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CASE OF THE MONTH - 11/01/05
History:

Chief complaint: Right knee pain and swelling.

HPI: A 17 year-old male was playing soccer, and felt a pop in his knee. He had no direct trauma to the knee. He was unable to continue play and noted acute onset of swelling. The athlete did not seek immediate care. He continued to have pain and noted a popping sensation that prompted a visit to the ER. Evaluation of the knee including radiographs proved no definitive diagnosis. He was diagnosed with a knee sprain, given crutches, and told to follow up in the sports medicine clinic. He presented to the sports medicine clinic with continued swelling of the knee and a popping sensation appreciated over medial aspect of the knee.

The athlete denied prior history of injury to the knee however he did note chronic posterior lateral knee pain. This had never been formally evaluated.

PMH: There are no other ongoing medical problems. Patient is up-to-date on his shots. He is taking no medications. There are no known allergies.

FH: There is no family history of any neurological, heart, or musculoskeletal type problems.

SH: Here today with his mother. He denies drug, alcohol, or tobacco use.

ROS: No other complaints

 

Physical Exam: General: A bright, alert, white male who appears in no acute distress. VITAL SIGNS: Patient weighs 65.7 kilograms. Temperature is 97.9 degrees. Blood pressure is 91/59. Pulse is 62. Athlete describes pain 2 out of 10. Right knee : 2+ joint effusion. Range-of-motion: Extension 0 º / Flexion 95 º . There is mild peri-patellar pain primarily over the medial facet of the patella. No patella apprehension and the grind test is unremarkable. Joint line tenderness is appreciated over the medial femoral condyle; mild to minimal tenderness is appreciated over the lateral joint line and lateral condyle. The athlete notes most pain over the posterior lateral aspect of the knee. Strength is 4+ in flexion and extension. Ligaments are all intact. Cartilage examination is negative and without significant pain or discomfort. Right Hip and Ankle: are stable and non-tender with full range-of-motion and full strength. Left knee: is stable and tender with full range-of-motion and full strength. Standing orthopedic : Normal knee alignment bilaterally, normal foot mechanics.

 


Initial Differential Diagnosis Based on the History and Physical:

1) What is your differential diagnosis?
     
     
 
     
     
 
© The American Medical Society for Sports Medicine
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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