An Unusual Case Of Knee Pain - Page #1

Author: Ami Kapadia, BBA, BSA
Co Author #1: Nate Milburn, MD
Co Author #2: David Tietze, MD
Senior Editor: Carolyn Landsberg, MD
Editor: Jennifer Gaitley, MD

Patient Presentation:
A 20-year-old competitive female gymnast presents with chronic bilateral knee pain.

The gymnast presented with progressive bilateral knee pain over the last 5 years. Pain was described as 7/10, aching, non-radiating, and began after an episode of patellar dislocation with subsequent episodes of subluxation. She denied swelling, catching, locking, or instability. She endorsed a history of easy bruising, weakness, and bilateral wrist fractures. She had a history of atrial fibrillation, postural orthostatic tachycardia syndrome, and cubital tunnel syndrome.

Physical Exam:
The patient could hyperextend her thumb to touch her forearm. Her gait was antalgic. She was stiff-kneed and experienced knee pain with ambulation. Bilaterally, her knees showed normal alignment, no erythema, swelling, or effusion. Sensation was grossly intact. The patellofemoral exam was normal on both sides, although the right knee showed 25% patellar glide while the left knee showed 50% patellar glide. Both knees demonstrated range of motion of 7 degrees of extension to 130 degrees of flexion, and she had lateral and medial joint line tenderness. Bilaterally, the patient showed 5/5 strength for quadriceps, hamstrings, and gastrocnemius/soleus with no quadriceps atrophy.

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