. It is entirely possible that an MCL injury could have a slight complication of meniscus involvement, but unlikely in Steph's case. Also, there was contact with Steph's medial knee onto the court along with the valgus stretch. This would be comparable to taking a rubber band (his MCL), stretching it to maximum length (valgus stretch), putting it over the sharp corner of a table (his tibia and femur), and then hitting it with a hammer (the court). Probably not fun.
So there ya have it... A breakdown of the medical side of things...
TL;DR There's a lot of stuff goin' on in Steph's knee. It probably hurts. Possibility of it worsening if rushed, but likely back in 2-4 weeks. I'm sure he's in good hands.
The therapist then applies a varus force to the elbow. This test is considered positive if the patient experiences pain or excessive laxity is noted and compared to the contralateral side. The test can be repeated in varying degrees of elbow flexion, but generally it is positioned between 5 and 30 degrees. While palpating the medial joint line, the examiner should apply a valgus force to the patient's knee. A positive test occurs when pain or excessive gapping occurs (some gapping is normal at 30 degrees). Be sure to not include rotation of the hip in your application of force. Next the examiner should repeat the test with the knee in neutral (0 degrees of flexion). A positive test occurs when pain or gapping is produced. There should be Varus Stress Test of the Knee: PURPOSE: Testing for the integrity of the structures that prevent lateral instability at the knee (lateral collateral ligament, joint capsule, cruciate ligaments). VIDEO DEMO, PROCEDURE, Positive Sign: Presence of pain and hypermobility at the lateral aspect of the knee... A positive test occurs when pain or excessive gapping occurs .siehe auch: Valgusstellung, Varusstress Verständlicher fände ich: Valgusstress bezeichnet die Kraft, die das Knie medial aufklappt und so Stress auf die . This page includes the following topics and synonyms: Knee Valgus Stress Test, Knee Varus Stress.hoeveelheden indien varus stress wordt toegepast. Valgus stress test How to Interpret Varus Stress Test. Positive Finding: A positive test occurs when gapping or pain is noted with this test in full knee extension; this may suggest both an LCL and cruciate injury. With the knee at 20 to 30 degrees of flexion, a positive test occurs when pain is noted along the lateral knee or gapping is present. Elbow Valgus and Varus Stress Tests Elbow Varus Stress Test. Use: Test for varus lateral collateral ligament (LCL) instability at the elbow. Procedure: Elbow flexed, slight supination, support forearm, gapping in/out to assess ligament. Findings: Positive finding is pain, decreased mobility, laxity as compared with the unaffected side. Elbow Valgus Instability Stress Test Valgus Stress Test Knee: Knock-Kneed Legs: Genu valgum is a condition in which the knees angle in and touch one another when the legs are straightened. Individuals with severe valgus deformities are typically unable to touch their feet together while simultaneously straightening the legs. A positive test occurs when pain or excessive gapping occurs (some gapping is normal at 30 degrees). Be sure to not include rotation of the hip in your application of force. Next the examiner should repeat the test with the knee in neutral (0 degrees of flexion). A positive test occurs when pain or gapping is produced. A positive varus stress test at 0° of knee flexion is usually indicative of a severe combined posterolateral corner and cruciate ligament injury. In addition, it is not uncommon to have an avulsion of structures off the fibular head and a possible combined common peroneal nerve injury when the varus stress test in full extension is positive. In the valgus thrust models, for ease of interpretation, alignment in a valgus direction was represented by a positive value and alignment in a varus direction by a negative value; a significant OR >1 indicates that alignment increase in a valgus direction is associated with greater odds of valgus thrust. Analyses were performed using SAS software version 9.2 (SAS Institute).
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