An Uncommon Cause Of Knee Effusion In A Middle-aged Female - Page #1

Author: Jacklyn Quade, MD
Co Author #1: Jeffrey Alan Housner, MD, MBA University of Michigan Health System, Ann Arbor, MI

Patient Presentation:
A 51-year-old female presented with a 2 month history of right knee pain and swelling.

The pain was anterior in location. There was no history of trauma, recent illness or fever. The pain was aggravated by activity and relieved with rest. The patient had a personal history of diabetes and Hashimoto's thyroiditis. Her medications included levothyroxine, lisinopril, metformin and atorvastatin. There was no family history of rheumatologic disease. Xrays of her right knee were obtained and showed an effusion and arthritis. Therefore, the patient's pain was thought to be due to an arthritis exacerbation. A therapeutic arthrocentesis with an intra-articular cortisone injection was performed. She returned 3 months later after completing a course of physical therapy with continued knee pain and swelling. Repeat arthrocentesis of the knee was performed and fluid was sent for analysis. MRI of the knee was also ordered.

Physical Exam:
Vitals: Afebrile Ht 5' 1.5" Wt 198lb. BMI 36.81 BP 128/88 HR 76 General: Well-appearing, obese female in no acute distress. Focused musculoskeletal exam of right knee: On inspection, swelling was noted. On active range of motion, flexion was limited to 115 degrees and caused pain. She had full knee extension. With palpation, a large effusion was appreciated and there was diffuse tenderness. Ligamentous testing was negative for any laxity. McMurray's test was negative. There was no pain with varus or valgus stress testing. Skin: No warmth or erythema of the knee.

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