Author: Anthony Kohlenberg, MD
Co Author #1: Ketan Mody MD, CAQSM
Co Author #2: Ketan Mody MD, CAQSM
Co Author #3: Ketan Mody MD, CAQSM
Editor: Yaowen (Eliot) Hu, MD
CC: Right-sided anterior knee pain with activities.
HPI: A 12 year-old male complains of worsening knee pain over the last several months. He denies significant knee trauma. However, he reports an increased physical activity level, including organized basketball and baseball. Additionally, the pain is aggravated when he kneels on the affected side. 4 weeks prior to exam, the patient was diagnosed with Patellofemoral Pain Syndrome but his symptoms did not improve with PT.
PMH: Periventricular Leukomalacia (PVL), a form of intrauterine brain injury. Diagnosis was confirmed at age 6 with brain MRI showing a hyperintense lesion of the left periventricular white matter. The patientís right sided growth and strength have been affected by this condition. Case Photo #1Case Photo #2
General: The patient is a well-developed, left-handed male with normal body habitus for stated age.
Inspection: The right leg has visibly less muscle mass than the left. The right calf circumference measures 29.0cm, the left measures 31.5cm. The right leg measures 1cm shorter than the left.
Active ROM: Right leg ROM is from 0 to 125 degrees of flexion at the knee. There is anterior knee pain with complete extension.
Palpation: There is 2+ tenderness of the inferior patella on the bone, no tenderness of the medial or lateral peripatellar borders. There is no patellar apprehension and no tenderness on the joint line, MCL, or LCL.
Strength: Right leg flexion/extension and foot plantarflexion/dorsiflexion are 4+/5. Respective left sided strength is 5/5.
Special Testing: Right leg ligamentous stability tests are unremarkable.
Neurologic: Bilateral patellar and Achilles reflexes are 2+/4.
Gait: Trace right-sided foot drop and intoeing.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.