Author: Shayne Fehr, MD
Co Author #1: Aaron Provance, MD
Co Author #2: Sourav Poddar, MD
Editor: Young Yoon, MD
A 15 year old male presents to clinic with his mother for evaluation of right knee pain, swelling, and inability to bear weight. One day prior to presentation, he was playing a game called “Buck Buck” when he heard a loud “pop” in his knee as he jumped while running. Afterward, he was unable to bear weight and in severe pain. He had swelling, bruising, and pain of the knee that worsened overnight.
The patient is interested in joining the ROTC and possibly pursuing a military career.
Past medical history is significant for a penetrating right knee injury at ten years of age involving a deep laceration with cartilaginous injury of the medial femoral condyle and osteochondral injury of the medial patella. Surgical debridement was required.
General: Alert and in no apparent distress.
Right Knee: He used a crutch to lift his right leg into extension as he moved to the exam table. Significant discoloration of the inferior knee and proximal tibia was noted. There were no abrasions or lacerations. A large palpable effusion was present. The knee was most tender to palpation over the proximal tibia to the inferior patella. Knee ROM, ligaments, and menisci were unable to be evaluated due to pain. The patient was able to actively dorsi-/plantar flex his ankle and flex/extend his toes. Sensation of the distal leg, foot, and ankle were fully intact. Distal pulses were palpable.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.