Aspirations Of A Troubled Knee - Page #1

Author: Edward Smith, DO
Co Author #1: John Pick-Jacobs, D.O.
Editor: Reno Ravindran, MD

Patient Presentation:
Patient is a 22 year old female that presented to the clinic with a 2 month history of left knee pain and swelling. No acute trauma indicated. She presented at this time due to worsening stiffness, pain, and swelling that acutely subsided then reappeared within one week. Location of her pain was above the knee and in her thigh. She noticed that her symptoms were aggravated with walking or standing for prolonged periods of time. She felt better with rest, elevation, and ibuprofen. She purchased an over the counter knee brace which provided no relief. She described the pain as dull and non-radiating. She denied recent fevers, chills, or body aches. She also denied a history of skin changes, rashes, numbness, tingling, or other joint involvement. She has had no recent travel or outdoor activities.

She has no significant past medical history and does not take any chronic medications. She has not had any surgeries in the past. She has no known medical allergies. Her family history is pertinent for osteoarthritis and heart disease in her mother, and her grandmother had a history of systemic lupus erythematosus.

She does not use tobacco and denies substance abuse. Admits to limited alcohol intake, mostly on special occasions.

She is a full-time student, not involved in competitive athletics. She jogs a few times a week as a hobby and for health benefits.

Physical Exam:
In general, this was a very pleasant, age-appropriate female without acute distress.

On inspection a +1 effusion was visualized of the left knee without any erythema, warmth, induration, or rashes.

She had full range of motion of the knee from 0-110 degrees with mild pain at the end point of flexion. She exhibited tenderness to palpation in the superior patellar region. She had a negative patellar grind test. There was no medial or lateral joint line tenderness to palpation. There was no valgus or varus instability. Lachmans test, Posterior Drawer, and McMurrays tests were all negative.

She had good pulses throughout of the bilateral lower extremities. +2/4 of the popliteal, dorsalis pedis, and posterior tibialis regions.

Her strength and sensation were intact and deep reflexes were intact throughout the lower extremities.

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